Video Summary

Our posture can greatly dictate shoulder position and influence its function.  In this video, I explain two common postural changes and the detrimental effects they can have.   I also explain the significance of the neck and how it is often the cause of shoulder issues.     
 

Video Transcript 

[0:19] Now, when dealing with shoulder issues, you must always consider and address poor posture. Just humour me for a moment. Round your shoulders, curve your upper spine and let your arms just hang forward. And then try and raise your arms above the head. It’s incredibly difficult. If you just correct upper body posture, it becomes much easier.

[0:45] There are various ways that posture can change. We’re going to look at two of those. And the first of those is called an upper-crossed syndrome. A term first coined by Vladamir Janda. In this, he essentially describes groups of tight muscles and groups of weak muscles which are changing or leading to that altered posture.

[1:08] So in the front we have tight pecs, we have tight upper traps, and muscles around the neck, sternocleidomastoid and levator scapula which are all tight. Then we have the weak muscles. We have serratus anterior, the rhomboid minor and major, and the middle and lower trapezius muscles. 

[1:30] So again, we want to try and create a better balance. One step we need to take is to open up the front. So stretching the front. But also most importantly, strengthening the back. Getting those muscles to be stronger to be able to maintain better posture. We’ll need to think about the movements that we’re doing on a regular basis that are creating that.

[1:54] So a classic example might be the gym enthusiast who is overworking their pectorals. They get very strong and tight in this region and don’t place enough attention on the muscles at the back to maintain better balance. It can also occur from just not being aware of your posture, just collapsing down when you’re on the computer or relaxing at home, or doing different tasks.

[2:18] When we find ourselves in this situation, not only do we want to open up and strengthen, but we also want to increase neural drive to the muscles which aren’t active enough, and decrease the neural drive to the ones that are too active. So for example, the upper traps muscles that elevate the scapula are often over-activated, too much neural drive, constantly firing or contracting at a low level.

[2:48] Underneath the lower trapezius which draws the scapula downwards are receiving less neural drive. If we become conscious of trying to depress the shoulder blade slightly and also draw them back together maintaining a low level of contraction to keep it there, we are creating that change.

[3:12] We are increasing the neural drive to those muscles, and at the same time decreasing the neural drive to the upper traps via reciprocal inhibition. So when the lower trapezius contracts it depresses the shoulder and therefore the upper trapezius needs to relax to allow it. Therefore becoming quieter.

[3:34] So if we are more conscious on a moment to moment basis of maintaining that just at a low level, then posture has a better chance to change. It’s not just about lengthening and strengthening, it’s about awareness and what we’re actually trying to do to make the body work more effectively. 

SWAY BACK POSTURE

[4:02] The next postural change we’ll look at is called swayback posture. Essentially the changes which take place are this: The pelvis tends to go forward, the upper back, back, and the head also forward into this kind of position. There is often a weakness of the core muscles, but in relation to the shoulder, it’s important because certain muscles can become overactive and can inhibit key muscles of both the glenohumeral joint and the scapula.

[4:36] The muscles which tend to become overactive are pec major and latissimus dorsi. They can inhibit muscles which leads to problems with stability and control of the joint. As always, to correct that we want to correct posture and develop a better balance of the muscles involved. 

[5:03] One of my favourite tools is the use of a modified orthopaedic test called wall angel. What we are trying to have the individual experience is what it’s like for the spine to be neutral using the wall to help us do this. So the feet should be about hip-width apart, knees slightly bent, and have them try to press their spine into the wall whilst maintaining their natural spinal curves.

[5:30] Check this from the side. So take a good look at the neck and it should look something like this with a normal curve present. As a general rule of thumb, you should only be able to slide about a hand’s width between the wall and the back of the neck. If the individual has poor upper body posture you will see that the head will be away from the wall as will the upper part of the thoracic spine. 

[5:56] If they are very stiff in their upper back when they try to bring their head to the wall, the neck will extend and they will end up in a really awkward looking position like this. So if needed put a block behind the back of the head to keep the eyes more level and then over time try to reduce this type of support. 

[6:14] If they are not stiff in this region then they may be able to lengthen through the spine and get closer to the ideal position. Also look out for if they try and straighten the neck too much, as it can end up looking like this which brings a lot of tension around the throat. Have them soften here completely.

[6:39] At the lower back they need to find pelvic neutral. This here is a posterior tilt and now the lumbar curve is lost. And this is an anterior pelvic tilt, and now the lumbar curve is exaggerated. Again they can use their hand to check what’s going on. There should be just enough space to slide a hand in between the wall and the spine. 

[7:01] With this all done, have the individual press the back of the hands into the wall. At the same time, the fingertips should move slightly towards the floor to take the shoulders well away from the ears. The pressure from the hands into the wall should be around 10 to 20% of maximum power, so a low-level contraction.

[7:23] This will tone the muscles at the back of the body which will commonly be weak with poor posture. This technique is something that I often get people to do regularly throughout the day, as it really helps remind them to maintain a better posture. 

NECK IN RELATION TO SHOULDER

[7:48] Now you can make a fantastic argument that the shoulders and upper spine are the foundation of the neck. Therefore you can correct many neck issues simply by fixing upper body posture. It’s very easy to do. However, neck issues can also cause problems in the shoulder. So for example improving a forward head posture, so when the head is pushed forward, correcting that can improve both pain and dysfunction of the shoulder.

[8:19] Also, consider that the neck is very vulnerable to injury during the course of our lifetime. And this can sometimes compromise the nerve supply to the shoulder. Of particular importance are the C5 and C6 nerve roots which can be seen from this image. These nerve roots supply all of the rotator cuff muscles.  If those nerves are compromised in some way, for example from a disc problem or degenerative changes to the neck, the function of the rotator cuff is compromised and therefore the function of the shoulder.

[8:59] That can lead to various issues. So I have a general rule of thumb when it comes to shoulder issues, and that is, “The neck is guilty until proven otherwise.” This will help you stay safe. It will make sure that you keep a close eye on the neck. Ensure you don’t give any movements which might aggravate it, and at the same time movements which may benefit it. 

[9:22] At the end of the day, most of us will benefit from improving the musculature and posture of our neck. Don’t fall into the trap that just because there is no neck pain that the neck is not involved.  For example, in some cases, there can be a great deal of degenerative changes to the neck, and there is no pain whatsoever. 

[9:45] If the individual does have neck and shoulder pain, keep in mind that there is a greater likelihood of more persistent and recurrent issues at the shoulder. This is also more likely if pain levels in the shoulder are high during the day. So keep that in mind. Always consider the neck as being a potential source of a shoulder issue.

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