shoulder flexionHow can Physical Therapy help with overhead shoulder mobility?

Lack of overhead shoulder mobility is a very common condition and something I have dealt with myself. The problem is that the shoulder is THE most mobile joint of the body. Although it is considered a ball and socket joint, the humeral head is much larger than the glenoid which makes it more like a golf ball sitting on a tee. This allows the shoulder to be so mobile. With that being said, the shoulder sacrifices a lot of stability due to its mobility. The shoulder also has poor static stability (the ability to maintain a constant position under load), it needs dynamic stability as it moves, and often times our postural adaptations cause imbalances throughout the shoulders. The old adage is true, if you don’t use it you lose it. The problem is when you want to use it, it is not there.

Take for example a person that works at a desk all day and decides they want to try a new form of training. Let’s say this particular form of training requires a lot of overhead activity. The most likely issue this person will face is that they lack the ability to fully achieve overhead mobility because they don’t normally use it and they start trying to force the shoulder into end range. This coupled with added load, increased speed, and higher reps will ultimately create a poor functional pattern and most likely result in pain and limited ROM/mobility.

From a physical therapy perspective, there are 4 main areas that need attention and assessment. They are:

  1. Shoulder: Does the shoulder have a capsular or soft tissue restriction that needs to be addressed? It has been my experience that it is the soft tissue that is causing the issue. So why force the shoulder capsule into end range which will ultimately create more inflammation and lead to further lack of mobility and pain?
  2. Scapula: How well does the scapula move with the humerus? How well does the scapula move with the thoracic spine and rib cage? What a physical therapist will look for is the ability to posteriorly tilt and upwardly rotate the scapula to allow for proper overhead mobility. This is accomplished by the upper trap, lower trap, and serratus anterior muscles. Most of the time the compensation I see comes from the upper trap being over-recruited to help the shoulder move overhead.
  3. Thoracic Spine: Often times people have too much thoracic flexion, kyphosis, because they sit and slump in a chair which inhibits the ability of the scapula to posteriorly tilt and upwardly rotate. This can lead to eventual shoulder impingement and poor movement patterns.
  4. Lumbo-pelvic control: This is sometimes overlooked because people don’t understand how the core works and its ability to affect other areas of the body. The truth is the core plays a vital part in the ability to raise the shoulder overhead without compensating somewhere else. Lack of anterior core control creates excessive hyper-extension of the low back and out-flaring of the ribs which is not a true indication of overhead shoulder mobility.

So, How can physical therapy help?

The biggest hurdle is determining what the underlying cause of lack of overhead mobility really is. Once you have established that, the treatment is the easy part. As a Physical Therapist, certain techniques such as myofascial release, active release, instrument assisted soft tissue release, and resisted PNF patterns are just some of the techniques that can be used to improve muscle imbalances and soft tissue integrity. The take home message is instead of forcing the shoulder through aggressive stretching, find out what else may be contributing to the lack of overhead shoulder mobility and start there.