Pain in or around your shoulder? Where does it come from and what can you do about it.

Then it is possible that you have developed symptoms due to an impingement. And you are not alone. Chances are that if you have focused on big pushing and pulling movements, you will develop these complaints sooner or later. Honestly, I know few people who spend a lot of time at the gym who don't develop this complaint at some point in their career. So if you are an athlete, it is time to better understand this complaint so that you can work on it. As a trainer, you will encounter this 100%, so use this article to gain that knowledge.

In this article, I'm going to explain to you what an “anterior humeral glide” is, why it can cause complaints, which exercises you can use specifically and how to modify larger exercises to prevent complaints.

And yes, with the aim of regaining 'full function'. In other words; so that we can get back bench press (I had to make it).

In this article, I'll show you how the shoulder joint works and what its role is in relation to the musculature in that area. From there, it should be clear why the humerus (your upper arm) slides forward relatively easily and why that causes symptoms. Then I'll talk about how to prevent this problem.

Attention! For this article, I will discuss my most common complaints and their solutions; complaints that arise from the positioning of your humerus. However, there are more options, so in addition to using the information in this article, it is always wise to call in an expert.

The relationships around your shoulder between your scapula, humerus, thoracic spine and surrounding musculature can be very complex. However, in practice, I have seen that many complaints often amount to the same patterns and you can achieve results with specific training, which is why I thought it would be very valuable to share this with you.

If you have specific questions, please mail to wouter@miloeduction.com

What is the shoulder kit?

You were given various parts when you were born. You got a humerus (upper arm) with a head at the end. That cup fits in a bowl, although it has quite a bit of space there and that is sometimes difficult. This' bowl 'consists of the acromion, your clavicle and your scapula.

I say come because it's best to take it roomy (see photo 1). As you can see, your caput humeri (head of the humerus) has only a small contact with the joint socket of your shoulder blade. Your humerus can therefore move freely between these different elements, although it is held in the correct position by the ligaments, tendons and muscles that settle around that area (see photo 3).

Perhaps the most important is your hair style and labrum. Your hairstyle wraps around the head of your shoulder and the bowl and holds them together (see photo 2). Your labrum sits between your head and come in for a good roll/glide. All in all, a joint is forming with an awful lot of movement options. It is not without reason that the glenohumeral joint is the most mobile joint in your body. But you know what they say: 'with great opportunity comes great responsibility' (my spider senses start tingling..).

Photo 3: (Anterior) the muscles and tendons around the shoulder joint from the back. Pay particular attention to how many muscles, tendons and nerves run through the small space between the head of the humerus and the acromion.

The glenohumeral joint

A relationship between your humerus, scapula, and thoracic spine.

In this video, I want to show what happens when you move your arm and what the relationship between those three players is.

Once that is all clear, the step towards a pain complaint or an exercise deficit has been made easy. It should now be clear that whatever exercise you do, if you don't let your shoulder blade dance in the dance that your humerus, scapula, and thoracic spine make, you're asking for trouble. Then you create an anterior humeral glide, resulting in shoulder pain. See photo 4.

This is the end position of a horizontal pull, the bottom position of a bench press and if you pull the forearm more towards the shoulder, it is the top position of a chin up. And with this example, you can also see the two most extreme variations when it comes to the position of the shoulder during those major exercises.

That brings us to the next term that is important for understanding this topic: the subacromial space. The space just below your acromion offers space for the passage of nerves, tendons and a bursa. That space is already quite tight, as you saw in the anatomy section.

If you fix the shoulder blade and use that glide forward of your upper arm, you create enormous pressure in that small space and tadaa: impingement.

See this explained in an image below:

What can you do about it?

This answer is both simple and complex, so context is appropriate. You have two different diagnoses: the medical diagnosis and the diagnosis of a lack of movement. I'll write an article about the difference later, but as a trainer, you can't make a medical diagnosis and I therefore always recommend working with an expert. Results from a medical diagnosis may indicate tissue damage. If you are unsure after a movement analysis; please forward.

However, you can say that if someone does not have the ability to position their shoulder blade, thereby giving the humerus space to get into an ideal position, they will have problems loading that shoulder in exercises such as the Bench Press.

That is also the purpose of this article, because you can be one step ahead of damage (wear and tear) and shoulder pain. Someone can go through various stages, from increased risk, from their exercise profile to actual tissue damage that requires specific treatment. By working on your mobility + coordination (control over 'big' movement results), you can prevent or remedy many of the problems.
Simply put, if you stop irritating the tissues in that small space under your acromion, it can get rid of the inflammation and recover.

I do think it's important to mention that your body is good at making this movement and that I don't want to promote that you're definitely not allowed to do this. However, you want control and an ideal position under load to prevent injuries and pain in your shoulder and simply provide more power.

My point is that this story not only takes place during a rehabilitation process, but also before. A better position provides more active stability, so more transfer of power and less risk of injuries.

And yes, you'll also do more bench pressing. I haven't forgotten about you.

So how do you get rid of shoulder pain? A plan of action:

Step 1:

We start by lowering the tone on the pectoralis (especially minor) and latissimus dorsi. These two large muscles often take over the stabilizing role of the smaller muscles: the serratus anterior, low trapezius and your rotator cuff musculature. You want the pectoralis and latissimus dorsi to work. However, they pull your shoulder into protraction, adduction, and internal rotation, which together causes anterior humeral gliding.

In short, we want their help but not at the expense of the rest. We are going to achieve that by removing tension and then activating the rest. Then thoracic extension is important to give the shoulder blade space while using a posterior tilt and medial rotation. I like to train extensions with rotation, so I added a video for that.

Loosen Pectoralis minor

Latissimus dorsi

Thoracic rotations

Use this series of exercises to mobilize the entire shoulder girdle and activate your mid-back (middle and low trapezius fibers):

Step 2:

Focus on activating the muscles that help position your shoulder blade. Keep in mind that you want to make space in the small space. Film yourself and watch the position you take. The shoulder blade stays in contact with your rib cage at all times and you make the movements as pure as possible. Use the coaching from the videos to your advantage!

Videos

Trap 3 raises

Serratus wall slides

Landmine press

Step 3:

Make sure the shoulder blade plays an active role during your compound exercises. Now we have arrived at the translation. We are now going to translate the lessons from the first few isolation exercises into large compound exercises.

Vertical pulling movements

Tripod row with a focus on coaching the shoulder blade

Modified KB sealrow

Build a strong upper back with the facepull (make sure to make space first)

Or try this version of Yoeri

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Horizontal pulling movements:
Ring chin up with full ROM in the shoulders

Presses

Push up with focus on shoulder blade protraction and retraction

Single arm DB bench press

Bench Press; how to ensure a strong upper back position.

Conclusion

I deliberately started this article with anatomy to make my point that the shoulder as a joint has many options in cooperation with the humerus and your thoracic spine. By training the function in that area, you develop the opportunities to get into a better position and then provide strength (or mobility) there to prevent shoulder pain.

It is not rocket science, but it does require a keen eye for detail and the will to actually control and improve the movement. I like to always use unilateral exercises in my programming to keep training that large range of motion. That balance in your programming is important. As a result, you train the function that is necessary to keep your shoulders healthy and strong and say goodbye to that pain in your shoulder. Use the exercises that I give you in the order described.