Tag Archives: Rounded Shoulders

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An Easy Exercise to Prevent and Treat Shoulder Pain and Instability

Proper rotator cuff and scapular muscle strength is critical to preventing and treating shoulder pain.  In this video, I demonstrate one of my favorite rotator cuff and scapular stabilizing exercises using an exercise band.  It works the lower trapezius, deltoid and rotator cuff muscles.

The rotator cuff is a critical component to shoulder mobility.  It’s made up of four different muscles whose job is to make sure that the ball of the humerus (arm bone) rotates, slides, and glides properly in the socket, which is made up of the scapula.  The rotator cuff allows the other major muscles of the arm, such as the deltoid and Latissimus dorsi (lats), to properly perform their movements.

The scapulothoracic muscles are the lower trapezius, middle trapezius and rhomboids primarily and proper strength and function in these muscles is critical to insuring proper shoulder blade movement and general shoulder mechanics.  Weakness in these muscles is often associated with shoulder impingement syndrome.

Weakness in the rotator cuff or scapulothoracic muscles can lead to rubbing of the rotator cuff tendon on the bone or impingement of the bursa within the shoulder leading to impingement syndrome (which can eventually lead to fraying and tearing).  With proper muscle strength and balance, you can help reduce the risk of this occurring.

Shoulder impingement or a partial rotator cuff tear can be very painful and may take many weeks to recover.  Many different causative factors can lead to these conditions.  In most cases, shoulder impingement (or even small partial tears) can be completely rehabilitated and should (when treated properly) leave no residual effects once a person has recovered.

For more information on how to address shoulder impingement, please refer to How Should I Treat Shoulder Pain and Impingement?

For an example of another shoulder exercise that can be helpful in improving rotator cuff and scapulothoracic strength, check out my video on How to Treat Shoulder Pain with an Exercise Band.

In addition to proper rotator cuff strength, it’s important to address adequate shoulder and thoracic (upper back) mobility.  Be sure to check out My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain.  Subscribe and you will automatically gain access to this FREE resource.  Download the .pdf file, which is full of photos and exercise instructions, to get started!

Shoulder pain can be debilitating by limiting your ability to exercise and perform daily tasks.  Be proactive in your care and management.  If you continue to experience pain, seek additional help.  Don’t let the pain linger.  The longer a condition is left untreated, the more potential for harm and damage which potentially could lead to a longer recovery.  The American Physical Therapy Association (APTA) is an excellent resource for learning more about physical therapy as well as locating a physical therapist in your area.

Which treatments have you found to be the most effective in dealing with shoulder pain?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

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How to Properly Perform I’s, T’s, and Y’s Exercises

The purpose of I’s, T’s, and Y’s exercises on an exercise ball is to address lower and mid trapezius and scapula muscle weakness and to generally activate the posterior chain (including the lumbar spine extensors).  Poor posture due to poor thoracic mobility and poor scapular muscle strength are often major contributors to neck, shoulder, and upper back pain.  Poor lumbar extensor strength is linked to low back pain.

I’s, T’s, and Y’s exercises on an exercise ball can be helpful in treating the following: 

  • Poor posture
  • Shoulder pain
  • Cervical pain
  • Headaches
  • Thoracic pain
  • Upper and lower back pain

Begin by performing the I’s, T’s, and Y’s exercises on a Thera-Band Exercise Ball.  Please refer to I’s, T’s, and Y’s Exercises for step-by-step instructions.  Start slowly without resistance.  Keep your chin tucked and head aligned with the body.

Version One:  Move your arms slowly up and down in each position of I, T, and Y.

Version Two:  Hold each position for the specified time.

To increase the difficulty for either version, add a 1-3 pound weight in each hand.  These exercises shouldn’t cause any pain in your neck, shoulder or upper/lower back. 

When this exercise is performed correctly, it engages and strengthens many critical muscles that help control many of our most common postures and movement patterns.  A slouched posture with a forward head and rounded shoulders can be associated with many common pain syndromes including:  neck pain and headaches; upper back pain; and shoulder pain.

It’s important to try to keep the proper postural alignment with your shoulders under your ears, and the shoulder blades set in a back and down position.  This is particularly important when performing any activity while using the shoulder.  This series of exercises can help to strengthen the important muscles that can help you maintain proper postural alignment.

Be sure to check out my video post, How to Use an Exercise Ball to Improve Posture and Treat Shoulder, Neck, and Back Pain, in which I demonstrate how to perform I’s, T’s, and Y’s exercises on an exercise ball in order to address lower and mid trapezius and scapula muscle weakness.

When performing these exercises, it is important to understand that they should never be painful.  You may feel a mild to moderate discomfort because the exercises are difficult, but if you are experiencing pain (particularly, the pain you are trying to treat) please discontinue the exercise and speak to your physical therapist.

Have you tried the I’s, T’s, and Y’s exercises on an exercise ball before?  If so, what has your experience been like?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

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How to Treat Shoulder Pain with an Exercise Band

Proper rotator cuff and scapular muscle strength is critical to treating shoulder pain.  In this video, I demonstrate one of my favorite rotator cuff strengthening exercises by using an exercise band.  It works both the lower trapezius and rotator cuff.

The rotator cuff is a critical component to shoulder mobility.  It’s made up of four different muscles whose job is to make sure that the ball of the humerus (arm bone) rotates, slides, and glides properly in the socket, which is made up of the scapula.  The rotator cuff allows the other major muscles of the arm, such as the deltoid and Latissimus dorsi (lats), to properly perform their movements.

When there is weakness or dysfunction, it will cause rubbing of the muscle tendon on the bone–leading to impingement or eventually fraying and tearing.  With proper muscle strength and balance you can help reduce the risk of this occurring.

Shoulder impingement or a partial rotator cuff tear can be very painful and may take many weeks to recover.  Many different causative factors can lead to these conditions.  In most cases, shoulder impingement (or even small partial tears) can be completely rehabilitated and should (when treated properly) leave no residual effects once a person has recovered.  For more information on how to address shoulder impingement, please refer to How Should I Treat Shoulder Pain and Impingement?

In addition to proper rotator cuff strength, it’s important to address adequate shoulder and thoracic (upper back) mobility.  Be sure to check out My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain.  By subscribing to my e-mail list, you will automatically gain access to this FREE resource.  Download the .pdf file, which is full of photos and exercise instructions, to get started!

Shoulder pain can be debilitating by limiting your ability to exercise and perform daily tasks.  Be proactive in your care and management.  If you continue to experience pain, seek additional help.  Don’t let the pain linger.  The longer a condition is left untreated, the more potential for harm and damage which potentially could lead to a longer recovery.  The American Physical Therapy Association (APTA) is an excellent resource for learning more about physical therapy as well as locating a physical therapist in your area.

Which treatments have you found to be the most effective in dealing with shoulder pain?  Additional discussion can help others to manage his/her pain.  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

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How to Use an Exercise Ball to Improve Posture and Treat Shoulder, Neck, and Back Pain

In this video, I demonstrate how to perform I’s, T’s, and Y’s exercises on an exercise ball in order to address lower and mid trapezius and scapula muscle weakness.  Poor posture (due to poor thoracic mobility) and poor scapular muscle strength are often major contributors to neck, shoulder, and upper back pain.

I’s, T’s, and Y’s exercises on an exercise ball can be helpful in treating the following:

  • Poor posture
  • Shoulder pain
  • Cervical pain
  • Headaches
  • Thoracic pain
  • Upper and lower back pain

Begin by performing these I’s, T’s, and Y’s exercises on a Thera-Band Exercise Ball.  Start slowly without resistance.  Keep your chin tucked and head aligned with the body.  Move your arms slowly up and down in each position of I, T, and Y.

For an advanced version, add a 1-2 pound weight in each hand.  To make it even more challenging, hold for time.  These exercises shouldn’t cause any pain in your neck, shoulder, or upper/lower back.

When this exercise is performed correctly, it engages and strengthens many critical muscles that help control many of our most common postures and movement patterns.  A slouched posture with a forward head and rounded shoulders can be associated with many common pain syndromes including: headaches; cervical pain, upper back pain; and shoulder pain.

It’s important to try to keep the proper postural alignment with your shoulders under your ears, and the shoulder blades set in a back and down position.  This is particularly important when performing any activity while using the shoulder.  This series of exercises can help to strengthen the important muscles that can help you maintain proper postural alignment.

In addition to muscle weakness leading to common aches and pains, poor mobility in the thoracic spine is also a common contributing factor in the pain syndromes mentioned above.  If you want to learn how to stretch and self-mobilize the thoracic spine, be sure to check out My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain.  By subscribing to my e-mail list, you will automatically gain access to this FREE resource.  Download the .pdf file, which is full of photos and exercise instructions, to get started!

If you continue to experience pain, seek additional help.  Don’t let the pain linger.  The longer a condition is left untreated, the more potential for harm and damage which potentially could lead to a longer recovery.  The American Physical Therapy Association (APTA) is an excellent resource for learning more about physical therapy as well as locating a physical therapist in your area.

Do you have a favorite “go to exercise” that you use to treat neck, shoulder, and upper back pain?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

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Why Does My Shoulder Hurt?

Shoulder pain is one of the most common ailments treated by physical therapists.  There are many potential causes of shoulder pain, but the two primary issues to consider include poor mobility and muscle imbalance.  The key to treating most common shoulder related pain is to improve your posture while focusing on thoracic mobility, shoulder position, and proper shoulder strengthening.

Poor Mobility

The most common reason for mobility issues is poor posture.  Poor thoracic mobility and tightness in the posterior capsule of the shoulder are the most common contributors to the lack of mobility which can ultimately lead to shoulder pain.

Mobility issues can occur if you adopt a chronic forward head with rounded shoulders posture.  As this position becomes more chronic, the thoracic vertebrae lose backward mobility (extension).  This happens in conjunction with shortening of the pec minor (which is located underneath the pec major) and causes the shoulders to roll forward.  The forward shoulder posture causes the humeral head (arm bone) to be positioned more forward.

This causes tightness in the posterior (back) portion of the shoulder joint which affects the natural roll and spin motion of the joint.  The alterations of the roll and spin motion combined with alterations in shoulder blade motion negatively affects the mechanics of the shoulder joint.  The alteration in mechanics is what ultimately leads to pain as the rotator cuff or biceps tendons become impinged, irritated, and painful.

This is commonly referred to as Shoulder Impingement Syndrome.  Shoulder impingement pain is often associated with pain reaching overhead, behind your back and/or out to the side.  Those who experience it may feel weaker in the affected shoulder and experience pain when sleeping on the affected side.

Perform the following stretch to address shoulder posterior capsule tightness.  Lie on the side of the affected shoulder.  Be sure to support your head with a pillow.  Your arm should be straight out from your body with your shoulder tucked under your body.  The goal is to pin your shoulder blade down with the floor.  Gently push your arm down (as shown).  You should feel a gentle stretch.  Hold for 30-60 seconds for two to three times.  Perform once or twice per day.

In case you haven’t already subscribed to my e-mail list, please take a moment to do so in order to access my FREE resources, including My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain.  It’s a downloadable .pdf file with my recommended stretches and exercises to address poor thoracic mobility and pec minor tightness.  These simple exercises (with complete instructions and photos) will help you to improve thoracic mobility and can be performed at home.

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Muscle Imbalance

Muscle imbalance is often an associated causative factor for shoulder pain.  In addition to mobility issues, altered strength and muscle activation patterns are also related to shoulder pain and shoulder impingement syndrome.  The reasons for muscle imbalance can vary, but are often associated with poor posture and/or cervical/neck related issues.

Two common muscles that must be strengthened in order to insure proper shoulder mechanics are the lower trapezius muscle and the supraspinatus muscle (which is one of four rotator cuff muscles).

The rotator cuff muscles are responsible for the stability of the shoulder and proper roll, glide, and spin of the ball and socket shoulder joint.

The lower trapezius muscle is responsible for proper shoulder blade timing and rotation during arm movements.  It helps in maintaining a proper upright posture.

For three easy and effective exercises to perform to improve your lower trapezius and rotator cuff muscle strength, please refer to Exercises for Lower Trapezius and Rotator Cuff Muscle Strength.

Most shoulder symptoms typically resolve when thoracic mobility and strength in the shoulder is improved.  Shoulder impingement is painful, but worse yet if left untreated.  It can lead to fraying of the rotator cuff tendons (and ultimately, a rotator cuff tear).  It’s always best to be proactive and address the causative factors early.

If you’re not improving or your symptoms worsen, consult with your medical provider to determine if other causes are contributing to the problem.  The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area.  In most states, you can seek physical therapy advice without a medical doctor’s referral (although it may be a good idea to hear your physician’s opinion as well).

If you’re experiencing shoulder pain, do you think either poor mobility or a muscle imbalance is causing it?  How can you improve your thoracic mobility and strength in your shoulder?  Please share below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

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How to Improve Posture & Eliminate Pain

Imagine how much the average person actually slouches during a day. One may slouch as she sits in a chair for breakfast, then she may hunch over the kitchen sink to wash dishes. She slouches while driving a car, then she slouches while sitting at work or at a school desk. She slouches while texting, watching TV, or using the computer. If she isn’t slouching, she’s bending over to clean or pick up children and/or pets. The list of slouching possibilities is endless!

Our bodies are designed to move both forward and backward. The problem is that we spend most of our times in a slouch, hunched over (flexed) position. Slouching is having a forward head and a rounded shoulders posture. It can also involve a posterior pelvic tilt which causes a reduction in the normal lumbar curve. This position tends to be even worse in people who are taller than average or in teenage girls and women (as many will slouch to modestly hide their chests). Over time, this constant flexed position causes excessive strain on posterior muscles, and it begins to overload the vertebral discs and ligaments which can lead to pain and injury.

PoorSittingPosture

Poor posture causes improper spinal positioning and affects the neck, shoulders, low back, mid back/thoracic, and ultimately, the entire body. This flexed (slouched) posture leads to postural muscle weakness which causes us to slouch more as well as predisposing us to injury. The lumbar spine is the most common area for injury (followed by the neck, mid back, and shoulders). Injuries can include: disc herniation, spinal degeneration, and shoulder impingements.

How to improve posture and eliminate pain? As simple as it sounds, first work on your posture!  Sit and stand up straight.  Initially, it may be difficult because the posterior chain, which includes the hamstrings, glutes, and back extensor muscles, is weak. Correcting your posture may actually cause some pain as the muscles will be utilized in a way that they aren’t used to. Persistence is crucial if you want to eliminate pain and decrease your risk of injury.  The following exercises can help you to develop better posture and strength to eliminate neck, shoulder, and back pain.

  • Increase Your Postural (Extensor) Muscle Strength – Refer to Prone Superman Exercises for instructions and photos of exercises that can be performed while lying on the floor or bed. The purpose of these exercises is to improve your back extensor strength, so it will be easier to maintain good posture. Move slowly and only raise the leg as far as you can without twisting.
  • Perform Foam Roller (Towel Roll) Stretches – A foam roller is the best option, but you could substitute one by tightly rolling up a beach towel or by rolling a beach towel over a water noodle. Make sure to keep your knees bent and your head supported. Subscribe to my e-mail list to gain immediate access to My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain for step by step exercise instructions and photos.
  • Start Squatting – The squat is a critical exercise to maintain mobility and function as we age. It is also the most beneficial exercise to develop your posterior chain. Please refer to 7 Reasons Why the Squat is Fundamental to Life.

For a comprehensive look at pain management, I recommend Robin McKenzie’s Treat Your Own Back and Treat Your Own Neck. He offers very easy and practical advice on how to treat and manage back or neck pain.

What are some different ways to raise awareness of your posture? How can you incorporate them into your daily tasks?  Feel free to leave your comments below.

If you have additional questions or comments, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

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Q & A: How Should I Treat Shoulder Pain and Impingement?

Q I suspect I have a left rotator cuff tear.  I have severe pain especially when I move my arm outwards.  It feels like a knife stabbing my left deltoid area with spasms.  There is no swelling or bruising.  The area is tender to touch.  I have trouble lying on my left side at night due to discomfort.  If I don’t move my arm, there is no pain.  Ibuprofen is not effective.  I have been applying ice.  I haven’t seen my MD yet.  When I raise my arm when I perform range of motion (ROM), I hear a cracking sound.  It has been six weeks.  Please advise, Dr. Ben! -Linda

A.  Thanks for your question, Linda!  Unfortunately, this is a fairly common scenario.  Shoulder pain can be one of worst most intense pains a person can experience.  It can be completely debilitating–rendering an arm almost useless in some cases.  The shoulder is vital for any movement of the arm which includes the hand.  It can even affect a person’s ability to utilize a computer mouse.

Linda doesn’t mention any specific causative factor which is common in these cases.  She also mentions pain at night and pain with movement.  Another very common symptom is where she describes the stabbing pain in the deltoid.  The pain is almost always located down the arm into the deltoid area.  Typically, it is located at the insertion point of the deltoid muscle.  It can migrate even further to the elbow or hand.

IMG_3759_RGB_4x6_Deltoid

In a situation like Linda’s, the source of the pain is rarely the deltoid and almost always the rotator cuff.  The rotator cuff tends to “refer pain” into this region.  Referred pain is a common phenomenon which occurs when the pain is being caused in one area of the body, but the pain is felt somewhere else.  (An example of referred pain would be left arm pain or jaw pain which is present during a heart attack.)

Linda states that the pain is present when she raises her arm.  This implies that she still has the ability to raise her arm, which tends to (but not always) rule out a full rotator cuff tear.  Typically with a full tear, the person loses the ability to raise his/her arm.  The level of pain on a full tear will vary depending on how acute or recent the tear.

To accurately diagnose Linda’s condition, I encourage her to seek treatment from her medical physician or physical therapist.  Based on her reported symptoms, she is likely experiencing either a partial rotator cuff tear or shoulder impingement.  Shoulder impingement can lead to an actual rotator cuff tear if it remains untreated.  The key to treatment (with either a partial rotator cuff tear or an impingement) is to first address the pain and inflammation.  Then the mechanical cause or causes which led to the injury must be addressed.

My Top Tips & Recommendations to Treat Shoulder Pain & Impingement include:

Reduce the Inflammation:

  • Use ice on the affected area (not directly on the skin) for 20 minutes per hour. Watch the skin carefully. If it looks white or blue and is non-blanching, then discontinue the use of ice. It is possible to frost bite your skin.
  • Rest the affected area. Stop or reduce any activities which tend to aggravate the area. This is typically overhead activities or repetitive activities.
  • When sleeping, try not to lie on the affected side. Hug a small pillow for comfort. This also promotes optimal blood flow to the shoulder area.
  • Try Mt. Capra CapraFlex. Mt. Capra, an organic goat farm in eastern Washington State, offers superior quality products primarily utilizing goat based products. Capra Flex is the best bone and joint supplement I have found. It is a blend of natural herbs and spices along with glucosamine and chondroitin. The herbal and spice formulation is designed to naturally decrease inflammation and support healing. I recommend it to anyone recovering from an injury or attempting to prevent injury when performing at a very high level. I personally use it, and in my practice, it has helped clients recover faster and prevent injury. It can interfere with some blood thinning medication, so if you are on this type of medication, please check with your physician.

Address the Mechanical Causes:

  • A slouched posture with a forward head and rounded shoulders can be associated with this condition. Try to keep a good postural alignment with your shoulders under your ears and the shoulder blades set in a back and down position. This is particularly important when performing any activity while using the shoulder.
  • Improve thoracic (upper back) mobility. The more mobility your upper back has, the less likely your shoulder will impinge when moving. Your upper back, shoulder blade, and arm must work together when moving. Tightness in the upper back will throw this system off.
  • Be sure to check out My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain.  By subscribing to my e-mail list, you will automatically gain access to this FREE resource.  Download the .pdf file, which is full of photos and exercise instructions, to get started!

Strengthen the Rotator Cuff:

  • The rotator cuff is a critical component to shoulder mobility. It is made up of four different muscles whose job is to make sure that the ball of the humerus (arm bone) rotates and slides properly in the socket, which is made up of the scapula. The rotator cuff allows the other major muscles of the arm, such as the deltoid and Latissimus dorsi (lats), to properly perform. When there is weakness or dysfunction, it will cause rubbing of the muscle tendon on the bone–leading to impingement or eventually fraying and tearing.
  • Here are my recommended Rotator Cuff Exercises  using an exercise band.

Shoulder impingement or a partial rotator cuff tear can be very painful and may take many weeks to recover.  My tips and recommendations are the first steps for treating and preventing shoulder impingement and pain.  Many different causative factors can lead to these conditions.  In most cases, shoulder impingement (or even small partial tears) can be completely rehabilitated and should (when treated properly) leave no residual effects once a person has recovered.

If your symptoms continue to worsen or you don’t improve, I highly recommend that you seek further medical treatment.  Many times, a person will require medical intervention, which could include anti-inflammatory medications either orally or through an injection.  A person may also need hands-on treatment from a qualified physical therapist to address other mobility issues in the shoulder, thoracic or cervical regions which are causing or contributing to the pain.  Sometimes, surgical intervention is needed to repair a fraying tendon or an acromion which is hooked and causing the impingement.

Good luck, Linda!  I hope you find the information to be helpful and provide some relief from the pain you’re experiencing.  If you have a question that you would like featured in an upcoming blog post, please e-mail contact@thephysicaltherapyadvisor.com.

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice.  No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.