You might have tight shoulders if…

You have ever asked yourself “Why do I have a hard time reaching up overhead.” For the gym junkies this often comes up as “Why is it so hard to hold weight overhead?” For the frequent flyer this comes up as “why is it so hard to put things in the overhead compartment?” And for those of you who have been told you have “tight lats” this post should provide you with some insight.

Anatomy

The shoulder is really two separate joints: The shoulder blade on the rib cage (scapulo-thoracic) and the arm bone on the shoulder blade (gleno-humeral). The sum of the range of motion of these two joints adds up to your ability to reach overhead. While once joint can compensate for the other to a small degree, full mobility in both joints is ideal.

The shoulder blade (scapula) is shown in yellow. The screen shot is from the anatomy app for ipad called Visible Body Muscle Premium

Test Yourself

Test A: Passive Shoulder Flexion

Step 1. Lie face up on a narrow foam roller.The back of your head, upper back, lower back and sacrum must all touch the foam roller throughout the entire duration of the test. (If you have a naturally large arch in your lower back, place your hand flat on the ground under your lower back and press your lower back into your hand). You must maintain contact between your lower back and the surface during the entire test. 

Step 2. Raise your arm directly overhead.

PASS: Upper arm is parallel to your torso, the lower rib cage does not flare out and the motion is not painful.

FAIL: Even though the arm is beyond the parallel, the test is failed because the lower ribs flare out and the lower back is arched. Try the test again without arching the back or flaring the ribs.

*If you feel discomfort at the top of the shoulder with this motion then grab your shoulder blade with the other other hand and pull it along the side of your body until the bottom corner is at the middle of the side of your body (mid-axillary line). If this relieves the discomfort then try to do the test again while moving the shoulder blade without your hand assisting. If this does not relieve the discomfort,  then stop the test and consult a physical therapist or other healthcare professional.

 

Rx: If you fail test A, do stretch A. You have a mobility problem. If you pass test A, go on to test B.

Test B: Active Shoulder Flexion

Step 1. Stand two of your foot lengths away from the wall with your back on a foam roller. The back of your head, upper back, lower back and sacrum must all touch the foam roller throughout the entire duration of the test. (Again If you have a naturally large arch in your lower back, place your hand under your lower back and press your lower back into your hand).

Step 2. Raise your arm directly overhead.

PASS: Upper arm is parallel to your torso, the lower rib cage does not flare out and the motion is not painful.

FAIL: Even though the arm is beyond the parallel, the test is failed because the lower ribs flare out and the lower back is arched. Try the test again without arching the back or flaring the ribs.

Rx: If you pass test A but fail test B, do exercise B. You have a weakness or motor control problem.

If you passed both, congratulations you can stop reading now. If not, then…

Why Did You Fail?

Possible Reasons One Would Fail Test A: Mobility Problems

One or several of the following structures are shortened:

• glenohumeral joint capsule
• latissimus dorsi
• levator scapulae
• rhomboids and accompanying fascia
• pectoralis major
• teres major
• posterior deltoid

Possible Reasons One Would Pass Test A but Fail Test B: Weakness or Motor Control Problem

One or several of the follow structures are weak

• lower trapezius
• serratus anterior
• upper trapezius
• anterior deltoid
• rotator cuff

One or several of the following motor control problems are present.

• Relative upper trapezius overactivity and serratus and lower trapezius under activity
• Teres major over-activity
• Loss of the skill of scapular posterior tipping, upward rotation and/or retraction

Understanding the Problem

I purposefully made the list above as exhaustive as I could to emphasize the point that the shoulder is a complex structure with many potential points of failure. As the joint(s) in the body with the greatest range of motion but the worst proprioception, the shoulder is really a remarkable product of evolutionary forces and it is amazing to me that it works so well most of the time. (More on the evolutionary story of the primate shoulder at a future date)

Luckily the complexity of the shoulder need not limit the ability of most people to find a solution to their lack of shoulder flexion range of motion.

As mentioned above, the two tests above will place you in one of two categories.

Failing Test A: You have a mobility restriction, something is short that needs to be lengthened. After it is lengthened your passive range of motion (test A) will improve but you may still need strength or motor control training to improve your active range of motion (Test B)

Failing Test B: If you passed the passive range of motion test (A) but failed the active range of motion (B) you do not need more stretching. Instead you have a limitation in motor control, strength or both.

*If you failed test A but passed test B you either cheated or you are are rare exception to the norm. The inconsistency in range of motion between positions is indicatve of a motor control problem. You shoulder practice position A until your learn to do it well.

Fixing the Problem

I believe the following two interventions will help the vast majority of people improve their shoulder flexion. If they don’t, I recommend finding a physical therapist or other healthcare practitioner to help you identify the problem more specifically. Providers trained in Mulligan Joint Mobilization with Movement (MWM), Strain Counterstrain and Active Release Techniques (ART) are most likely to have the skills to address specific mobility problems and those trained in PNF, Feldenkrais or Reactive Neuromuscular Training are most likely to have the skills to address motor control problems.

Mobility Solution A: The Lat stretch

Explanation

I prefer this stretch as a general shoulder flexion/abduction stretch because it focuses more on scapular mobility and the broad fascia of the latissimus dorsi which in my experience is easier to improve than the tough glenohumeral joint capsule. Furthermore this stretch is more comfortable for my patients with shoulder impingement (perhaps because it facilitates scapular upward rotation). If your performance on test A improves after stretching 3x30sec, then go to test B.

Option 1: Grab a railing with the palm up. Pull away from the railing and tilt your hips away. You should feel the stretch where the arrows point and no pain.

Option 2: In my opinion this version is not as effective however it is a good substitute when you can’t find a railing.

Implementation

Do this stretch for 3x30sec on each side taking slow breaths with long exhalation. If you breath in for 4 seconds and out for 6 seconds and take 3 breaths, this will get you to 30seconds. Repeat twice daily. Test A should improve immediately afterwards or over the course of 4 weeks of diligent stretching. Once full range of motion is achieved, use it!

 

Strength or Motor Control Solution: The Reach Roll and Lift

Explanation

When it comes to motor control training, specificity is key. Only perfect practice makes perfect, and this drill is particularly good at reducing sloppy practice. Having one’s forehead resting on one’s fist reduces upper trapezius over-activity compensation and a flexed spine eliminates spinal extension compensation. Later you can progress to placing your forehead on the ground as you get more flexible.

1. Reach

2. Roll: Turn the palm up to externally rotate the shoulder

3. Lift: Lift the shoulder from the shoulder blade using the lower trapezius to upwardly rotate and tip the shoulder blade back.

Lift shown with use of yellow theraband attached to top of door frame for assistance. This picture also shows me placing my forehead on the ground without a fist under it. This is a progression of the exercise.

The picture below highlights the lower trapezius which is the muscle you should feel working the most during the reach-roll-and-lift exercise.

Implementation

I recommend starting by holding a light resistance band in one’s hand which is attached to the wall behind you at what would be chest level. Gradually reducing the amount of band resistance when doing this drill will allow you to build strength. Do 3 sets of 3 then retest test B. If it improved your problem is mostly motor control. You should do a few repetitions of this exercise daily and particularly before and overhead lifting. If test B did not improve then either 1) This is the wrong exercise for your, 2) You did the exercise wrong or 3) you have a problem with lower trapezius weakness. Conduct the exercise carefully and do it 3x a week for 3 sets of 10-50 repetitions. If test B improves over the course of 6 weeks, strength may have been your limiting factor.l

 

 Summary

Fail test A -> Seek Mobility Solution: Lat stretch

If you have limited shoulder flexibility when lying on your back you are inflexible and should stretch

Pass Test A but Fail Test B-> Seek Motor Control or Strength Solution: Reach-Roll-and-Lift

If you have good shoulder flexibility when lying on your back but bad shoulder flexibility when standing up, you have a strength or motor control limitation and should do motor control or strengthening exercises instead of stretches.