Overhead Shoulder Dysfunction – Fix Your Spine Position First

Shoulder pain is the 3rd most common orthopedic complaint (behind the low back and knee) and it’s no wonder considering how so many of the sports, exercises, and skills we perform are ‘shoulder expensive’. Olympic lifts, volleyball, throwing sports, swimming all require a tremendous combination of mobility and stability at the shoulder joint itself as well as the scapulothoracic articulation (though it’s not a true joint, people, just the interaction between scapula and thorax). Classic interventions/corrective exercises target the rotator cuff  and potentially the periscapular muscles – though it is surprising (disappointing) how many physios will neglect even this. However, the purpose of this post is to draw attention to how screwed up your lumbar spine position is with overhead tasks and it’s impact on shoulder mechanics. Check it:

Here’s the deal: Before we can even attempt to fix your messed up shoulder we first have to look at the ability to globally control the midline. Last week’s post is a good start in looking at motor control and stability though it doesn’t account for the extreme demands on the torso seen in overhead positioning. Without accounting for the ribcage flying open due poor control of the spine, our best efforts to fix the shoulder are thwarted by the undue loads placed upon it due to lack of spine control. We can get the scapula under control, mobilize the thoracic spine, and optimize the rotator cuff, but once we go back to throwing, pressing, or spiking all is lost if midline control is compromised. Not to mention loading an overextended spine is dangerous for the facets (hello spondy) and nerve roots being crushed by the vertebrae above.

But most importantly, this robs force generation and power production. Minimal active tension prevents control at the end-ranges where we need it most. Want a stronger spike, faster pitch, better push-press? Proximal stability will buffer poor mechanics much better than a soft spinal position. Otherwise we’re just blowing through our much smaller engines at the shoulder and elbow and asking them to do what they aren’t built for.

Try it yourself: take your arm up overhead. If you can’t get your arm to your ear (with your elbow straight!) without flying open and exposing your rib cage, then there’s a problem. Why is it a problem? Well if your a thrower, opening up too soon alters the load to the shoulder and elbow – there’s a ton in the pitching mechanics world about the detriments of opening too soon and over-extending. It also changes the positional relationship between the arm and torso and can cause excess anterior translation of the humeral head (not good for your labrum and biceps tendon) making it more difficult to actively stabilize the shoulder – particularly in Olympic lifters and overhead pressers.

Key Point: The question then becomes, is the athlete flying open because their thoracic spine is stiff? Maybe but if they’re over-extended then they’re…. over-extended. Fix this first then we can address the t-spine. Otherwise the learned pathomechanical motor pattern remains, such that even if we do loosen up the thoracic spine the athlete will not likely utilize this new range during the task. As evidenced in the hip by Dr. Stuart McGill, a must read. We need to organize before and while we mobilize! The athlete can loosen up the thoracic spine as much as they want (and I do think that thoracic spine mobility is hugely important) but without the training to overcome the hundreds or thousands of reps they performed overextended, the carry-over will be minimal.

You will be shocked at how organizing your spine (squeezing your butt and bracing the abs) generates much more stability and power with overhead tasks. Try an active brace while holding something overhead, you literally feel the difference. One point I should make – this often feels weird for athletes who are used to being so over-extended. They feel as if they are pitched forward (another indication their sense of midline control is lost). Hollow rocking is a great way to initiate anterior core function while making the connection to overhead position prior to reloading the athlete overhead. Nothing in sport happens statically, so we need to progress to dynamic isolation quickly where possible.

Bottomline: organize your lumbar spine and pelvis first (noticing a theme here from previous posts?) then we can address the thoracic spine, scapula, and rotator cuff when dealing with overhead positioning. More to come….

-Seth

Here’s a quick vid on hollow rocks: