Blade Runner 2019: Five Things You Really Need To Know About Your Shoulder

What Is the Shoulder & Come to think of it, Where is it?

The shoulder is, in some ways a rather vague term.  What we have is an upper arm bone and a shoulder blade.  Also in the mix, but not actually the shoulder is the collar bone and the rib cage. Without them there would be no shoulder.

I bet you are thinking, “Where is shoulder?  Everyone knows that…!”   We do and we don’t.   The natural position of the arms is by the side of the body but if you are round shouldered or tight across the chest (which is a lot of us) then the normal position is shifted forwards relative to the rib cage.    The shoulder blades are surprisingly wide on the back.    This makes complete sense, give that each one attaches to an arm, but we still tend to think of them as being closer to the spine.      We all agree that the shoulder blade is at the back of the body.  This is a problem for our awareness – it is out of sight and out of mind.

What Does It Do, and How?

Most of what the shoulder does is about movements of the arms.  We can achieve an astonishing complexity of three dimensional movements without giving it a thought.

We have some awareness of the arms moving but don’t really appreciate that the shoulder blade is governing all of this.     The ultimate back seat driver!   The arm doesn’t move in isolation, the shoulder blade and the arm move together.

It is important for the trunk, (and the spine and  internal organs)  that there is enough mobility in the shoulder for it to move independently of the rib cage.   When the shoulder gets tight it cannot move without dragging the ribs and spine along as well,  causing the spine to overwork.    A lack of mobility also reduces the capability of the shoulder – when the shoulder are stiff, it is harder to to buttons up at the back of clothing for example.  It is far more tiring to sustain the arms high above the head.

Sometimes we get greater range  and reach by moving the rib cage as well.  Think of fast bowling in cricket: you reach/rotate back with the ribcage to take the arm further back and then use the power of the back muscles for greater speed.

Another source of the tremendous range of movement of the arm is the very shallow nature of the shoulder blade to upper arm bone joint.  It’s full name is the Acromio claviculuar (or AC) joint.       This shallowness brings with it the possibility of joint dislocation or partial dislocation, known as Subluxation.    There is a group of muscles whose primary function is to prevent dislocation of the joint.  Collectively they are known as the Rotator Cuff of the shoulder.    Think of them as surrounding the joint like a short sleeve of a T shirt.

Blade Running

We feel the shoulder blades most easily when we move them on their own.   Think about squeezing them together at the back – retraction, or the opposite: Protraction. “Give yourself a hug” and reach the shoulder blades wide and therefore the arms across the body at the front.

I think we all understand shoulder blade elevation or shrugging, but the opposite is depression,reaching the shoulder blades downwards towards the pelvis

The shoulder blades also rotate on both axes.  To imagine long axis rotation, think of holding a drinking glass in your hand and twist it around in between your fingers.   To imagine short axis rotation, think of a banana on its side rocking stalk to tip

Which Muscles are Associated with the Shoulder?

Loads of muscles attach to the shoulder blade and the arms, or the shoulder blade and the ribs, or the shoulder blade and the skull.   They do absolutely oodles of different things.    Here are a few of those things.   This is written in in very simple terms, but if it wasn’t then we’d simply have a long, rather meaningless list of muscles with funny names.

Shoulder Stability

Because the joint is so shallow, the muscles crossing it are essential to keep the shoulder stable.  The Rotator Cuff is a group of 4 muscles which surround the joint, maintaining its stability in a range of different positions. The muscles are a bit of a mouthful: Subscapularis, Infraspinatus, Supraspinatus, Teres Minor.  The following pictures show the more famous and big shoulder muscles at the front and back but also show the smaller stabilisers that live underneath the big muscles

Movements of the Arm

The Deltoid muscle moves the arm forwards , sideways and backwards, assisted by the Pectorals at the front and the Lats (Latissiumus Dorsi) at the back (and others).  These same muscles assist you in crossing the arm in front of you and crossing them behind you too.

If you imagine taking your arms out onto a capital T position and from there move them forwards and back, that is the work of part of your Rotator Cuff going forwards and the the Rear Deltoids, a different bit of the Rotator Cuff and (another one!) Teres Major going backwards.

Movements of the Shoulder Blade

To stabilise the head/neck relative to the shoulder blades you have the Upper fibres of Trazpezius and the Levator Scapulae.  These muscles will also shrug your shoulders.  For the opposing move in the shoulder blade: an un-shrug if you like, or Scapular Depression, you have Lower fibres of Trapezius.  You can squeeze your shoulder blades together using your Rhomboids and Middle fibres of the Trapezius.  The opposite movement to this is moving the Scapulae apart, performed by  Serratus Anterior – also known as your Boxers Muscle.

In many ways, it is these shoulder blade movements that we need to focus on more.  As I have said, our Shoulder blades are out of sight and out of mind , and neglected in terms of strength, and maintenance.     Even amongst people who do strength training there is a tendency to forget or neglect working the muscles at the back.

For those of us who don’t do Strength training, at the very least, we need to work on upper body alignment   Some people have shoulder blades that wing out – they need to work Serratus more.   For some of us the shoulder blades roll forwards.  They need to work the Rhomboids more.  Some of us have  chronically elevated shoulder blades and need to work Lower Traps and Latissimus dorsi more.

How Should We Best Care for your Shoulder?

Well it is the usual story really.  The best thing to do is to keep the shoulders moving through big ranges of movement which reflect the ability of the shoulder to move in 3 dimensions, that is up and down, across at the front and towards the back but also diagonally

We really need strength training too.   In classes like Pilates you can use body weight or add in Dynabands.    When starting out in the gym, the fixed machines are great place to start because they are partially assistive.  We all need more work for the back of the shoulders – anything that involves a rowing action for example.

The very hardest of all in terms of strength training is hanging or pull ups/chin ups.  In Yoga this re-appears in Inverted poses such as  shoulder stand or handstand  These are pretty niche but if you are really serious about shoulder strength, they are important because they work these vital muscles which keep the shoulder blade in the correct position at the back of the body and also contribute to our ability to stand and sit tall, as opposed to be curved forwards with gravity.  We don’t quite realise it but part of  the ability to stand tall comes not just from remembering to do it (which helps!) but having sufficient  strength in our back to keep us upright

We need to be mindful of our alignment.  Our shoulders work more efficiently if the spine maintains its natural shape.    Once the upper back gets over curved and somewhat fixed in that position, the shoulder blades can no longer sit  correctly on the rib cage (which also becomes more curved) and this has serious implications for arm  and shoulder blade movements.

Stretching is very helpful indeed.   All of our shoulders benefit from stretching and simply moving our arms in big circles in both directions will give lots of them a little bit of a stretch.    Given our lifestyles, one of the most important stretches is for the front of the chest to correct the tendency to round the shoulders.   The main muscle being stretched here are the Pectorals.  There are two: a Pectoralis Major and a Pectoralis Minor.  The Minor one is diminutive but is a disruptor when tight.   The Shoulder Blade elevators, which are Upper Trapezius and Levator Sapulae are often tight due to our lifestyle and also they are mood muscles – we tense here under stress.

Beware the Easy Fix!

This is the movement that people seem to think corrects their posture.  Particularly in sitting but also in standing people do the following to “correct” a slumped posture:     Hinge through their lower back to send the entire upper body slightly backwards and pin the shoulder blades back, supposedly to open the chest.   Please don’t do this!  To unslump, grow your spine carefully and gently so that it is elegantly and gently long.  Next, widen the collar bones and relax the shoulder blades

What might happen if we don’t take care?

For most of us it’s a gently progressive denuding of normal shoulder function.  We’ll gradually get more stiff, less mobile and less able to manage strength related upper body activities: lifting, pulling, pushing, carrying.

There are other things that will follow from poorly maintained shoulders though

• Aesthetics: round shoulders are not a good look and over time it will affect our breathing because the tight, curved forwards posture in the shoulders and ribs will prevent the expansion of the ribs.
• Running: without the natural swing of the arms by the sides in walking or bent arms by the side (NOT in front of of the body) whilst running, our gait is disturbed.  Not radically, but disrupted and less efficient
• Increased risk of injury: misaligned joints are more prone to injury.   Tightness and misalignment is more likely to lead to injury and inflammation to the bursae (fluid filled sacks within the shoulder joints)  tendons, ligaments
• Overwork of the back follows from tight shoulders when we cannot dissociate the shoulders from the ribs.  This will correspondingly lead to under-work in the abominals which are stretched and pulled to accommodate the work at the back.
• Nerve impingement can happen when tight muscles disturb the nerves  entering and exiting from the brachial plexus. This can cause pain and discomfort
• Loss of strength and insufficient shoulder work will increase the risk of Osteoporosis of the Shoulder
• Stiffness and tightness  can lead to niggling pain and discomfort, possibly headaches

Post Script

The last paragraph would be  slightly depressing note on which to end, so I’ll carry on for a bit and be more positive.

Basically I want to say that we are all a bit naughty and we don’t  respect our shoulders as much as we should.  They are marvellous, amazing, magnificent pieces of kit.   Despite our neglect they still keep on working for the most part.  They are like an untended lawn, carrying on despite the neglect – over grown with weeds but still hanging in there.

With a bit of care and support a lawn will spring back to life, and so will your shoulders.    Not everyone can leap to the floor and start doing press ups, or do fancy moves with a kettlebell.  Everyone can do arm circles, shoulder blade circles, and a bit of a chest stretch.  We can all try to sit tall, widen the collar bones and allow our arms to hang by our side and let the shoulder blades relax away from our ears.