There is a famous quote by Benjamin Franklin that states "an ounce of prevention is worth a pound of cure".
In my line of work as a corrective exercise and posture specialist, I take these words very seriously. Everyday I work with athletes and individuals who are experiencing chronic muscle and joint pain due to a lifetime of muscle imbalances, poor posture and faulty movement patterning. For many, a lot of their pain and posture problems could have easily been avoided by implementing some preventative measures.
The human body is a stimulus-response mechanism. It responds and adapts to the demands you place on it day in and day out. Much like a car that requires good alignment to drive straight and reduce wear and tear, you can think of your posture and joint mechanics in the same way. The easiest way to keep everything in your body moving freely without common muscle and joint pain is through correct MOVEMENT! As Dr. Kelly Starrett [mobilityWOD] likes to say "Every human being should be able to perform basic maintenance on themselves." And I agree.
Over the past three years I've had the privilege of teaching a Mobility and Corrective Exercise class here in Apple Valley, MN. My goal is simple. To introduce simple corrective exercises and self-myofascial release techniques that local CrossFit athletes (and the general public) can do to on their own at home to do basic maintenance on their bodies.
So let's talk about shoulder pain. Here was the big idea. There's a bunch of stuff going on in and around the shoulder joint (I know, very technical!) that needs to be considered before you try to treat the symptom.
But, before you begin to mobilize a joint (in this case the shoulder) that is causing you pain, restriction and/or is susceptible to repetitive injury, have you ever taken a step back and evaluated the situation. You are after all, more than just a shoulder! The body works as an integrated unit.
Your shoulder (and thoracic spine) are not separate of your entire body. If you're trying to address problems in your shoulder without addressing the entire musculoskeletal system, at best you are mitigating or chasing your symptoms.
If you are a CrossFit athlete, weekend fitness warrior, active older adult or any age or ability in between, and having constant pain or problems in a particular area AND your traditional means of trying to get it to heal are not working STOP!
The definition of insanity is
doing the same thing over and over and expecting different results!
Ice, massage, chiropractic, kinesiotape, flossing, foam rolling, banded distractions, myofascial release are all helpful ... BUT in my professional opinion, they are not the first step if you want a lasting result.
In The 4-Hour Body, author Tim Ferriss evaluated many different modalities for dealing with injuries. In the chapter on reversing "permanent" injuries ,he writes:
"looking at the ultimate results (what worked and what didn't) I could have saved myself a lot of expense by following a four-stage approach. Only when options in the first stage fail do you proceed to stage two, and so forth, up to the final stage and last resort: surgical repair." - The 4-Hour Body, p. 298
Note the order of what Ferris recommends on how to take care of yourself if you have chronic pain/injury.
That completely runs in line with what I coach and teach.
So let me ask you this?
Are you are doing things out of order?
If you are struggling to overcome chronic shoulder pain, repetitive injury or stress to the shoulder and thoracic cage, start thinking about the WHOLE body, versus the symptom.
Correcting your posture, alignment and muscle balance will have a far better overall change.
The Shoulder Girdle and Thoracic Spine are where mobility and stability work together as one. But their ability to perform and function correctly have more to do with what is occurring underneath them, than simply through them.
In my experience, I believe there are the four common posture related problems associated with an imbalanced Shoulder Girdle and Thoracic Spine. They are:
If you have any one of these four postural mis-alignments (typically all four tend to run hand-in-hand), you are susceptible to shoulder pain and injury.
This is further compounded if you sit at a desk 8+ hours per day. I promise you that no matter how hard you stretch, foam roll or manipulate your body, if you don't correct your posture first, you are simply working out and loading up a shoulder that is functionally unable to perform according to it's design. It is only a matter of time for chronic pain and/or an injury to occur. Now take that body into your favorite exercise of choice. Hmmmm, does anyone else see a potential problem?
Please do not mistake what I am saying. Manipulations (found in the second step) are fantastic. Not only am I a big fan, but I practice these things on myself AND teach them to my clients, but we do it in the correct order.
If you engage in manipulations without placing the joint and rest of the body in the correct position and movement patterns, you are still in a dysfunctional position. The effects of those manipulations will mitigate symptoms but not totally correct the position of the joint.
The first step is to ALWAYS address your posture, or better said, your joint position. It's not as simple as just standing up straight (although that does help). Your feet, ankles, knees, hips, pelvis, spine, shoulders, shoulder blades, neck and head have a neutral position under a static stance. This is where hiring a coach who specializes in corrective exercise and biomechanics can help. After testing out many different modalities, Tim Ferriss lists:
as the modalities that he found with research to have the most immediate and lasting effects, with barefoot walking and posture alignment (corrective exercise) being the two most helpful. (I'm thrilled to say that here at Pain Free Posture MN, we offer over half of these modalities to our clients each day).
In the Manipulations category Ferriss lists massage, acupuncture and acupressure, active-release techniques, advanced muscle integration therapy and gausha (traditional Chinese Medicine)/Graston in this category. Personally I would add self myofascial release techniques, foam rolling, working on lacrosse, tennis and golf balls, banded distractions, and voodoo flossing into this category.
In my opinion, if you've had a lot of pain/injury to a particular site, the progressions should start with self-myofascial release, soft foam roller, then move into golf ball, tennis ball, lacrosse ball, banded distraction and flossing. I highly encourage you contact a corrective exercise specialist who can watch you get into the positions and cue you to get the position correct to get max benefit out of the mobility.
So what's the take away? Shoulder Pain Relief STARTS with Fixing Your Posture. Find and hire a corrective exercise specialist who can show you how to restore your posture and address your position. Then add on the manipulations in conjunction, and work your way back into the activities you love to do.
You'll have to re-learn some movements (since in the past you trained and gained strength in a compromised postural position) with your newly stabilized body, but in the long run you'll have less pain and injury.
If that's not an option for you, start taking Foundation Training or STOTT Pilates classes or find someone who teaches yoga from a postural alignment perspective. At a minimum, you will being to address your posture and mobilize/strengthen from a better position.
Questions? Please reach out. Remember, we're in this together, and I am here to help!
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Head Photo Credit: Melissa Thome Photography
Author: Deb Preachuk is a Certified Foundation Training & STOTT Pilates Instructor, Corrective Exercise & Posture Alignment Specialist, and the founder/owner of Pain Free Posture MN.
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