The shoulders commonly have a lot to do with our posture. We can recognize our poor posture by the position of our shoulders. Our prime postural presentation actually comes from our torso but imbalances in the shoulder muscles can help pull us forward into poor postural habits.
Imbalance between the shoulder mechanism can also create a great deal of pain and discomfort. Unlike the hip joint which has a large ball and socket, the shoulder is a very shallow joint which gives us the range of motion we are accustomed to. Because there is no real strength in the joint the shoulder relies on muscles that strap the arm to the shoulder blade and the shoulder blade to the neck, rib cage and spine.
This slightly less sturdy arrangement is therefore more prone to injury and muscle imbalance, hence postural distortions. Due to the often heavy lifting and constant arm use, we can develop micro or macro tears in the shoulder. These are complex and cumulative and over time can amount to significant damage and can lead to sudden loss of shoulder function.
In simple terms, we have the muscles on the front of the shoulder pulling it forward, the muscles on the back of the shoulder holding it back and the rotator cuff muscles that hold the arm up into the shoulder joint.
The relationship between the shoulder and neck is also very important as some of the muscles from the shoulder attach to the neck. The nerve supply to the muscles of the shoulder, arm and hand come from the neck and any problems in this area may mean irritated nerves, which also mean irritated muscles and possibly altered sensation in the hand.
The balance between the muscles on the front of the shoulder and the muscles on the back of the shoulder is really important. If one group is tighter than the other, then the shoulder will be pulled out of its ideal position. This puts strain on the weaker group ultimately causing pain and inflammation while compromising posture.
The most common situation is where the muscles on the front of the shoulders are too tight. This drags the shoulders forward and pulls us into a slump. This sets up a tug of war between the muscles on the front and the muscles on the back of the shoulders. Because our arms point forward and most of our activities are forward, the muscles on the front tend to have the advantage, which puts the ones on the back constantly under strain.
The pectoral muscle is a significant player in the above scenario. The pectoral muscle comes off the chest wall and attaches to the front of the upper part of the arm. When this muscle is tight, it is like having a tight piece of elastic on the front of your shoulder pulling the arm forward and leaving us with rounded shoulders. This puts a constant strain on the muscles on the back as they try and hold the shoulders back.
So instead of the front and back muscles being in easy balance, there is a strong pull forward and the back muscles have to “rope up” to stop the shoulders dropping off the front completely. The strain that this puts on the back muscles of the shoulder can be really painful.
Many will know that pain you feel on the inside of your shoulder blade. An intense pain that at times will not go away no matter how hard you massage it or how often you get certain treatments. This is mostly because our shoulders are too far forward and the muscles at the back just can’t cope with the strain any longer and they become inflamed. You can keep taking pain relief medication but the best way is to correct the muscle imbalance and stop tug of war. In short, the back muscles are sore and painful because the front muscles are too tight.
The other thing that happens with this big pectoral muscle is it can mimic a heart attack. When it goes into spasm you can get chest or breast pain, tightness and pain in your chest and pins and needles radiating down your arm. I have treated many people who believed they were having a heart attack but nothing showed up on their medical tests. By simply releasing the pectoral muscle their problem was removed. It is amazing how unwell muscle tightness can make you feel.
Another interesting thing that often happens in conjunction with the tight pectoral muscle involves the smaller pectoral muscle called the pectoral minor. This lies underneath the big pectoral major muscle. It’s fibres go up and down just in front of the shoulder. The nerves to the arm and hand come from the spine, through the neck muscles, under the collarbone and under the pectoral minor muscle.
If this muscle is tight, it can compress the nerve bundle that supplies the arm and hand and can cause pins and needles in your hand and fingers. This is most commonly noticed when in bed and if already tight through the front of the shoulder, the extra compression can pinch the nerves. This can also be noticed with certain arm positions, and sometimes when driving or even just at rest. These activities can create just a little more tension through the front of the shoulders and cause that nerve compression resulting in pins and needles. Two other common conditions that befall the shoulder is supraspinatis tendonitis and frozen shoulder. The supaspinatis muscle is one of the rotator cuff group.
Supaspinatis tendonitis is where it gets really sore on the tip of the shoulder. This becomes really aggravated when you raise your arm to the side and more so if you rotate your arm backwards as if you were going to brush our hair or scratch the back of your head. This muscle comes off the top of the shoulder blade, descends down through a bony tunnel, attaches to the top of the arm bone and brings the arm out to the side.
If this muscle becomes inflamed it will swell. Inside the confined space it becomes even more irritated and more inflamed. Being in an environment with a poor blood supply diminishes the ability to heal itself.
Frozen shoulder is when the whole shoulder seems to have completely seized up making any movement very painful. There are degrees of its intensity where some people have more movement and others have less. Generally it is a build up in tension in the whole of the upper back, neck and shoulders and this accumulation culminates in one of the shoulders having a melt down, some times very quickly. It is a very difficult condition to treat.
The typical pattern of the frozen shoulder is first the first stage becoming increasingly painful and dysfunctional, then staying in this state before slowly coming right in the third stage. No matter what the treatment, sometimes it just does not seem to help and you have to go through the body’s own process. Unfortunately this can be up to three years, a year in each stage. So prevention through upper back and shoulder maintenance is by far the better approach.
Because our arms point forward most of our activities are forward so anything that accentuates that position or holds us forward for extended periods of time will really put a lot of strain on the muscles across the back of our shoulders. There may be inherited tendencies like an increased spinal curvature or heavy breast tissue, or poor work habits.
It may be caused by long periods of driving, breast feeding, just being a teenager or any other activity that causes us to slump forward. One of the most common causes of this presentation is an incorrect gym routine where the focus is on one group of muscles at the expense of another. Try giving each group of muscles equal attention.
If you have that intense pain between your shoulder blades then it is highly probable that your shoulders are dragging forwards too much and is a classic sign that you need to do these exercises and get balance in your shoulders.
Strengthening is the other important issue for good shoulder function. Even a small increase in shoulder muscle strength can make a huge difference in your ability to maintain good posture and perform daily activities with ease.
If you have tried everything to relieve that annoying pain by your shoulder blade and nothing seems to be working, then you need to strengthen the muscles across the back of your shoulders so they can help pull you back into your ideal posture and handle the forwardness of your daily activities.
An increase in strength also reduces vulnerability to injury when you exceed what you would normally be doing. So the key with the shoulders is stretching the muscles on the front of the shoulders to maintain muscle balance and strengthening the muscles on the back to help pull the shoulders back.
Osteopathic treatment is often required to sort out the nerve supply from the neck, the position and function of the vertebral segments in the upper back and any related muscle problems. As anywhere in the body, there can be many possibilities that can be the cause of pain and dysfunction so seeing your osteopath to eliminate more serious problems is essential. Once you know that it is muscle-focused, then you know you can safely go ahead with your home based program.