Responding to email questions: "Why is my shoulder hurting and how can I fix it?"

I have been getting a lot of emails from Crossfitters and recreational Oly lifters about the shoulder complex, "WHY are the newer-more-recreational members of Crossfit and Olympic Weightlifting more susceptible to shoulder injuries?" I have posted a few blogs about common causes of shoulder impairments, particularly for the participants mentioned above. I recommend reading through them (HERE) and (HERE) if you really want to better grasp the complexity and learn how to prevent injury. In this blog, I'll give you the short and sweet version. Additionally, I'll provide a list of impaired muscles, common joint issues, common shoulder injuries, and some useful Therapeutic Exercises to help.

As always, a big shout-out to those who take a proactive approach to learning, Thank you for your emails and questions (keep em coming), and thank you for the love and support.

Upper Crossed Syndrome (the upper extremity movement impairment syndrome) typically exhibit predictable patterns of injury including rotator cuff impingement, shoulder instability, biceps tendinitis, thoracic outlet syndrome, and headaches (1,2).

So what do the newer-more-recreational athletes of Crossfit and Olympic Weightlifting have in common? From my experience, the majority are professionals working behind the desk. Sitting at a desk type of job (without appropriately working to improve abnormality built-up) will eventually lead to Upper Crossed Syndrome. Naturally, when misalignments occur due to prolonged sitting, the altered shoulder mechanics will more than likely lead to degenerative changes in the shoulder’s capsuloligamentous structures, articular cartilage, and tendons (3)(4). Preventive and corrective solutions that address these misalignments are essential in preventing shoulder injuries during other activities such as running. Hebert LT et al., 2002 page 62 suggests that rounded shoulders (forward shoulder posture) alter the normal length-tension relationship and joint kinematic balance of the shoulder complex (5). If a person has unaddressed static misalignments and participate in activates not yet prescribable, a chain reaction will negatively alter the movement systems and cause other impairments. Sahrmann (2002) suggests “static malalignments (altered length-tension relationships or altered joint arthrokinematics), abnormal muscle activation patterns (altered force-couple relationships), and dynamic malalignments (movement system impairments) can lead to shoulder impairments.” (1)

Super Tight Muscles:

Pectoralis major

Pectoralis minor

Anterior deltoid

Subscapularis

Latissimus dorsi

Upper trapezius

Teres major

Sternocleidomastoid

Scalenes

Rectus capitis

Levator scapulae

Super Weak Muscles:

Rhomboids

Lower trapezius

Posterior deltoid

Teres minor

Infraspinatus

Serratus anterior

Longus coli and longus capitis

Common Joint Dysfunction:

Sternoclavicular joint

Acromioclavicular joint

Thoracic and cervical facet joints

Possible Injuries:

Rotator cuff impingement

Shoulder instability

Biceps tendinitis

Thoracic outlet syndrome

Headaches

A few simple solutions to rectify the Upper Crossed Syndrome are alleviating tight overactive muscles and strengthening weak underactive muscles:

Regular stretches such as:

Seated chin tucks: 5x5sec hold/regularly throughout the day, especially at the office.

Ts & Ys pictorials stretches: 3-5x30 sec hold. 2x/day

Cervical stretches: 5x5sec hold/regularly throughout the day, especially at the office.

Regular strengthening such as:

3 way-rows with Thera.Bands: 10x2ea. Slow and concentrated (motor control)

Ext rotation/Int rotation @ 90 Abduction resisted bands: 10x2ea. Slow and concentrated (motor control)

References:

1) Sahrmann SA. Diagnosis and Treatment of Movement

Impairment Syndromes. St. Louis, MO: Mosby;

2002.

2) Janda V. Muscles and Motor Control in Cervicogenic

Disorders. In: Grant G, ed. Physical Therapy

of the Cervical and Thoracic Spine. New York, NY:

Churchill Livingstone; 2002:182–99.

3) Matsen FA III, Thomas SC, Rockwood CA Jr. Ante- rior Glenohumeral Instability. In: Rockwood CA Jr, Matsen FA III, eds. The Shoulder, Vol 1. Philadelphia, PA: WB Saunders; 1990. p 526–622.

4) Blasier RB, Guldberg RE, Rothman ED. Anterior shoulder instability: contributions of rotator cuff forces and the capsular ligaments in a cadaver model. J Shoulder Elbow Surg 1992;1:140–50.

5) Hebert LJ, Moffet H, McFadyen BJ, Dionne CE. Scapular behavior in shoulder impingement syndrome. Arch Phys Med Rehabil 2002;83:60–9.