• Mia

What the hell do shoulders do? Part Six

Updated: Aug 12, 2020

PART FREAKING SIX



Well, when I embarked on this shoulder blogging mission, I had not envisioned that I'd end up with a six-part Ken Burns docudrama about acromions and labrums. I just thought it'd be all "Here's some sweet shoulder movements, now go do them you lazy ingrates."

But, as ever, I believe that a deeper understanding of the way our bodies work is a foundational pathway towards better health. It's like in Beauty and the Beast when Philippe the horse (perhaps the only likeable character in the movie besides Mrs. Potts) and Maurice come to two paths in the woods.



The more I considered how best to present the shoulder in this blog, the more info I felt was necessary to include. I'm with Philippe, opting for the bright, sunny, wide-open path. The sunny path is full of anatomy, mechanics, and a firm grip (lol) on the idea that your shoulder health relies on everything from your fingers to your tailbone. If that sentence makes no sense to you, it's time to go straight to part one. Do not pass GO. Do not collect $200.


Mia.


Your five shoulder blogs are like an hour of reading already and that doesn't include part freaking six. I really have to go back to part one?


Yes, yes, ok. They're long. But they're funny. And important. And if you're tired of your shoulder hurting then isn't it time to help it...stop hurting?


If you're going to self-diagnose your shoulder issues (and I know that's what you're doing because you're here instead of sitting with a physical therapist), then you better learn the reasons behind your shoulder issues. Don't keep randomly doing shoulder exercises and hoping that they help. Stop trying to make fetch happen.

Randomness in exercise is bad. Randomly choosing some upper body exercises from an IG hero or fitness magazine and thinking they'll be exactly what you need is like heading down the dark horror path in Beauty and the Beast. In which positions are your shoulders strong? Which are weak? What ranges of motion are you missing completely? If you can't answer these basic questions but still rifle through the entire internet looking for some arm exercises, then your health is gonna depend on a stopped clock being right twice a day.


Moreover, a lot of people on Instagram have no idea what they're talking about. Like, a lot of them. Belle's father Maurice is just like that dumbass influencer who doesn't know shit about fitness but is all "COME ON IT'S A SHORTCUT," and leads you straight to the wolves. No thanks, Maurice. Ya dope. Learn to identify these people and then don't take their advice.


Fun fact, I just learned that the directional signs in front of Maurice and Philippe are faded images of "Anaheim" and "Valencia." Anaheim, where Disneyland is, is the bright sunny path. Valencia is the dark horror path...where Six Flags resides. This is the kind of pettiness I live for.


I seriously hate Maurice. The entire situation could have been avoided without his dumb blind confidence. Like, they spend several scenes establishing that he has no reason to be confident in his abilities. Get a GPS, Maurice. And furthermore, Beauty and the Beast in general is full of blindly overconfident men and I'm all set with them. MRS. POTTS FOREVS. (I will also accept into my life those who love the wardrobe Madame De La Grande Bouche, because I am into extraness as a rule.)


Ok, I'm done with that. FOR NOW.

By way of review, and JUST IN CASE you missed one of these vital works of art, here are all the previous portions of Lazerpiece Theatre: The Shoulders Among Us.

Part one: On the bony anatomy that make up the shoulder joints as a whole.

Part two: On the individual joints of the shoulder—the AC joint, the SC joint, the GH joint, and the scapulothoracic joint.

Part three: On the big muscles of the shoulder—the delts, the lats, the pecs, and the traps.

Part four: On the rotator cuff and the serratus anterior.

Part five: Videos of 25 different shoulder exercises and why and how you might need each one.

AND NOW WE ARE AT PART SIX WHICH SHALL BE THE FINAL SPARKLING STONE IN THIS GLORIOUS CROWN OF SHOULDER BLOGS.


I had intended part five (the movement videos) to be the last part of the series. But as I was filming all the videos, I realized that I couldn't finish the shoulder lectures until I addressed the spine and core. So here we are.

The reason the spine and core matter is because, as we have been saying all along, the arm bones require an extremely stable base beneath them. Like a crane, your long arm is only as useful and reliable as the stability of its foundation. In all the previous blogs, I tried to make it clear that the shoulder blade is an indispensable part of that stability. With a weak or restricted shoulder blade, your arm cannot be expected to lift well.

But, as always, the arm bone connects to the shoulder bone. And the shoulder bone connects to the spine, hip, pelvis, and squishy abdomen bones.


Remember that the shoulder blade basically swims freely in the ocean of back muscles and relies on those muscles to be strong enough to create a platform for the arm. So those muscles attach to the shoulder blade. But, uh, where does the other side of them go? They all have to attach to something at the other end. Which means that the spine, the hips, the pelvis, the ribs, and everyone's governor—the abdominal core—are all involved in shoulder health too. Together they create the foundation that supports it all.


So let's talk about some of these pieces of the shoulder that we've already identified and look at where they come out on the other side. You'll see that all of your living, elastic tissue transmits force to and from very distant stations in the body. So when you're trying to get stronger, or trying to solve an anatomical problem, it's important to look up and down the chains and not just at one grumpy joint.

(All anatomical images are from the Essential Anatomy App, an indispensable part of my teaching and learning.)

Traps




Your traps are a biiiiiiiiiigass muscle. Note, not a big ass muscle. A bigass muscle. The traps are a behemoth and you can see that the diamond they create spans from skull to mid-back, and across from the point of one shoulder to the point of the other. And it's not a tent of muscle. Your traps attach at the base of the skull, and then onto every vertebrae from C1 (the first at the top of the neck) to T12 (the last one before your lower back begins). For those keeping count, that's 19 vertebral attachments. So yeah, what your spine does will make a difference in what your shoulders do.

The most common problem that arises here is the standard slumped computer posture. As we've mentioned, if your mid and upper spine cannot extend up out of that slump, the ribs will block proper movement of the shoulder. I addressed this in part two with Justin Bieber. If you have to force your shoulder up overhead because your ribs and thoracic spine can't get you there, it's almost assured you'll see top/front of the shoulder problems.

What your spine does makes a difference in what your shoulders do.

But there are other common dysfunctions here too, that don't have anything to do with putting your arm up overhead, or even lifting. That rounded mid-back changes the way your traps generally hold and move your upper body. The lower traps, which we already said are a major stabilizer for the shoulder/arm, are biomechanically far less able to perform. That means that instead of distributing loads (like the weight of your head, for example) across that big diamond of muscle, the bottom 1/3 of the diamond can't help. So the top two-thirds, and especially the top one-third, have to take up the slack.

Translation: If you have constant dull neck pain, or a constant desire to rub your neck and where your traps cross between the neck and the point of the shoulder, or a constant desire to tilt your head to the side and stretch, or constant tension headaches, or or or or or...


You get it. This is another example of the dutiful student who does 90% of the group project because the rest of the group sucks. The upper traps don't like being asked to do that much work, and I don't blame them. Your head and torso get heavy. Your arms move all day long. Thus, your neck would really appreciate if you would spend some time correcting your posture. Learning how to access the mid-back muscles can do wonders for neck and shoulder pain.


This is important too


How do you know if your traps might be an issue? Go look in a mirror either topless or in a shirt where you can see your traps and shoulders. Pinch your shoulder blades together. If you see a shrug, and especially if you can't figure out how to UN-shrug, this might be you. Furthermore, it can be easy to confuse "pinching your shoulder blades together" with "leaning back because something backwards is happening."




How do you fix it? Spend all day, literally all day, walking around pulling your shoulder blades around. Up, down, backwards, forwards, circles. Learn how they move and learn how you can control them better. Most importantly, learn how to disconnect their movement from the spine and hips. Yes, they're attached of course, but (as with any body part) you want to be able to move each independently.


Video from behind can be extremely helpful here.


Lats




Lats hang out!!!


Your lats are another biiiiiiiiiiigass muscle. And they are tantalizingly close to also being a big ass muscle, but not quite. Remember that your lats attach from your lower back and hip all the way up to the inside of your upper arm bone and can have many or few attachments on the way. But it's the first part of that sentence that really matters the most: your lats start all the way down from your lower back and hip.

Here's a neat diagram that shows why that lower back attachment matters:




(This looks like a terribly malformed depiction of a vagina but is actually a cross-section taken as if you were standing above someone looking straight down onto the top of one of their vertebrae. Those triplet muscles at the bottom are the most superficial muscles that run straight up your spine, then one layer deeper is the QL which runs between ribs and hips, and then that deepest layer is the psoas, which is a powerful hip flexor that actually controls the front of the body, even though it is attached to the back.


However, what we're most interested in is the piece of lat on the left and right, and the ab muscles on the sides.)


All of that white-blue that winds in and around each individual muscle is thick, layered fascia. We can do a whole different post about fascia but mostly I describe it to people as the reason the juice of an orange doesn't sink straight to the bottom of the orange. Oranges have all of that membrane to hold everything in place, and so does your body. A LOT of muscles are contiguous with that lower back fascia.

Your lats attach to your lower back and hip. What happens in your shoulder can affect your lower back and vice versa.

Fascia is poorly understood (experts didn't even realize that it has nerves running through it until relatively recently) but we know that it is both contiguous with muscle tissue and also facilitates those muscles sliding on each other. You can see in that image that some of your ab muscles, and three layers of back muscles all share this same canopy of connective tissue. As such, it means that tugging on one part of the muscle-fascia complex is going to tug on all the surrounding parts too. And that tug can extend all the way up to the shoulder.

So can your lower back and hip mechanics affect your shoulders? Yup, and in a few different ways. Your lats create a sling that hugs all of the complexities of the lower/mid back and holds them closely against your torso.


Moving partway up the lats, a couple small studies have looked at the effect of excessively tight lats on shoulder blade placement. An overly-tense lat muscle has the potential to pull your shoulder blade slightly out of its preferred resting state. That means that when you move the shoulder blade, it could veer off of its normal track and onto a track you really don't want it on.

Continuing up to where your lats attach to your arm, remember that this big back muscle that seems like it's nowhere near your arm is actually a powerful internal rotator of the shoulder. A very tight lat, therefore, can maintain your arm in a bit of a forward slump. And as we've gone over before, if you take slumping shoulders overhead, you're gonna be riding a crazy roller coaster all the way to Impingement World.


So if you have a chronically tight low back, does that have potential to wreak havoc on your upper body workouts? Sure does, and treating the shoulder itself might have absolutely no effect on the problem. You may find yourself with shoulder pain that lasts for years, or until you just give up on it as incurable shitty shoulder.


It might not have to be this way!


How do you know if your lats might be an issue? Try this stretch: Place your butt, back, and shoulder blades against the wall, feet out a bit from the wall. Place your forearms together and lift your arms in front of you, keeping your elbows touching as long as you can. If you, like me, can barely lift your arms and keep them together, that's a strong sign of excessively tight lats.


How do you fix it? This stretch you just tried is one really good fix. Move into that stretch as far as you can and slowly release. Do this several times, several times a day. If you note the height of your elbows at the point where they can't stay together any longer, you'll be able to determine their progress over time. (So your elbows should be able to get higher and higher without separating.)



Serratus Anterior



Serratus is the fan-shaped muscle in orange

Ok, so with the traps we looked at how your shoulder connects to your neck and upper back, with the lats we looked at how your shoulder connects to your mid and lower back, and with the serratus anterior we're gonna look at how your shoulder connects to your rib cage. (Don't forget that I did a detailed look at SA in part four of this series.)


SA hugs your shoulder blade into your thorax and slides it along the rib cage towards the front of the body. So if you hold your arms out in front of you, and then push them forward as far as you can, it's SA that's doing that push.

Your lower traps and your serratus anterior work to oppose each other a bit: your lower traps pull your shoulder blade down and back, while your SA pulls the shoulder blade down and forward. Together they help it to rotate smoothly in place.

So here's why rib position matters. Insufficient core control allows the ribs to flare up and out when you take your arms overhead:


each employee is required to wear 15 pieces of flare

If the ribs are flaring out while you're doing overhead work, it cuts off the need for the serratus anterior to do its full job of pushing forward (because the range of motion has been reduced by the ribs). It's tricky, because rib flare allows you to get the weight to its final destination, so it feels like you did it perfectly. Notice in the picture above that I can get the bar overhead just fine, but my shoulders are very obviously not fully extended.


Over time, the SA gets weaker and less able to push all the way out. A weak SA won't be able to oppose your lower traps, which pull the shoulder blade backwards. This is called scapular winging, and it's when the shoulder blade sits back off the rib cage because it has nothing pulling it into your body.


If you liked it then you shoulda put a wing on it

Again, anything that takes the shoulder blade off of its preferred track is bad news bears.

How do you know if your serratus anterior might be an issue? Take a video of yourself shirtless, from behind, starting with your arms down at your side. Keep your arms straight, and lift them slowly straight in front of you until they get overhead and back down. Do it a second time, holding a small weight in your right hand (3 or 4 pounds is enough, a half gallon of milk, whatever), and then a third time, this time with the weight in your left hand. Watch your shoulder blades when you watch the video. They should glide smoothly against your body and not shove backwards. They should absolutely 100%, seriously never look like the guy just above this paragraph.


How do you fix it? I did a whole Instagram post on exactly this topic. Start from video two, and hit that follow button while you're there for more quality content. Don't forget to send it to all of your winged friends!

Rhomboids



I don't have too much to add about the rhomboids here but at this point it feels weird that I haven't mentioned them at all since they are an important shoulder puller-togetherer. Since they work similarly to the traps (residing just beneath them), all I'm going to add is that to target the rhomboids (which you should if you're a persistent shrugger), research suggests that your best angle to work them is with the arms at approximately 120 degrees. That angle is shown here:




You can do pulls from behind like this guy (maybe I'd protest his gentle lean back, however), pulls from something anchored up in front of you, or isometric holds, or even just bringing your arms up to that angle and practicing shoulder squeezes.


The Spine

All I want to say here is that one of the most common problems in ANY kind of overhead work is the leaning-back, over-arching of the spine to assist in getting the hands up. Your spine, selfless creature that it is, bends over backwards to help you live your life. But in this particular instance, your core has the very important responsibility of helping your back stay strong and steady while putting your arms up overhead. The arched back, the rib flare, the neck craned, etc, is no good.




Hopefully this blog has helped to converge the idea of all of these movements and how they affect shoulder function. To close it out, one more self-diagnostic. If any of the below is true for you, going overhead might too hard for you for right now, but here are some modifications:

If you can't:

* Press overhead without arching, try pressing with just one arm at a time, and concurrently start overhead mobility immediately—see shoulders part five for ideas.

* Hang from a bar without leaning backwards, try leaving your toes on the floor to assist the bottom range of motion.

* Do a handstand without hitting full banana position, try handstands with your belly against the wall instead of your back, tuck your head in and push up and away from the floor.

Alright, that closes out our shoulder series for good (for now). Remember, if you're turning to the internet for exercises and pain relief, make sure you at least have a good enough idea of what's going on that you can choose wisely. If you still have no idea what's happening with your shoulder, it's definitely time to see a physical therapist or another medical professional. Then you can come back here to shore up the remaining loose ends.

Don't forget to share this with all of your aching-shoulder compadres! Congrats on your shoulder-reading tenacity! May you never impinge again.

#exercise #fitness #rehabilitation #shoulders #health

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