Stop and rethink how you handle shoulder pain. When the shoulder hurts or its mobility is limited, many people instinctively yank or force it. This isn’t usually the best approach. In this post by Andrew Millett, a Boston-area physical therapist, you’ll find better and more effective options.
The shoulder is a highly mobile joint, especially the glenohumeral joint. It needs to move in many directions: flexion, extension, abduction, adduction, horizontal movements, and internal and external rotation across several planes. Even though the shoulder is very movable, many people have limits in at least one area of its motion.
Bony limitations
People who participate in overhead sports, like baseball or softball, often show changes in the glenoid and humeral head. In throwers, internal rotation can be reduced and external rotation can increase on the throwing shoulder compared to the non-throwing side. This is usually due to humeral retroversion from years of overhead activity. This change is common in overhead athletes. If the total motion (external plus internal rotation) is within about 5 degrees of the non-involved shoulder, it’s considered normal. In other words, a loss of internal rotation on the throwing shoulder can be an adaptive, normal change and may not need fixing.
Acromion type is another bony factor. The acromion is a part of the shoulder blade, and it comes in three basic shapes. Type I looks relatively normal; Types II and III have a curved or hooked shape. This can cause pain or limited motion when reaching overhead. Definitively identifying a Type II or III acromion requires imaging. If someone’s overhead mobility is limited due to a Type II or III acromion, therapy may need to adjust to more horizontal pulling or pushing rather than overhead work. Most people with a Type II acromion can improve their range of motion with therapy, while Type III often requires surgical intervention.
Capsular limitations
Most joints have a capsule that surrounds them, like a plastic bag around the joint. Over time, injuries or surgeries can make this capsule tight or stiff. Older individuals or those with long-standing injuries may have decreased range of motion because of the capsule. The thoracic spine also plays a role: limited thoracic extension or rotation can restrict shoulder flexion and external rotation. A simple test for thoracic mobility is quadruped passive thoracic rotation; normally, it should be about 50 degrees. Less than that can significantly limit shoulder motion.
Soft tissue restrictions
This is the most common reason for limited shoulder mobility. Most people have some increased muscle tone in areas around the shoulder, unless they are hypermobile. Several muscles can limit different shoulder motions:
– To flex the shoulder: pectoralis major and minor, teres major, latissimus dorsi, and subscapularis.
– To abduct the shoulder: pecs, teres major, latissimus dorsi, and subscapularis.
– To externally rotate: pectoralis minor, teres major, latissimus dorsi, and subscapularis.
– To internally rotate: infraspinatus and teres minor.
The latissimus dorsi is a big limiter for overhead movement because it attaches to the trunk and crosses into abduction and flexion, and it can limit external rotation because it also acts as an internal rotator. Pectoralis minor can limit overhead motion because it attaches to the coracoid process and the ribs, and tight tissue here can tilt the shoulder blade forward, restricting humeral motion on the socket. Subscapularis and teres major attach to the front of the shoulder blade and humerus and can limit overhead motion as well. Often several muscles contribute. Rather than forcing big stretches against a stiff joint, it’s better to assess what’s tight and address those specific areas.
Assessment
Active motion
To check active ranges of motion, have the person move through:
– Shoulder flexion
– Shoulder abduction
– Shoulder internal (medial) rotation
– Shoulder external (lateral) rotation
Normal ranges for a general population:
– Flexion: about 180 degrees, with the upper arm in line with the ear
– Abduction: about 180 degrees, with the arm alongside the body
Passive motion
Next, test those motions passively. Do not force through tightness or pain. If you cannot move the arm passively to the targets above, there is a true mobility limitation.
Addressing the issue
If there are limitations in passive flexion, abduction, internal rotation, or external rotation, using some self-myofascial release (SMR) can help. After SMR, re-test the passive motion. If mobility improves, you’ve addressed the right areas. If there’s no improvement, refer to a manual therapist (physical therapist, sports chiropractor, massage therapist, etc.). If motion improves, use appropriate mobility drills to reinforce the new range.
Mobility drills
Horizontal adduction and posterior rotator cuff stretch:
– Keep the shoulder blades retracted by pressing against a wall or door frame.
– With the scapula fixed, gently move the arm across the body.
– Hold for 5–8 seconds before training or about 30 seconds after training.
Latissimus dorsi stretch:
– Fix the scapula to the rib cage with the opposite hand.
– Hold onto a stable object and sit back to feel a gentle stretch along the latissimus dorsi.
Motor control
After mobility improves, it’s important to retrain the brain and body to access the new range and prevent compensations.
For shoulder re-patterning, use movements that promote proper patterns, such as:
– Forearm wall slides
– Back-to-wall shoulder flexion
– Quadruped assisted reach, roll, and lift
Then, bring the pieces together with integrated movements:
– Turkish get-up
– Kettlebell bottoms-up baby get-up
In short, address the real limitations first, then retrain movement patterns to build solid control and get back to training effectively.
