Shoulders are the most commonly injured joints in the body because they are the most mobile and the least stable. Instability is what causes this unique and complex joint to be the third most common musculoskeletal complaint presenting to physical therapy.
So, if instability is the reason for such a high rate of pain and injury, can you make the joint more stable to reduce your risk of shoulder problems happening in your life? Yes, but it may surprise you to learn you must train your whole body in order to improve your shoulder function. You can’t successfully reduce your risk of shoulder issues by isolating your rotator cuff muscles or by just working your shoulder joint.
Your rotator cuff is designed to provide more stability in your mostly unstable shoulder joint; yet each year there are millions of visits to medical offices for shoulder pain due to rotator cuff problems. What is commonly seen is that one (or two) of the four rotator cuff muscles have become torn or injured. This is called Rotator Cuff Syndrome. The most common medical treatments advised for this issue are steroid injections and surgery.
Sadly, a systematic review of scientific studies reported steroid injections were not seen to work any better than manual therapy, and the clinical data doesn’t find any evidence to support any intervention (surgical, non-surgical, or post-surgical) one way or the other.
So, if the common medical treatments for the most common shoulder problem don’t appear to be effective enough, what can be done about it?
Let’s look at shoulder anatomy to see if it can provide some clues.
A total of 18 muscles, including the four rotator cuff muscles, directly affect shoulder function. This is why the term “shoulder complex” is often used. All that mobility is possible because the arm bone (humerus) sits in a very shallow cup (glenoid fossa) that allows a great deal of motion. The job of the rotator cuff muscles is to provide stability during all that motion. So why do they appear to fail so often? There are three main reasons.
Workouts That Isolate Muscles
First, what I have seen as a physical therapist certified in Applied Functional Science, taught by the Gray Institute, is how isolating muscles during workouts can injure the human body. While you can focus on major body parts to maintain or restore healthy function, isolating muscles is an entirely different thing.
Isolating muscles is tantamount to asking one person to lift something that requires a whole team. Your body is designed for authentic physical function. This means your whole body is a team player and nothing is designed to work all by itself. Your lungs need your heart which needs your lungs, and so on.
Muscles work together when you’re performing normal physical tasks, and your whole body is in play. When you reach up to a shelf overhead, you use your whole body, not just your anterior deltoid. When you lower a heavy bag of groceries onto the kitchen table, you use your whole body to control the motion, not just your biceps.
Isolating muscles is a common reason for tendonitis and chronic pain to occur in major body parts. If tendonitis occurs without having been to the gym and isolating muscles, there are probably major body parts not doing their job. Typically, this happens from sitting all day, which leads us to the second reason.
Decreased Hip and Power Source Function
Believe it or not, your shoulder complex is dependent on having a strong foundation below. There may be 18 muscles directly affecting shoulder motion, but there is a whole body indirectly affecting shoulder function.
It is a physics thing.
For every action there is an equal and opposite reaction. This means your shoulder doesn’t perform in isolation from the rest of your body. When you push open a door, your back hip provides the opposite force to push from, not your shoulder. When you lift your arm up overhead, your shoulder pushes off of the lower body.
What this means in practical terms is that weak glutes can impair healthy shoulder function. If you sit on your backside all day and do nothing to ensure your glutes have functional strength, you may experience shoulder issues. You can treat your shoulders till the cows come home, but if you have what I respectfully call a pancake butt, you will not permanently restore healthy shoulder function. To do that, you must first restore healthy hip function.
This means squats and lunges can be your friends when it comes to achieving healthy shoulder function. Of course, you may need guidance if these motions elicit pain. There are ways to switch that pain off (depending on your medical issues) with these motions, but you need to know the right things to do. This is where expert guidance is required.
Impaired hip mobility, not just loss of strength, can also impact shoulder function, as rotation in your hips is required when you walk if your trunk is to rotate authentically and allow your shoulder girdle to move in healthy alignment. Everything is connected to everything else, which brings me to the third reason for shoulder issues.
Impaired Ankle Function
You may be saying, “What on earth does my ankle have to do with my shoulder?”
I once worked with a highly trained 22-year-old college football quarterback who came to me with a diagnosis of shoulder and elbow tendonitis. I never touched his shoulder or elbow. His problem was unstable ankles. We worked to restore stability in his ankles, and his shoulder and elbow pain resolved in just four sessions. Everything is connected to everything else.
You see, once motion is initiated, your muscles work to control that motion. Controlling motion requires exquisite timing to occur throughout your body. This is how ankles, hips, and so forth, impact whole-body motion, including shoulder function.
If your ankle has impaired mobility or stability, your foot will not be able to transition from flexible to rigid as needed, and will create a whole chain reaction up the leg and, ultimately, to the shoulder. That young quarterback had shoulder pain during his long training sessions throwing the football because of unstable ankles. When he went to release the football, his ankle didn’t provide the stability needed to control the release of the ball at the right time. His shoulder was being strained every time he released the ball because of ankle weakness and resultant instability. His shoulder was not the culprit, it was the victim.
I could have treated his shoulder with stretching, ultrasound, heat, ice, isolated exercises, and so on, without any resolution of his pain. He needed to be seen as a whole body that walked through the door, not just a shoulder. So do you. If you have shoulder issues, your whole body needs to be assessed to best determine the source of the problem.
Is it your shoulder, hips, ankles, or the portion of your spine that runs from the bottom of your neck to the bottom of your rib cage (your thoracic spine)?
If you have a history of ankle sprains or hip issues, this may be why your shoulder has pain. If you have a history of not bearing weight on a leg due to injury or surgery—and this affected the function of that ankle or hip—this may be why you have shoulder pain. If you can’t turn well (poor thoracic spine function) to see to back up your car, this may be why you have shoulder pain.
The kicker is you may not have any symptoms in your hip, ankle, or rib cage. The victim (your shoulder) gets no justice because the culprit(s) are quiet.
Now that you know your shoulder is dependent on the authentic function of your ankles, hips, and thoracic spine, you know it’s pivotal to assess, train, and restore any existing deficits in these areas. If there hasn’t been a direct injury to your shoulder and yet pain occurs, please remember, your shoulder just may be the victim.
I have created a video that teaches how to self-assess 3-plane whole body function (HaveLifeLongWellBeing.com/self-assess/) and locate potential problem areas leading to shoulder (or back or knee or neck) pain. Doesn’t it make sense to address the reason the pain is there instead of just addressing the pain itself?
Eileen Kopsaftis is the founder of HaveLifeLongWellBeing.com. An eclectically trained physical therapist, nutrition educator, and best-selling author of the book, “Pain Culprits!,” her passion is to empower people with accurate knowledge and effective training to move without pain and age well into their 90s and beyond.