A lot of shoulders get better with a standard approach. Get the rotator cuff working well, sort the shoulder blade mechanics and reduce the load through the tendon for a little while and they slowly but surely get better over 8-16 weeks.

But what if that doesn’t work. What if the exercises make it worse?

The simple answer is that there is probably another area in your body that is not working well. This causes your shoulder to over work or puts your shoulder into a compressed unhappy position. Working an already compressed overworked joint with rotator cuff exercises will simply make it hurt more.

So what other areas could be causing the shoulder to be more compressed?

It could be anywhere from an old ankle sprain to altered painful hip mechanics. The more likely scenario is it is something close to the shoulder. The rib cage which the shoulder sits on or the neck which the shoulder sits next to. The link are the muscles and fascia which connect the two areas.

It is normally two levels of your rib cage or neck that can cause the problem but there may be the following in your history which makes it become more apparent that it isn’t just your shoulder

1. The pain moves to the opposite shoulder from time to time

2. You recently changed from being more active to a more desk based job

3. Desk work bothers it

4. You play sport that is asymmetrical or have habits that are asymmetrical eg racket sports, holding kids, kick boxing

5. Pain will move through to between the shoulder blades or neck and no amount of foam rolling or spiky ball work helps

6. You’ll also get headaches or difficulty twisting your neck or trunk

7. Your shoulder pain comes back 2 days later after treatment

8. Your breathing feels off or you just can’t take a deep breath no matter how much wim hoffing your doing

If you suspect this is the case a Connect Therapy Hour assessment is a good way to delve into what is actually going wrong. 

A big focus is on your unique story. How potential past injuries may influence your body now, what habits and work may also influence your body. It looks at all these old injuries or areas affected by bad habits and assesses how they link with your painful shoulder. 

Does correcting them into a better position offload the shoulder and help you immediately move better? 

Do the two areas make each other worse? 

It helps answer these questions and finds a way into your system to create immediate rapid change. How? By “disconnecting these fascially stuck” areas and creating space via our hands,  acupuncture needles and mindful movement to help solve the problem long term. Not just a temporary bandaid solution. The goal is to strengthen those weakened areas whilst also rehabbing the painful area for great long term results. 

The rib cage and neck make up to 20% of whole body length and up to 35% of your body’s mass. If you have imbalances in muscle control of your thorax, it can result in a lean of your thorax to one side – left or right – and you will then habitually and repetitively end up loading one shoulder more than the other – this often explains why repetitive loading your shoulder makes it worse!

The rib cage is the centre for trunk twisting. Think of how many movements require your trunk to twist well from running to twisting in your chair to look at a second screen. If this isn’t working well your shoulder compensates and has to twist more. 

It is generally from a postural habit you have or an old injury. The good news is that old injuries can be rehabbed. They are normally muscle imbalances that require a guided program to get better so don’t just think it can’t be fixed. It’s simply a matter of understanding your unique story and how it may influence your shoulder. Then it’s a better of decompressing that area and then balancing out the system which is a combination of down training tight muscles and up training weak core muscles followed by a good strength program that progresses slowly. 

Check out this video which shows a shoulder moving in a less than optimal way causing persistent pain over months of repetitive strength training. The cause of the problem was actually a muscle imbalance around the trunk (secondary to limping from a hip injury). As you can see when this imbalance is corrected via a thoracic ring correction the shoulder immediately moves in a better way. Retraining this new pattern will fix the shoulder pain for the long term as opposed to a bandaid temporary fix!

If you feel this could be you send me an email with your story to nick@balanceinmotion.com.au. I can tell you whether we can help, which Physio you should see and if I don’t think we can help I can recommend somewhere that can. 

OR you can click HERE to read more about Connect Therapy.