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

In the common complaints series: "I have pain at the front of my shoulder." Do you or your client suffer from pain at the front of the shoulder, in your biceps and/or "inside" your shoulder? Does it sometimes feel dull, nagging or even sharply painful? In short: do you recognize the person below?

Then it may be that you have developed complaints due to an impingement. And you are not the only one. The chance is high that if you have focused on big pushing and pulling movements, you will sooner or later develop these complaints. Honestly, I know few people who spend a lot of time in the gym and do not develop this complaint somewhere in their career. So if you are an athlete, it is time to understand this complaint better so that you can work on it. As a trainer you are going to encounter this 100%, so use this article to absorb that knowledge. In this article I am going to make clear to you what an "anterior humeral glide" is, why it can cause complaints, which exercises you can specifically use and how you modify bigger exercises to prevent complaints. And yes, with the goal of regaining "full function" again. In other words, so that we can bench press again (I had to make that one). In this article I 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 complaints. After that I tell you about preventing this problem. Watch out! For this article I discuss my most common complaints and their solutions; complaints that arise from that positioning of your humerus. However, there are more options, so in addition to using the information in this article it is always wise to consult an expert. The relationships around your shoulder between your scapula, humerus, thoracic spine and the surrounding musculature can be very complex. However, in practice I have seen that many complaints come down to largely the same patterns, and you can achieve results there with specific training, which is why it seemed very valuable to me to share this with you. If you have specific questions, then email wouter@miloeduction.com

What is the shoulder's construction kit?

You were given various components when you were born. You received a humerus (upper arm) with a head at the end. That head fits into a socket, although it has quite a bit of room there and that is sometimes tricky. That "socket" consists of the acromion, your clavicle and your scapula. I say socket because you may interpret it quite loosely (see photo 1). As you can see, your caput humeri (head of the humerus) makes contact with the glenoid socket of your shoulder blade over only a small surface. Your humerus can therefore move freely between those various elements, although it is held in the correct position by the ligaments, tendons and muscles that attach around that area (see photo 3). Perhaps the most important are your capsule and your labrum. Your capsule forms around the head of your shoulder and the socket and holds these together (see photo 2). Your labrum sits between your head and socket for a good rolling/gliding movement. All in all this forms a joint with an enormous number of movement possibilities. The glenohumeral joint is not for nothing the most mobile joint of your body. But you know what they say: "with great opportunity comes great responsibility" (my spider senses start tingling). Photo 1: Overview of the shoulder joint without capsule. Photo 2: Overview of the shoulder joint with muscles, joints and capsule. Photo 3: (Anterior) the muscles and tendons around the shoulder joint seen 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 your thoracic spine. In this video I want to show what happens when you move your arm and what the relationship is between those three players. Once all of that is clear, the step to a pain complaint or a movement deficit is easily made. It should now be clear that whatever exercise you do, if you do not let your shoulder blade join in the dance that your humerus, scapula and thoracic spine perform, you are asking for problems. Then you create an anterior humeral glide, with pain in your shoulder as a result. See photo 4. This is the end position of a horizontal pulling movement, the bottom position of a bench press, and if you pull the forearm more towards the shoulder then it is the top position of a chin up. And with this example you also immediately see the two most extreme variations when it comes to the position of the shoulder during those big exercises. Photo 4: In the left-hand photo you see an "anterior humeral glide," in other words the head of your upper arm falling forward because your shoulder blade blocks it at the back. That brings us to the next term that is important for understanding this topic: the subacromial space. The space just under your acromion provides room for the passage of nerves and tendons and houses a bursa. That space is already quite tight, as you saw in the section on anatomy. If you fix the shoulder blade and initiate that forward gliding movement of your upper arm, you create an enormous amount of pressure in that small space and tadaa: impingement. See this explained in an image below: Source 6: Here you see how much pressure you can therefore create on these tissues when you create a lever in this way.

What can you do about it?

This answer is both simple and complex, so some context is in order. You have two different diagnoses: the medical diagnosis and the diagnosis of a movement deficit. I will write an article later about the difference, but as a trainer you cannot make a medical diagnosis and I therefore always recommend working together with an expert. Results from a medical diagnosis can point to tissue damage. If, after a movement analysis, you have doubts, then refer the person on. You can, however, state that if someone does not have the ability to bring their shoulder blade into position, and thereby give the humerus the room to come into an ideal position, they are going to get problems while loading that shoulder in exercises such as the Bench Press. That is also immediately the goal of this article, because you can stay one step ahead of wear and tear and pain in your shoulder. Someone can be in various stages of increased risk through their movement profile, all the way up to actual damage to tissue that requires specific treatment. By working on your mobility plus coordination (control over "large" ranges of motion) you can prevent or remedy many of the problems. In simple terms: if you no longer irritate the tissues in that small space under your acromion, it can shed the inflammation and recover. I do think it is important to mention that your body can perform this movement just fine and that I do not want to propagate that you must absolutely not do this. However, you want control and an ideal position under load to prevent injuries and pain in your shoulder and simply to be able to produce more force. My point is that this story does not only take place during a rehabilitation process, but also before it. A better position gives more active stability and therefore more transfer of force and less chance of injuries. And yes, then you also bench press more. I have not forgotten you.

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

Step 1:

We start with lowering the tone on the pectoralis (especially minor) and latissimus dorsi. These two large muscles often take over the stabilizing role from the smaller muscles: the serratus anterior, lower 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 cause the anterior humeral glide. In short, we want their help but not at the expense of the rest. We are going to achieve this by removing tension and then activating the rest. Then thoracic extension is important to give the shoulder blade room while initiating a posterior tilt and medial rotation. I like to train extension with rotation, for which I have added a video. Releasing the pectoralis minor Latissimus dorsi Thoracic rotations Use this series of exercises to mobilize the entire shoulder girdle and activate your mid back (middle and lower fibers of the trapezius):

Step 2:

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

Videos

Trap 3 raises Serratus wall slides Landmine press

Step 3:

Ensure an active role of the shoulder blade 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 big compound exercises.

Vertical pulling movements

Tripod row with the focus on coaching the shoulder blade Modified KB seal row Build a strong upper back with the face pull (note: first create room) Or try this variant from Yoeri ‌ Horizontal pulling movements: Ring chin up with full ROM in the shoulders

Presses

Push up with the focus on protraction and retraction of the shoulder blade Single arm DB bench press Bench Press: how do you ensure a strong position of your upper back.

Conclusion

I deliberately started this article with the 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 ability to come into a better position and then produce force there (in other words mobility) so as to prevent pain in your shoulder. It is not rocket science, but it does require a sharp eye for detail and the will to actually control and improve the movement. I love to always use unilateral exercises in my programming to keep training that large range of motion. That balance in your programming is important. This way you train the function needed to keep your shoulders healthy and strong and to say goodbye to that pain in your shoulder. Use the exercises I give you in the order described.