How you can reach overhead pain free!
If you’re getting pain In an area of your body like your shoulder or back when you’re reaching your arms above your head, chances are one of a few things is happening so let’s break down how you can reach overhead pain free.
- You’ve had a previous shoulder or back injury that you’re recovering from or haven’t done anything about it.
- You are tilting your ribcage upwards – in other words if you run your hands over the front of your stomach, you can feel the bony prominence of your ribcage poking through under your chest.
- You are pinching your shoulder blades back.
- You are cheating and creating movement through other areas such as your lower back.
A lot of things can go into the simple task of lifting your arm above your head. Some of us are lucky and never need to think about it, others not so much.
This task may be something you avoid, you might dread reaching for an object in the higher cupboards, hanging the clothes out or engaging in tasks like throwing and swimming to name a few.
Let’s break down the normal mechanics and what’s involved in healthy shoulder movement.
Starting with the bone anatomy we have a few bones that make up the shoulder joint.
- Humerus – this is the bone of your upper arm
- Scapular – this is your shoulder blade where there are multiple attachment points
- Clavicle – this is your collar bone
- Ribcage – This is where the scapular sits on and glides around (not technically considered part of the shoulder but none the less important for motion).
- Sternum – the middle part of your chest where your ribcage attaches too.
These bones form together via ligaments which make up joints such as your
- Glenohumeral joint (between the scapular and humerus)
- Scapulothoracic joint (scapular and ribcage)
- Acromioclavicular joint (a bone on your scapular and clavicle)
- Sternoclavicular joint (sternum and clavicle)
Now we have a basic understand of some of the key bone structures and joints, let’s delve into the muscles.
First let’s split the body into front and back.
The front we call anterior, the back we call posterior.
On the anterior compartment of the body, we have several key muscles:
- Pec major and minor (chest muscles)
- Serratus anterior (ribcage)
- Deltoids (shoulder)
- Rotator Cuff (subscapularis)
- Biceps Brachii (humerus)
- Traps and scalenes
On the posterior compartment of the body, we have more muscles:
- Latissimus Dorsi (big back muscles)
- Serratus Posterior
- Rotator Cuff (supraspinatus, teres minor and infraspinatus
- Traps (upper and Lower)
- Triceps Brachii
- Levator Scapulae
That’s a lot of muscles and areas to consider isn’t it!
Now there are even more muscles and areas to consider but I don’t want to bog this down too much.
What do we do with this information?
First appreciate that the shoulder can move quite a lot, in fact it’s considered the most moveable joint in our body being able to lift up and down, side to side and even big circle motions.
To be able to accomplish all these tasks areas such as the ribcage, shoulder blade and humerus must work in unison moving independent at varying degrees.
What happens when this doesn’t happen? We get a shoulder that doesn’t move well.
Why this happens can be a host of reasons:
- Injury & Compensation
- Lifestyle / Work
- Use it or lose it – lack of movement often means we get stiff
- Bias from playing sports
How can fix and restore normal shoulder movement?
This can be a complex question and ultimately does depend on the individual, getting assessed by a quality practitioner will always be my first answer.
What are some great ways to improve your movement?
Restore what is lacking!
If your arm can lift up (external rotation) but you struggle to drop it back down as shown in the image. Then chances are you are quite rounder through your ribcage or you are already in internal rotation.
How can you tell? Go look in a mirror and take 2 photos – 1 side on to a mirror and 1 in front.
What you will see if you have this disposition is that
From the side:
- You will have ab tension, and around where a bra strap would be will likely be rounded more.
From the front:
- Your arms will be rotated in or internally. This might mean the tips of your thumbs are facing each other when having your arms relaxed by your side or their facing your body more than they should.
If you can’t lift your arm up (external rotation) but you can drop it down (internal rotation), again adopt the same approach and take some photos.
What you might see will vary this time:
From the side:
- You may see the ribcage elevated or popped up at the front
- Shoulder blades will likely be squeezed together
From the front:
- The tips of the thumbs will be more forward, the sternum will be lifted up
- Think of a proud chest
Each of these positions are extremely common. Both can get away with lifting their shoulder above head, they will just likely compensate in the process.
Person number 1 with the rounder back caused through excessive ab tension.
This person needs to extend slightly, let their abs relax instead of being contracted all the time. Use your head to look upwards.
Try rotating your palms or thumbs outwards more to give you shoulder external rotation. This person will also benefit from practising breathing in and expanding their ribcage.
Person number 2 with the straight or extended back will likely have more lower back tension.
This person should focus on the exhale – breathing out, as well as aiming to place more weight on their heels (will likely need this walking as well) as this will enable them to move their hips backwards, and re-centre their gravity.
For healthy movement we must be able to move in and out of these positions. Static postures don’t really give us much of an indication, rather the ability to move dynamically.
That is, can you access both internal and external rotation of your shoulder? Can you flex and straighten your spine?
If you are stuck in one of these predispositions then you may struggle to get into the other.
For these people that is the key, restore what is lacking.
Set yourself up in a favourable environment and you’ll reduce the likelihood that you need to cheat with tasks like lifting your arm up over head. Initially you may lay on your back and elevate your legs, this will give you a neutral playground for your body to work.
Eventually you want to progress into more complex movements while keeping the compensations down, then before you know it, you’ll be able to reassess the movement you are after e.g. lifting your arm above your head.
My top three exercises to accomplish better shoulder motion are: