Shoulder pain is no fun. It can get in the way of golf, tennis, gardening, carrying groceries and even washing your hair. Shoulder pain can vary from mild soreness to excruciating pain and may be diagnosed as a torn rotator cuff, bursitis, tendonitis/tendonosis, frozen shoulder, labral tear, arthritis, thoracic outlet syndrome, or a nerve impingement. All these different symptoms must have many different causes and specific treatments that address these causes right? Maybe not.
Most shoulder problems and pain are caused by the same thing: thoracic flexion which causes forward rounded shoulders.
Most shoulder problems and pain are caused by the same thing: thoracic flexion which causes forward rounded shoulders.
The image above shows thoracic kyphosis and the forward head and shoulder posture that follows. When the shoulder joint is forward like this the joint surfaces, muscular stability and strength, and shoulder range of motion are all compromised.
A research group wanted to look at how different sitting postures affected shoulder range of motion. They studied 30 healthy young men, 18-35, with no recent history of shoulder problems and measured their shoulder range of motion in 3 different sitting postures.
Their analysis "demonstrated significant differences in all comparisons (p < 0.001)."
They concluded:
A research group wanted to look at how different sitting postures affected shoulder range of motion. They studied 30 healthy young men, 18-35, with no recent history of shoulder problems and measured their shoulder range of motion in 3 different sitting postures.
Their analysis "demonstrated significant differences in all comparisons (p < 0.001)."
They concluded:
- "Changes in sitting posture affect shoulder ROMs in all directions tested"
- "Greater changes in shoulder ROMs were associated with greater increase in thoracic kyphosis"
- "Even subtle changes in thoracic kyphosis need to be considered during shoulder evaluation".
Image on left shows humeral flexion with normal thoracic spine position. Image on right shows humeral flexion limitations from thoracic kyphosis.
Thoracic kyphosis or thoracic flexion causes a decrease in range of motion of the shoulder, but how does that cause tendonitis or impingement or a rotator cuff tear?
 Shoulder nerve and blood supply - anterior view |  shoulder ligaments - anterior view |  deep shoulder muscles - anterior view |
 superficial shoulder muscles - anterior view |  deep shoulder muscles - posterior view |  superficial shoulder muscles - posterior view |
The shoulder is a complex junction of bones, muscles, tendons, ligaments, nerves, blood vessels, and connective tissues that are all affected by slight changes in bone/joint position and movement patterns.
Individuals with thoracic kyphosis exhibit less than normal and ideal thoracic mobility especially thoracic extension. Thoracic extension is needed for any overhead arm movement (throwing a ball, pull-ups, overhead presses, changing a light bulb, reaching top shelf in kitchen/closet) and without proper thoracic extension, scapular positioning and rotation is compromised creating nerve, blood vessel, tendon and ligament impingement and compression along with muscular strain.
No matter whether you are dealing with supraspinatus tendon impingement in the subacromial space, bicipital tendinopathy, or peripheral nerve entrapment in the shoulder, these can all be resolved by restoring proper thoracic, scapular, clavicular, and humeral position and mobility and stability.
It is important to look at the underlying reason for the shoulder pain and dysfunction and address all related imbalances and not solely focus on the shoulder and associated muscles. The underlying reason for the faulty shoulder biomechanics can be pelvic position and lack of function which causes changes in thoracic extension and scapular positioning and movement. Without looking at and treating the entire posture and biomechanics of the body, we are simply treating symptoms and those same symptoms or related symptoms will return later. The client/patient might temporarily feel better but this false sense of confidence will lead to future injury and pain - often much worse than the original injury and pain.
Individuals with thoracic kyphosis exhibit less than normal and ideal thoracic mobility especially thoracic extension. Thoracic extension is needed for any overhead arm movement (throwing a ball, pull-ups, overhead presses, changing a light bulb, reaching top shelf in kitchen/closet) and without proper thoracic extension, scapular positioning and rotation is compromised creating nerve, blood vessel, tendon and ligament impingement and compression along with muscular strain.
No matter whether you are dealing with supraspinatus tendon impingement in the subacromial space, bicipital tendinopathy, or peripheral nerve entrapment in the shoulder, these can all be resolved by restoring proper thoracic, scapular, clavicular, and humeral position and mobility and stability.
It is important to look at the underlying reason for the shoulder pain and dysfunction and address all related imbalances and not solely focus on the shoulder and associated muscles. The underlying reason for the faulty shoulder biomechanics can be pelvic position and lack of function which causes changes in thoracic extension and scapular positioning and movement. Without looking at and treating the entire posture and biomechanics of the body, we are simply treating symptoms and those same symptoms or related symptoms will return later. The client/patient might temporarily feel better but this false sense of confidence will lead to future injury and pain - often much worse than the original injury and pain.
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