The Shoulder Dysfunction Epidemic and Enhancing Mobility

I have noticed an alarming trend in the adult population that I work with: a high prevalence of shoulder dysfunction.  What I mean by dysfunction is significantly decreased range of motion, pain with specific motions, instability, compensation and asymmetries in muscular balance, timing, and control.  I would estimate that greater than 50% of the people over the age 30 have some sort of dysfunction.  Equally, men and women are affected. 

I have to take these shoulder dysfunctions into consideration when designing exercise training programs.  More often than not, I need to spend time helping clients simply regain shoulder range of motion before loading the shoulder.  Many exercises will not be tolerated very well, such as a barbell overhead presses, push-ups, or bench presses.  The shoulder is an interesting joint because it needs adequate mobility from multiple areas, not just the shoulder (gleno-humoral) joint.  The upper (thoracic) spine needs to be able to extend and rotate adequately.  If not, the shoulder blades (scapulae), which sit on the thoracic spine, cannot move to their proper position.  The Reach and Rotate exercise on a roller is a great exercise to improve thoracic spine mobility.  The shoulder blades range of motion and stability can also be limited by the muscles that have direct connections to them.  These muscles have no direct connection to the shoulder joint, but influence the position of the shoulder blades and therefore the shoulder joint.  These large, multi-joint muscles (including the bicep, tricep, pectoralis major, minor, and latissimus dorsi) generally are very tight and dominant.  In addition to developing adequate activation, timing, and control of the smaller muscles that stabilize the shoulder joint (rotator cuff muscles) and shoulder blades, developing adequate flexibility of these large multi joint muscles is key to keeping the shoulder joint healthy and pain free.

If a client has a new shoulder injury, a recent surgery, or significant pain, I would recommend that they see an orthopedic physical therapist or physician.  If a client is cleared to exercise but still has shoulder range of motion limitations (as many do), range of motion should be addressed prior to pursuing more challenging (strengthening) exercises.  Interestingly, simply performing shoulder mobility exercises will improve shoulder function and can eliminate some aches and pains.  There are many effective shoulder exercises, such as kettlebell arm bars, but here are two very effective ones that I use regularly with clients and myself: