So I guess I am on a “what comes first” theme. When I think about movement these are places my mind goes; what is causing the immediate discomfort or disruption in movement? Is it some kind of compensatory action? How has this person adapted to their pain or decreased range of motion? The body is amazing in how it adapts; the trouble lies in when this “adaptation” becomes habit. Compensatory motion is the cause of a lot of pain and discomfort.
So I wanted to talk about shoulders today. So many people are coming through the studio with shoulder pain and limited range of motion only to say that it’s been that way for awhile and they have just decided there is nothing they can do about it. Needless to say people are frustrated and wonder if they will have these limitations forever.
One basic fact we need to remember is that the arms are attached to the trunk. There is a beautiful set-up here; when properly aligned the trunk is the structural “base” that lends itself to all the range we require and desire of the arms. When the trunk is not properly aligned then the arms are encouraged to work beyond their intended “scope” and they get stressed; sometimes this stress causes joint problems and other times soft tissue strain.
Once this balance is disrupted we must “back up” and revisit some of the trunk basics; open up the upper chest, get the ribs moving well, stretch out tight muscles (probably the pecs!) and allow the bones to realign. The shoulder joint is “special”; it’s a very loose and accommodating joint. That’s why we can do all the wonderful things we ask of it; reaching long across the trunk, reaching high above the trunk, reaching behind our trunk. But if the trunk itself is limited in motion then it all becomes stressful for the arms. Think about it for a moment; the arms move in a beautifully choreographed rhythm; the scapula glide across our rib cage; up, down, across, and then the arm (the humerus) can then go where it pleases. If the trunk is “stiff” (not enough rotation or extension) then scapular movement is limited and strain is put on the actual arm/shoulder to make up for the lack of movement; the rhythm is “off.”
So here comes the part about stability before mobility. Lie on your back and most likely all of us have shoulders that are way too forward — it’s a postural thing. When we stand our sternum is dropped, our shoulders are forward, and some of us eventually have the head and neck too forward. Exaggerate this and then try to move your arm(s). Feel the limited range of motion, feel the strain on the shoulder joint. Now stand more erect and lift your sternum up allowing your shoulders to broaden and go back and the head and neck to settle more directly above your spine. Now try moving your arms — aha! Much more movement and much less strain. Now this is hard to see/do when standing because for many this is years of accumulated poor posture — sitting at a desk, pouring over notes, etc. So for most we need to start on our backs.
Lying down we can use whatever props we need to support opening of the upper chest and eventual release of the shoulders more posterior. Strengthening the mid and upper back muscles will help support this posture. This takes time – you just can’t force a joint to realign too quickly but its worth it — once proper alignment is reinstated, movement and strengthening of the arms and shoulders happens quickly.
So we reinstate mobility in the trunk, then the trunk becomes a flowing breathing entity; it provides that dynamic stability which supports the movement of the arms and shoulders. Mobility begets the proper stability which results in mobility. That’s what it is all about!