Better Shoulder Mobility through Corrective Exercise

As trainers, we know how important shoulder mobility is and how much it can influence our client's exercise program. The shoulder anatomy is intricate, and it is vital to understand how corrective exercise can improve shoulder mobility issues. There could be several types of shoulder mobility issues present at once contributing to poor mobility within your clients. Let's explore what these issues can be and how they can develop.

Types of Shoulder Mobility Issues

Mobility issues that develop in the shoulder can result from several types of activity or inactivity. Some of the most common types of shoulder mobility issues are impingement, rotator cuff tears, and frozen shoulder. Instability and overuse of the joint cause many of these. The shoulder is the most mobile joint in the human body. It is made up of the humerus, scapula, and clavicle bones, with many ligaments, tendons, and muscles in the adjoining anatomy.

When you have a joint providing an increased range of motion, it is capable of producing a lot more movement. This creates uncertainty and a higher susceptibility for shoulder pain and shoulder conditions that we will see as personal trainers. (1) The shoulder performs a variety of movements:

• Adduction

• Abduction

• Flexion

• Extension

• Internal rotation

• External rotation

Impingement

A poorly positioned humerus bone in the shoulder socket impinges on the tendons and bursa in the shoulder. The constant rubbing from arm movement aggravates the shoulder region including the rotator cuff. This leads to inflammation in the area and can cause bursitis or tendonitis. Overhead reaching is a movement highly affected by impingement and if a client is experiencing pain and weakness of muscles while performing this motion, they could have shoulder impingement.

As fitness professionals, we must address the issues right away to avoid any further shoulder mobility issues. Unaddressed shoulder impingement can cause a rotator cuff tear from the constant grinding of the humerus bone on the tendons. With the shoulder being a ball and socket joint, the head of the humerus is sitting in the shoulder socket. The goal is to have the head of the humerus bone move freely in the shoulder socket or blade, without any disruption.

Torn Rotator Cuff

If your client develops a rotator cuff tear, they will be in much more pain and experience an immense amount of movement dysfunction. The rotator cuff's key role is to stabilize the shoulder joint. It helps keep the humerus in the shoulder socket. Four muscles make up the rotator cuff:

• Supraspinatus

• Infraspinatus

• Teres minor

• Subscapularis

Make sure that if your client initially has a partial tear of the tendon, they do not continue to put any load on their shoulder. This could cause a complete tear. Degeneration of the shoulder through repetitive stress is the most common cause of a rotator cuff tear but adding resistance will make it even worse. The constant wear and tear this muscle group undergoes causes it to deteriorate enough. Poor shoulder mobility not only results from movement dysfunction but also improper technique and extra load or resistance. This is why it is especially important to address signs of these types of issues immediately with corrective exercise to prevent further damage.

Frozen Shoulder

In many circumstances, we overlook our clients' lifestyle habits, but they are major contributors to these mobility issues. Every muscle in the shoulder contributes to certain movements, but as humans, we use our arms every day in all different directions. When a client encounters a more serious mobility issue or injury, they become more vulnerable to frozen shoulder.

Frozen shoulder usually develops in individuals who are recovering from an injury or surgery. (2) It is a condition causing stiffness and pain, creating more difficulty in joint motion. This is a result of non-use of the shoulder. Being proactive in the rehab process and understanding the right phases to start stretching and strengthening the area will help avoid creating more mobility issues within your clients.

Common Causes of Poor Shoulder Mobility

As a personal trainer, you must observe and interpret how closely related shoulder mobility issues are to your client's lifestyle habits. This will help you discover what might cause poor shoulder mobility. Achieving optimal balance in the shoulder joint is crucial. Even though the shoulder has incredible flexibility, it is very susceptible to developing poor mobility.

Force Coupling

An important part of keeping the versatility of the shoulder joint is force coupling. Force coupling is when two equal and opposite forces act upon one another to produce rotational movement. In other words, as one muscle works and produces movement, another is acting against it to keep the shoulder stabilized. This is important to understand because poor mobility can result from unequal forces pulling against one another. This leads to muscle imbalances later amplified by lifestyle activities, posture, and exercise.

The scapula bone, one of the three bones that make up the shoulder, is essentially a "floating" bone. The scapula plays a vital role in stabilizing the shoulder to allow for free movement in the joint. For this bone to allow for rotational movement the trapezius and serratus anterior pull against each other. Knowing this type of information can help you pinpoint client problem areas more efficiently.

Inactivity

One of the most common causes of poor shoulder mobility is not actually from movement, but instead inactivity. Frozen shoulder is always a concern due to inactivity and being the most mobile joint in the human body, it has a high desire to move often. Flexibility only remains through unrestricted movement. If your client is inactive for a prolonged period of time this can cause restriction to how they move and the way they move.

If connective tissue becomes tight or weak, the stability and flexibility of the shoulder joint become less. Even though stiffness and pain develop from inactivity, frozen shoulder is still much more common in those recovering from an injury or surgery. Movement of the arm and shoulder joint is usually severely limited with a medical condition, which causes adhesive capsulitis. The shoulder capsule will thicken and tighten with frozen shoulder giving it its name of adhesive capsulitis. (3)

Poor posture

This also contributes to impingement issues due to internal rotation of the shoulders. With internal rotation, the humerus bone will tilt and sit improperly in the shoulder socket. Upon movement with this positioning, a client could experience aggravation to the tendons. This creates inflammation within the connective tissue causing shoulder pain. Focus on fixing forward posture within your clientele can help avoid impingement, but more importantly internal rotation of the shoulders. If your client begins to experience inflammation in the shoulder, bursitis or tendonitis could be present. (4)

Lack of Stability

Often, a client's shoulder is not stable to begin with, due to lack of strength and flexibility. Many exercise movements use the shoulder, so you need to ensure it is strong and stable. This is important because with exercise comes increased load in addition to the original movement dysfunction a client has. Improper technique can compromise areas like the rotator cuff. We see this often in athletes depending on the type of sport they play. Most sports involve having to use one side of the body more than the other. Athletes also constantly produce repetitive movements causing limitations to the shoulder.

Corrective Exercises for Shoulder Mobility

Muscle strains, wearing of joints, and even nerve compression are complications to be aware of that cause poor shoulder mobility. If your client has mobility problems in the shoulder joint, rotator cuff, or shoulder blades, you should avoid having them perform any movements that cause pain, tightness, or stiffness. Most of the time it is safe to assume a client experiencing poor shoulder mobility should not perform any overhead movements.

To assist clients in improving poor shoulder mobility you should prescribe corrective exercises. Corrective exercises for shoulder mobility will help improve range of motion and flexibility and alleviate pain present in the shoulders.

Aim to prescribe these seven corrective exercises for better shoulder mobility to clients:

• Wall Slides (scapula and overall mobility)

• Internal and External Rotation (rotator cuff)

• Prone T's and Y's (rotator cuff)

• Towel stretch (frozen shoulder)

• Outward and Inward Rotation (frozen shoulder)

• Pec Stretch "TRX Chest Opener" (impingement)

• Theraband Rows (impingement)

These exercises help with scapular movement and overall shoulder mobility. They will allow for movement and activation through the rotator cuff to help improve stabilizing the shoulder joint.

All seven of the exercises work problem areas for the shoulder to prevent and correct mobility issues. Use these to increase and improve range of motion and shoulder mobility even if your clients do not have poor mobility to start. Be proactive in designing the right program for your clients. These stretches and exercises help relieve tight muscles that result from poor posture, prior injuries, poor technique, and inactivity.

How to Design a Corrective Exercise Program to Improve Shoulder Mobility

In a corrective exercise program, include a combination of stretches and corrective exercises as noted previously. Be sure to avoid any type of overhead pressing or any movements where the arm is raised above the head. Any other movements bringing on pain should be avoided also. The duration of the actual program should be designed for a quick and efficient recovery, but these exercises should always be part of your client's program to keep the integrity of the shoulder. No matter what we do as our clients age and go through life there is constant degeneration in the shoulder, some more than others.

To determine what issues your client is having, use these four steps to decide what exercises to prescribe them.

1. Pick an actual exercise to examine.

The overhead press is the most common exercise to observe but remember that if this movement causes too much pain, you need to choose a different exercise and recommend they see a medical professional. This exercise completed with shoulder issues brings out more imbalances, especially through observing trunk stability, thoracic spine mobility, and any limitations in the joint of the shoulder.

2. Next, divide the movement into concentric and eccentric phases.

Take note of what occurs within the shoulder and other body parts. Compare what you see to what you expect to see happen when done correctly.

3. Record whether full range of motion was completed, if they kept postural control, and how the joints responded through flexion and extension of the arms or elbow.

Also note any tightness, stiffness, or pain, where the pain is found, and at what point it is brought on.

4. Form a proposed explanation based on your findings to establish what the client might have.

Your findings will be based on if they had a recent surgery or the degree of pain they experience in the shoulder. With a recent surgery or medical condition causing inactivity, we can hypothesize a client has frozen shoulder, assuming they are ready and cleared for exercise. If this is the first time pain is present with tightness, then your client would most likely benefit from impingement corrective exercises. If there is severe pain, an incredible amount of tightness, and it's not the first time a client is experiencing this, then you can assume the rotator cuff needs to recover and repair properly.

Remember, always recommend your client sees a physician. X-rays and physical examinations will be performed to confirm shoulder conditions and you should never diagnose a client as a personal trainer.

Expand Your Education: Specialize in Corrective Exercise

Interested in designing a results-driven program? First, make sure personal training is the career for you, then consider specializing in corrective exercise so you are better able to address a variety of mobility issues.

References

1. 12 common shoulder problems & how to treat them. WebMD. (2023, May 8). https://www.webmd.com/pain-management/why-does-my-shoulder-hurt#1

2. Mayo Foundation for Medical Education and Research. (2022, August 19). Frozen Shoulder. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/frozen-shoulder/symptoms-causes/syc-20372684

3. Frozen shoulder - symptoms, causes, diagnosis, treatment. WebMD. (2021, March 18). https://www.webmd.com/a-to-z-guides/what-is-a-frozen-shoulder#1

4. MediLexicon International. (n.d.). Bursitis of the shoulder: Symptoms, treatment, and exercises. Medical News Today. https://www.medicalnewstoday.com/articles/320495