Frozen Shoulder? Identify Dysfunction

Our clients work hard to develop shoulders that are aesthetically pleasing, and learning how to spot frozen shoulder and other dysfunction is an integral part of the big somatic “picture.” However, there is much more going on in this area than meets the eye. The shoulder complex involves more than one joint, and healthy, functional shoulders are more desirable than ones that merely look good on camera. How do you determine the best course of action for training? You must assess.

Accurate data are needed to determine the best corrective strategies. A trained, experienced corrective exercise specialist will also be able to pinpoint movement errors.

Common shoulder complex dysfunctions include the following:

Unwanted shrugging. This is fairly easy to spot. Underactive lower trapezius muscles let the upper trapezius and levator scapulae run away with the show and pull the shoulder blade up. This alters glenohumeral (GH) and cervical spine alignment, which can lead to headaches, a tight neck and inflamed bursa sacs.

Shoulder blades that don’t protract and retract. Think of the client on the seated row machine who is moving only from the GH and elbow joints. The loss of scapular action increases range of motion at the elbow and shoulder joints and, over time, may lead to tendonitis. This also closes off space in the anterior aspect of the shoulder, which may put more strain on the biceps tendons, bursa sacs and rotator cuff tendons.

See also: Yoga for Neck and Shoulder Pain.

Program Design

Note the following training tips and programming guidelines:

Be careful about using the cue “Put your shoulder blades in your back pockets.” While it may be useful during a prone cobra pose, that doesn’t mean the shoulder must always stay back and down. Elevation and upward rotation are critical actions during overhead activities.

Avoid barbell upright rows, full-range-of-motion dips or anything that makes the joints go past safe end ranges when shoulder impairment is suspected. Behind-the-neck barbell presses can also be dangerous, especially for a frozen shoulder. As the bar is lowered past the crown of the head, two things typically happen: The head goes forward, placing the cervical spine in extension and causing greater uneven force distribution through the cervical disks; and as the bar continues to go down, the load transfers from the active system to the passive system. In the close-packed position of abduction, external rotation and extension at the GH joint, there is nowhere else to create movement without also creating laxity in the ligaments and joint capsule. If an asymmetry is present, the risk for injury is even higher. The combination of a bilateral grip, barbells and asymmetries is not a healthy mix.

Be aware that lateral and anterior raises increase impingement risk and add stress to the cervico-thoracic region (Osar 2012). Fixed-range-of-motion machines can be dangerous in this scenario, but you can work around them for a safe and effective workout. Lower the seat toward the bottom of most fixed-machine shoulder presses to limit exposure to excessive end ranges of motion. Bottom line: Know the range of motion for joints and don’t go past their physiological end range.

See also: The Top 10 Corrective Exercises.

Important Takeaways 

Think globally; act locally. Look at the entire kinetic chain and then burrow down to the smaller details around the shoulder complex. Remember, pain is a messenger; don’t kill it! When the rotator cuff screams during every pull-up, don’t tell your client to just “choke it out” with a foam roller or tennis ball. Try to find out why it’s yelling. If you suspect more than a muscular imbalance or overuse, refer out to a qualified professional.

You need to free the thoracic spine before the scapulae. The scapulae float on the posterior thorax and are intimately interconnected with the thoracic spine. The scapulae will not move properly until the foundation of the thorax and thoracic spine are functioning optimally. Include some “up” exercises. More scapulae are stuck in downward rotation than not. Restore upward rotation before operating directly overhead.

Remember: Practice makes a pattern. Make sure your clients are practicing the right patterns, not the same old ones that got them into trouble, and don’t rush things. It generally takes time for shoulders to lose function; it will also take time to return your clients’ shoulders to their aesthetic and functional glory.