For: upper shoulder pain, trapezius pain, scapular pain, upper back pain, bicep tendonitis
Not for: frozen shoulder, rotator cuff tendonitis, labrum tear or any type of sharp pain form the neck, upper back or shoulder.
This protocol is not for acute injuries or those listed above. It is for chronic, low to medium grade pain in the upper shoulder to mid back including the scapular (shoulder blade). If you are not sure, just PM me and we can have a quick chat about it.
I call it shoulder pain as most of my patients refer to it as that. To me upper back, shoulder blade or trap pain would be more accurate but hey it’s not up to me! So this 6 week shoulder (really upper back/shoulder blade/trap) protocol is about correcting the muscular imbalances that lead to overuse in certain muscles and hypermobility and pain in certain joints. Remember it’s not a fix all. If you’re not sure, please ask.
Most of my clients have sedentary jobs. And with sitting a lot of the time, comes poor upper back posture.
A rounded upper back, forwardly rotated shoulders and a forward head carriage, which leads to inevitable changes in use, length and strength of certain muscles.
Upper traps, scalenes, SCM and levator scap become hypertonic (short and tight). So do the pecs and anterior delts.
Middle and lower traps become weak
With these muscular changes, the scapular round out laterally exposing the joints between the ribs and spine. As this happens they slowly become hypermobile and sore.
Rotator cuff muscles (the little muscles that sit on top and behind the scapular) shorten and limit shoulder ROM.
With all of these changes, pain can be generated from a variety of structures, the most common being the upper traps and the upper costovertebral joints (creating pain along the inside edge of the shoulder blade). And in most cases, consistent pain comes along after these imbalances have been in place for a while, so getting rid of pain now isn’t going to occur after one massage or one gym session (If anything this will lead to an aggravation of symptoms).
So what do you do?
Simple! Follow the protocol below for the next 6 weeks and you’re sorted. Or if you don’t, risk suffering a more acute injury to your shoulder joint (ie: develop rotator cuff tendonitis or strain a joint in your neck or upper back). It took time to make a mess of your upper back/neck biomechanics by slouching at your desk and not enough regular exercise, so accept it will take time to turn it around.
Gently reintroducing extension into the upper back and neck.
1. lying flat on the floor with a rolled up towel under your neck for 15 minutes, twice a day.
2. Pec stretch.
Best to do in the shower so the muscles are warm and can take the stretch easy. Hold each one for 45 seconds 2/3 times per side, once daily.
Keep the exercises from above going and add,
3. Scalene and trap stretch– again best to do in the shower. Same reps and time for the pec stretch above.
4. Posture maintenance.
Start being aware of your posture at work, on the bus, during exercise etc. Start to practice correct posture as a form of exercise daily. The best way to do this is to and from work. If you catch public transport, drive or walk, make it your goal to maintain correct upper back posture during this time. Lift your chest and roll your shoulder blades down your back, keep your head tall. Keep it this way during the journey. It will be uncomfortable to begin with (because you never do it) but slowly your muscles will adapt and it will feel more natural.
Once we have completed 2 weeks of rebalancing, you should be feeling a little less pain and probably feel it more intermittently rather than constantly. Now we have a better foundation to get some work done.
5. Modified push up.
The purpose here is to retrain correct upper back muscle firing as well as developing the scapular stabilizers. The push up is going to start off against the kitchen bench or dining room table so its not too hard and we can focus on the movement being correct. IT IS NOT A FULL PUSH UP. It is a short movement from the bottom position, up 15cms and then back down. Almost like a little pulse movement. We focus on the chest being lifted up, head tall and the shoulders away from the ears. In that position we pulse in the bottom third of the push up. We are going to try and complete 3 sets of 10 reps and look to complete this every second day.
6. Get a massage ball or a tennis ball and massage out the rotator cuff muscles.
Basically we lie on our back and pop the ball under the shoulder blade. You should notice as you create pressure against the ball and roll around you’ll find a couple of spots that are quite tender. Any tender spots just maintain pressure on these for 10-15 seconds and then move to the next tender spot. Over the next two weeks as it loosens up, the tender spots will become harder and harder to find (as the muscles are loosening up). Aim to massage each side for 4-5mins each day.
Keep going as above. Nothing new to start this week.
Yoga shoulder movement
Great exercise to maintain the scapular stable whilst stimulating increased ROM of the shoulder joint. Again focus on your posture; chest lifted, neck tall, tummy tight. Take a wide enough grip that you can get the towel over without compensating. 2 x 20 reps. Best to do after the shower (as you have the towel handy)
Continue with all the exercises.
Somewhere from week 4 – 6 you should see your symptoms dissipate quite a lot. Depending on the particular structure that is causing the pain and the duration that you had your symptoms for, you may still have a low grade level of discomfort remain. If this is the case it is best to have it professionally assessed. After completing the 6 week protocol, you should find your response to treatment from a chiropractor or physiotherapist to be a lot faster.
Let me know how you go guys!!
Dr Riaz Behi