We rarely think about our shoulders until something goes wrong. A shoulder grumbles when you reach up to grab a bowl from the cupboard. It yelps when reaching across to buckle the seat belt. Once shoulders have been provoked, they’re often easily offended, taking issue with benign stress like your favorite sleeping position or pouring a cup of coffee.
We ask a lot of our shoulders, and it should be no surprise that they are problematic. While our fingers and elbows must frequently bear high loads, they only have to bend and straighten. And while hips and wrists move in multiple directions, they act in a relatively limited total range of motion. But our shoulders move frequently, in all directions, and through an extremely large range of motion.
How can we care for and nurture our shoulders? Are there stretching or strengthening exercises, manipulation, or dietary supplements that help? Some of these are beneficial, depending on the exact nature of the problem. But first, we should avoid issues as much as possible by being aware of these four ways that we often sabotage our own shoulders.
- Slumping when we sit:
The foundation of many shoulder issues is poor sitting posture. Our thoracic spine (mid back) slumps forward, our head protrudes, and our shoulder roll inward. Our neck, back, and shoulder blades are placed in this tucked forward position while we sit during our morning commute and during the work day, at lunch and while driving home, while eating dinner, and watching TV. Much of adult life is sit-sit-sit-sit. And after that, we sit.
Sitting in itself is not stressful on the shoulder joint. But all the stiffness and poor alignment that has developed over months and years translates into problems when we reach or lift something over head.
The first key to shoulder health is being aware of the long duration postures that we apply to our bodies over months and years. If your upper back and shoulder blades are kyphotic, your shoulders don’t stand a chance when you go to use them. Sit up tall. Stand up and move. Pull your head and shoulder blades back.
2. Reaching and lifting with poor form:
Shoulders functions best when the top portion of the humerus (the upper arm bone) has margin to spin and glide in the “socket” that is formed by the shoulder blade (scapula) and collar bone (clavicle). If you lift and carry objects with the palm of the hand facing downward and your elbow out to the side, the humerus is less stable in the shoulder socket, and the rotator cuff muscles and bursa can easily get pinched between the moving bones. But if you reach and lift with the palm or thumb facing upward and elbow in, the humerus will be in a more stable position and spacing will be adequate for the muscles to do their work.
Whenever possible, reach overhead and lift with the palm of the hand facing up and your elbow more toward the center of your body (rather than out to the side).
3. Weekend Projects:
High performing athletes diligently train their bodies and closely monitor use of their shoulders. Swimmers and pole vaulters cycle the intensity of their practices. Baseball pitchers keep careful pitch counts. But the average adult with little physical preparation frequently dives into weekend painting, trimming, and cleaning projects that put their shoulder through thousands of loading cycles over a few days. Even with perfect posture and lifting technique, chances are slim that the shoulder muscles, ligaments, and tendons will hold up.
Be aware of the demands that weekend projects place on the shoulders. Temper your expectation and find time to prepare by stretching the chest, upper back, and strengthening the muscles of the shoulders and upper back.
4. Exercising our shoulders:
You read that correctly! Exercise programs are absolutely one of the biggest risk factors for shoulder injuries. Many people with the best of intentions take on too much – too soon (inappropriate progression), they perform exercises that are simply not a good idea (inappropriate exercise selection), or they fail to address postural and alignment issues (number one above) prior to performing typical upper body strengthening and stretching.
Seated Dips (on the right) are a common terrible exercise selection. They place the upper back and head into a slumped position while the upper arm bone is jammed into the shoulder socket.
Exercise is great, unless you hurt something. Here are a few general guidelines to get the benefits of exercise with less risk of shoulder injury.
-Stay off the machines. Most resistance machines require you to sit and press your hands overhead or raise them to the sides. But these can not possibly fit all different shapes and sizes of people correctly, they place you in the same chronic sitting position that you already had too much of, and they do not require you to activate the core muscles that support good posture and movement of the shoulder blades.
If a machine or rack or person must hold the weight up for you, it may be more than the shoulder is prepared to handle. What cannot be lifted off the ground in good form should not be pressed overhead. For example, sitting or standing dumbbell presses are self-limiting. This is favorable because these exercises demand support from the stabilizing muscles in the torso and you will not even attempt to shoulder what you cannot lift up off the ground.
-Stretch what is tight but not what’s already loose. For most people, this means not stretching the shoulder joints aggressively, but instead stretching the upper back and pectoral muscles.
-Strengthen what’s loose but not what’s already tight. Most of us need more upper back strengthening work, and less strengthening exercise of the chest and biceps, which act to pull the shoulder blades and humerus forward.
A few facts and stats on shoulder issues:
Shoulder pain is the 3rd most common musculoskeletal problem treated by physical therapists.
Shoulder problems are generally higher in women (15 to 26%) than in men (13 to 18%).
Shoulder problems are most common in middle age, and the onset of pain peaks at around 50 years of age.
The strongest evidence for managing long-term shoulder pain is exercise.
Ironically, one of the biggest risk factors for shoulder injuries is exercise. Do not assume that all stretching and strengthening is good for you. Make sure you’re attending to posture and form, making good choices on exercise selection, and using reasonable progressions.
- Kooijman MK, Swinkels ICS, Leemrijse CJ, de Bakker DH, Veenhof C. National Information Service of Allied Health Care. 2011.
- Barrett E. Examining the Role of Thoracic Kyphosis in Shoulder Pain, 2014
- Pribicevic M. The Epidemiology of Shoulder Pain: A Narrative Review of the Literature. Pain in Perspective 2012. InTech.
- Luime JJ, Koes BW, Hendriksen IJ, Burdorf A, Verhagen AP, Miedema HS, Verhaar JA. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scandinavian journal of rheumatology. 2004 Mar 1;33(2):73-81.
- Shoulder Disorders and Occupation at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4836557.