Back Pain – What’s The Shoulder Got To Do With It?

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Welcome to the Back Pain Solutions Podcast – Back Pain. What’s The Shoulder Got To Do With It?

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Introducing Back Pain. What’s The Shoulder Got To Do With It?

When thinking about spine health, and back pain, very few people would consider that the shoulder could play a role. However, the shoulder is a unique joint, and is not just the point where the upper arm is attached to the body! The upper arm attaches to the glenoid, a part of the scapula (the shoulder blade), which itself is attached to the ribs by a number of different muscles. The shoulder is inherently unstable, and the sedentary lives we lead is increasing this instability, which itself impacts spine stability.

In this episode we introduce the shoulder joint, and shoulder anatomy, as well as demonstrating the role it can play in spine health. We discuss the joint as a ‘joint complex’, which is stabilised (fixed) by a number of muscles. We highlight how stabilising the shoulder blade to the ribs should be a primary focus in stabilising the shoulder, and how this is often overlooked. We also discuss how the lives that we lead is impacting shoulder stability as we develop a more rounded posture with resultant muscles imbalances that need to be corrected. We also highlight that in modern society some key movements have been lost from our daily routine, and how this is having an impact.

Sitting is having a negative impact on joint health

Sitting for long periods is having an impact on our posture with resultant impact on back health. Not only does sitting for long periods contribute to the back pain epidemic but it also increases the risk of injury to our shoulders.

When sitting for long periods we often develop a rounded posture and the chest muscles, and upper trapezius tighten, and our lower trapezius muscles weaken. A rounded upper back, or upper crossed syndrome, limits shoulder mobility and increases the risk of injury to the soft tissues of the shoulder joint. If shoulder range of motion becomes limited then we can end up relying on movement through the lower back to execute simple activities of daily living. For example, if you were to reach over your head and our shoulder extension is limited then you may have to extend far more through the lower back. We know that moving out of neutral spine increases our risk of injury so this lack of mobility in the shoulder can impact our spine health.

Show Highlights Back Pain – What’s The Shoulder Got To Do With It?

Don’t just assume that focusing on the low back alone is the solution to back pain. We have to take a holistic approach to movement if we are to favourable recovery from injury, that includes a consideration for the shoulder.

Interview Transcription for Back Pain – What’s The Shoulder Got To Do With It?

Ben James 0:00
When we’re young, we move with freedom and confidence with a great resilience to injury. Somewhere along the line, we’ve developed poor habits and become more vulnerable to back pain, smart, strong features, evidence based and practical advice to help you take back control of your health and get back to the activities you love. This is your guide to better health through movement. So join us as we demystify some of the commonly held beliefs about back pain and build your confidence to a stronger back, the smart way.

So welcome back to the smart school podcast everybody. I’m your host, Ben James, and we are co host as always, Jacob stay morning, Jacob. So today we’re talking about the shoulder and common theme with some of the other podcasts we’ve done recently. Well, how does the shoulder affect back health? How does back health potentially affect the shoulder and it’s one that you’re going to want to continue listening to because a lot of people will think on the shoulder is just where they are attached to the body. But actually the shoulder joint is quite unique and there’s some bony anatomy we want to discuss as well as some important muscles that cross that joint that contribute to stability that the shoulder and, and the muscles that contribute to stability of the spine. And obviously, if these joints aren’t working effectively, and if the mechanics of movement around the spine isn’t, as we would hope, and we can have impact on the shoulder, we can have an impact on the back and again back to sedentary lives and the lifestyles we lead, what are the things that are affecting shoulder health and back health that are contributing some of the problems are not specifically going to talk about some of the shoulder injuries and some of the common problems that we see in sporting activities with the shoulders, but it’s very much about linking the shoulders to the spine and it’s one of those subjects that, again, people just aren’t familiar with, and they don’t think of when I think about back health and shoulder health. So To start off with Jacob, let’s dive straight in, as we discussed just before we started around the bony anatomy, and put a bit of context around the shoulder joint, that a lot of people will maybe be quite surprised about, I guess, when we talk shoulder.

Jacob Steyn 2:17
Yeah, so the things you’ve said there, the thing to consider is actually the the shoulder joint, or the shoulder stability itself, contributing to the core stability. And we can, we can more or less break it up into two groups of muscles just for the purpose of explaining it. And the first is the muscles that makes up this stability of the shoulder blade. And then when we have a stable shoulder blade, the other group of muscles and there’s a slight overlap that actually contribute to the stability of the core. And so, to explain that better, if you think of the shoulder blade, and like Ben said, we’re looking at the Look at the shoulder, we’re looking at the shoulder blade fixed onto the ribcage. And how stable that is. And Shall I mentioned some of the muscles?

Ben James 3:10
Yeah, maybe we’ll come on to the muscles shortly because you mentioned the ribs there, which is interesting because one of the things that I found amusing when I’ve spoken to a lot of friends when we talk about the ribs, is people. People are surprised when you say, well, the ribs go from the front of the chest, right the way back around into the spine. So you got ribs at the back? Yep. Yeah, you got ribs of the go off of your head. It’s about all right. And on that, on that kind of barrel at the back is the scapula or the shoulder blade, which is an important part of of the shoulder clearly, as chiropractors we know that but a lot of people just think of that kind of ball and socket. Not that it is a true ball and socket, shoulder joint. I guess.

Jacob Steyn 4:00
Yeah, and I think, where, what people don’t know about the joint where the shoulder blade is fixed onto the rib cage Is that how it becomes unstable is the fact that, you know, in our modern day life, we don’t actually do any more movements or make these movements actually stabilize the shoulder blade.

Ben James 4:20
Interesting. Yeah.

Jacob Steyn 4:21
It’s already a very unstable joint to start with it. Because if you think of it, if you’ve got the ribs forming this, this platform where the shoulder blade is sliding on top of and so it’s very dependent on a big group of muscles actually positioning it in the right place. Yeah, and from there, they’re providing stability towards the whole spine from the head down all the way to the, to the to the pelvis. But I think where it goes wrong, and this is very important to know for a lot of people is that we we don’t actually do any more pulling movements. That involves us standing upright and pulling a heavy thing with Good posture, you know, and I tell people opening a door is not actually pulling anything. Yeah, because it’s not, it’s not weighing up to enough effort that you’re applying to actually pull something heavy, if you pull heavy object on the floor with a rope, immediately all the muscles around the shoulder blades going to jump into action and it’s gonna, it’s going to be stimulated, we just simply don’t do that anymore. So we lose that stabilization at the shoulder blade itself so that the shoulder blade itself starts migrating to a different position. And then we end we end up with a situation where some of these, you know, and there’s a good few muscles contributing to the stability and some of them actually go on holiday. And, and then we have a few others who take over and start doing the job as if that’s normal, but it’s actually not normal. So we we have a compromised posture, looking at the shoulder complex and its function. Yeah. And that becomes the norm, you know, and that’s where the brain then starts thinking that this is just normal. And of course, it tries to give stability to the spine from there. And that’s how we end up with a whole cascade of other problems.

Ben James 6:18
Yeah, and it’s interesting because coming back to your point about the, the shoulder blade being very much fixed by the muscles, that in itself is incredibly unique because if you look at most joints, you know, the shoulder, the hip, they have the label tissue that helps to increase the depth that joint and increase stability, then we’ve got a lot of ligaments that we’ve touched on before that attaching and making those joints much more stable again, but the scapula on the rib cage on that platform, as you as you described at the back, is very much reliant on the muscles holding it in place. So we’re kind of we’re looking more proximal towards the spine. First, when we look at The shoulder before we even consider what people would think is the shoulder joint. And again, you know, just before we touch on some of those muscles and and not just muscles in the back that help them with stability but also muscles in the front because surprisingly that that bone protrudes through to the front, which a lot of people would again think, Well, okay, so that it sits on the ribcage, but actually there’s a bony process that is that is anterior in the in the upper chest,

Jacob Steyn 7:28
Just under the just under the collarbone is that bony process.

Ben James 7:31
Exactly, exactly. And people wouldn’t, wouldn’t assume that if they didn’t do any anatomy or have any knowledge of this. And I think again, when we apply that to people in the gym, you’ll see so many people just lifting shoulders, the deltoid, that kind of big muscle on the lateral part, your shoulder, which is the the muscle a lot of people would associate with the shoulder is where we’re training. And again, we’re not giving ourselves that stable base. And we’ve talked About that stable base around the spine, the same rule applies with the shoulder and the impact that not doing that in half can contribute to to instability and again, problems at the spine like we discussed. So, let’s talk a bit about the muscles. Because we’ve we’ve talked about how the scapula sits on the ribs at the back, there’s a bony process protrudes anteriorly in the coracoid process, and then you’ve got that kind of glenohumeral joint where the where the humerus the upper arm, attaches into that scapula, and that’s how you are your arms are attached effectively to to the body so that that scapula that shoulder blade is a key bone that is important for for obviously, activity, but it’s the muscles around it that we want to kind of focus on for a moment here. So you want to start off with some of those key muscles and when Talking about the problems that we see.

Jacob Steyn 9:02
Yeah, so just going to reiterate what we just said. So what often happens when somebody has a shoulder problem specifically or something coming from the shoulder going to the neck or to the spine, is there’s often focused on the small muscles that are actually going from the shoulder blade to the upper arm. And I think that’s a mistake. Personally, I think the main focus should be on what we just said it’s actually stabilizing the shoulder blade on the ribcage first, because that’s the anchoring point that we’re considering and have been mentioning throughout the previous podcast, you know, contributing to the stability of the whole trunk. So the muscles that actually take care of the stability of the shoulder blade itself is what we speak of as the big muscles at the shoulder blade, not the short the small muscles. These big muscles if you look at, look at it from the back and from the side. The main ones there is the latissimus the lats that actually runs down on the side of the body, from the shoulder blade into the lower back spine. And then we have together with the lower trap. So we have this, we often just know of the traps of trapezius muscle that sits on top of the shoulders coming from the shoulder blade to the neck. And in fact, you actually have one it goes downwards. And this is this is a very important muscle and very underdeveloped in most almost all people. Yes and get back to this in a moment. But then there’s the other very important muscle that actually contributes to a lot of stability of the shoulder blade and that’s the serratus anterior. Yep, and this serratus actually just pulls the shoulder blade flat onto the rib cage. And that’s if this muscle is on holiday we usually speak of winging scapular winging scapula is actually a winging opening shoulder blade. So the, the medial part of your shoulder blade will come off the ribcage and will stand out like what we consider to be wings. Yes, yes. Good, good description. And then the last very important that there are more obviously but the last big important muscle is actually the PEC. Yes. So the back in the front actually gives a lot of stability to the, the wall not directly to the shoulder blade but to the upper arm, but it’s very important and the pec minor, very important. It’s just the pec minor is just below the, the big chest muscle. Also coming from the ribcage and the front, going to this little bowtie process which we talked about sitting just underneath the collarbone. Yeah, yeah. So those those are the big muscles you have to consider and you have to stimulate somehow in with the right movements. And maybe continuously in the beginning and later just from time to time, but you have to, you have to consider how you’re going to use the muscles to create more stability at your shoulder blade.

Yeah, no, I think you’re absolutely right. And I think when you, when you put it into context, if you think about the different line of pull and drive of those muscles that you’ve described, serratus kind of anchoring that scapular down, almost pulling it flat onto the ribs. When you think of the lower traps, that the orientation trying to pull that scapula down to kind of towards the floor, if we’re standing in the same with the with the lats, and then you’ve got your pec minor attach that croco process anteriorly trying to pull it forward a little bit, you can imagine that if those muscles are imbalanced, that scapula is going to be moving in, in potentially a number of different planes or directions. And clearly, from a biomechanical point of view or mechanical point of view, that’s going to have impact elsewhere and back to the trapezius. Muscles specifically. And in fact that the pecs, one of the things that we commonly see, excuse me is, again, back to that a lot of that century seated posture is we’re starting to become around the shoulders. And I know we’ve touched on this before in previous podcasts. But as I shoulders around in those packs, those muscles anteriorly are becoming tighter, the upper traps are becoming tighter. And actually, the lower traps are weaker, the serratus is becoming weaker straights. And anterior because we’re just not doing activities, like you alluded to that are that are activating that muscle. And so what we’re starting to see is that scapula is often migrating, it’s moving, superior and it’s moving up, and it’s often tilted forward. And so, when we, when you imagine that’s occurring, if you just sit in your chair, now, if you listen to the podcast, you’re in a position to do so if you just sit and kind of round your shoulders forward, a touch and Then you try and lift your arm up as high as you can its not going to go very far. And that’s,

Yeah cos you’re blocking it off.

Ben James 14:08
Exactly. Exactly. So I guess the question is, in terms of kind of bringing that back to the spine, if we if we are seeing more of this posture, is that in itself, contributing to more shoulder problems? And how’s that influencing spine problems? And, again, this is going to be a kind of there’s no definitive Either way, it’s going to be a bit of both, right?

Jacob Steyn 14:36
Yeah. And I think, yeah, exactly. It’s going to be a bit of both and you never end up where you never know where the problem will end up. But you’re you want to go for that. The most advantageous mechanical advantage and that is obviously, you know, being putting that scapula or putting the shoulder blade in the right place, but also being able to use it when like you said, when you want to put your arms over your head, not having not having shoulder blades that just gets pulled up onto, you know, below your ears, but actually having them moving outwards having a good range of motion and so they can have a good movement. That’s not going to put more pressure through, for example, the shoulder joint. We want to don’t want to focus too much on the shoulder joint. But, but, I mean, all of this goes together. You know, if it’s good, if you’re going to stabilize your shoulder, you’re going to have better shoulder joint health, which we will discuss in a later podcast.

Ben James 15:33
Yes, yeah. Sorry, just a touch on the spine there. Because again, we’ve mentioned this before in terms of thoracic that kind of mid back as it were. Extension and mobility there that again, influences the shoulder.

Jacob Steyn 15:50
Absolutely. And it comes back to if you’re sitting on a lot and you have an entry job or you know you’re driving your you’re a driver of a truck or a or a Every car or whatever, you will most likely end up with a very stiff upper back, which means your shoulder blades will automatically move upwards. And you will lose the the lower trap and let and stabilizing effect of probably the ship that serratus interior as well. So, you know, you’re going to have to go and look up the range of motion, the mobility in the upper back spine, you’re going to have to go and activate the lats, the lower trap, the serratus anterior. These are just things you’re going to have to look up in terms of range of a range of motion if you want to restore and it doesn’t have to be perfect, but if you want to avoid serious problems, you have to have some function and the communication between the brain and these muscles, which and a lot of people is just just not present at all.

Ben James 16:52
Yeah, yeah, yeah. And I think as always, if your affair to the show notes will have some videos and some Visual guides to support and put into context, some of the things that we’re saying and one of those is, is a great stretch for the thoracic spine to start to get to get that moving, because kind of bringing this back in terms of what we can do and where individuals can start if you’re suffering from some shoulder pain or just discomfort around the back around the shoulder blade, because you’re sitting all day, a good place to start is to think well, let’s move back to the spine, let’s start with the spine because that’s where our stable base is. And if the thoracic spine is moving better, if we’ve got more mobility there, then hey, that’s gonna reduce impact on the on the lower back, but also that’s going to have an impact in terms of the movement of the scapula. And that’s where, where things begin. I think it’s fair to say,

Jacob Steyn 17:53
Of course, we want to consider all these aspects and usually when you have a dysfunctional shoulder complex or upper quarter, as we call it, you know, around the shoulder blade, then if that’s been going on for a while, you most likely have a stiffened up lower back as well as a response to the forces and the the work that needs to be done in that area not being distributed between these these areas. That’s what usually happens, one area gets isolated in doing the work, so you, you get a very, it just opens up and you get a very stiff, localized area. And that’ll happen in one place and it’ll happen another place. And then the end, you become very rigid throughout. Yeah. And we know from the research, if that happens, you expose yourself more to a to a link in the chain breaking instead of, you know, instead of all of it actually absorbing it and allowing you that nice fluid movement and not getting injured.

Ben James 18:57
Yes, yeah, absolutely. Absolutely. So I think to kind of bring this back to to the people listening in terms of what they can do, it seems, it seems a sensible thing to say to initially start focusing more on your posture and bringing it back to that neutral spine and the brace. Because as we’ve talked about before, the brace doesn’t just involve the abdominal muscles, but it involves the pecs, the lats, and really if we’re trying to visualize and get better control the lower traps as well. Of course, those are muscles that we’ve talked about that have a have a key influence on scapular positioning and stability. So for the listeners, should we just focus back on bringing this back to that, that neutral spine and that brace, just to put into context how a good brace will will positively influence the scapular and shoulder positioning.

Jacob Steyn 19:58
Yeah, So, we’ve in the previous podcasts, we talked about the neutral spine and the bracing technique and how important that is. And now we’re basically adding the upper quarters, the, you know, the thoracic spine, the upper back and the shoulder blades. And we need you to have the mobility in the upper back. So you’re able to raise your chest bone. So you’re proud, not exaggerating that into extending too much, but you need to be in a midpoint into that neutral spine extending from the low back up to the neck. And then, if I understand you correctly, Ben and I’m answering answering correctly, but then we want you to be able to actually direct the force to not only the core but also to the pecs and to the lats to feel the tension the shoulder blades but the shoulder blades has to maintain as to maintain their their their position. Yeah. From there, we want you to tend the core. And the shoulder blades, in other words tends to hold trunk without compromising posture.

Ben James 21:10
Yes, yeah, exactly.

Jacob Steyn 21:12
Yeah. What do you see in a lot of people as if I say, Okay, I want you to, you know, I want you to stand up, right, put your feet next to each other. Now I want you to brace in the core. And I want you to push your shoulders down. So we create some compression, because that’s adding, that’s the other link to the to the stability factor, you see it you push the hands to the floor, to pushing or pulling the shoulder blades into the, into the hips. That’s a great that compression that you see that you need and use it when you do a deadlift, for example, or you lift heavy things. But what you see with a lot of people is you see actually a tilting of the shoulder blades forward so that the shoulder blades will tilt forward so they actually lose the lower trap and the muscles that keep the shoulder blade in the right position and that’s not what we want.

Ben James 21:58
No, no and I think You know, it’s, it’s, it’s, it takes practice, because, you know, over time with the studies that we’ve had in there and the training we’ve done, you become very aware and you and you become very good at being aware of these individual muscles and, and the movements that help to activate those muscles. And you can, you can’t ever isolate one muscles we discussed before, but you can certainly become more aware and it does take practice, because a lot of patients that I’ve spoken with before and a lot of friends that are working at the gym, if you try and get them initially to try and activate this muscles, it’s like well, you know, the movement as you say often is completely opposite to what we want to see. And it does take practice to try and draw those shoulders back and draw them down and activate those pectoral muscles at the front and the muscles in the back together to kind of pull your shoulders back and down and pull that scapula down and then with time, you can definitely learn to do it and you’ll definitely feel it. But it has to be a daily habit. Again, as we’ve said before, this isn’t something that, you know, just happens overnight with bracing and with with. With neutral spine it takes it takes some effort.

Jacob Steyn 23:16
Yeah, and if you if you spend 10 years sitting at a desk and losing the sorry, losing losing the the communication between, you know, the nervous system and the right group of muscles to be able to do this, then I don’t say it’s going to necessarily take 10 years to get it back. But you have to understand it’s gonna take, it’s going to take some weight to lose a month. And you know, what, what we be discussed further, especially if you go look on the website is the small drill muscle exercises that you do on a daily basis and that you build up because there’s always a progression with the exercises to get to a certain level, where if I say hey, can you turn on the shoulder Complex, meaning all the muscles we’ve discussed so far, you can create a lot of tension in that shoulder without compromising the posture. And that’s what we want. That’s what we need. And that’s when you will feel it, then once you felt it, you understand it, you will use it when you have to open a heavy door. Or you have to you have to pull something with a rotational force through the spine, but you’d be able to lock your core and be able to stabilize the shoulder. And the chances of actually getting hurt in that way. is very small. That’s what that’s what we’re aiming for. Right?

Ben James 24:36
Exactly. Yeah. I mean, back to back to the, the name of, of the podcast, smart, strong. You know, this is this is effectively what we’re trying to create in people’s minds is that actually, if we have a better understanding and education and awareness, and we train ourselves to have a stable platform, those simple activities, like opening a door A becoming less efficient for a lot of people, but the contribute into some very maybe minor injuries, but they’re the start of some, some more problematic injuries and it’s those simple activities on a daily basis that are now causing us problems. Just simply be because the sent to denture nature, the lives we lead and the lack of awareness and the lack of knowledge. So I think, you know, like you say, it’s, it’s about taking ownership and it’s about practice, but in time, that awareness will come. And when you start to do those activities of daily living, it will just become natural to move with a better posture in a neutral spine with a good brace, from the core and also at the shoulder. And that in itself is going to make things far easier for you but it’s also going to make things much less risky and put in you know, bringing Briefly that came back into the gym because again, we like to just touch on those gym goers that are leaving work from that identity across the from the desk and go into work and maybe didn’t shoulder routine or workout. Don’t just pick up that big weight and do a shoulder press because if you’ve got that rounded back and those rounded shoulders, then you are going to risk injuring some of the smaller muscles of the shoulder and they then can become chronic injuries because it takes a lot of time to put those right. If we look at the platform first and we bring it back and we start at the spine and we start with stability, then you’re going to be a lot healthier and a lot fitter and a lot stronger, moving forward when you start to add in some more athletic activities. So again, consider what we’re saying when you go to the gym. Because it’s not just all about lifting heavy weight, it’s about forming that stable platform. And we’ve got some exercises on the website for thoracic mobility. Also specifically for the serratus anterior, that’s another important muscle that is a big focus when we look at and starting the journey, I guess with with regards to, to shoulder mobility. So head on over, take a look at the website, take a look at some of the videos that will support some of the information that we’re saying today and put into context what we’re saying. And as always, head on over to iTunes and give us a rating helps us share the message helps us to get awareness out of the podcast as we develop and we we add content. And in time, we’ll have some additional videos and we’ll have some courses that can help to put a lot of this information into a journey for people to help improve back health. So any final points, Jacob that you want to add in on the shoulder before we close for today?

Jacob Steyn 28:09
No, I just I just want to say to people, for a lot of people this, especially if you if you listen to this, maybe you’ve had some shoulder issues or maybe you understand what we’re telling you of how important the shoulder and upper back my shoulder stability and upper back mobility as it is and contributes to maybe listen missing core strength that you’ve been experiencing or low back problems. And maybe what we’re discussing sounds a little bit far for you right now. But I would encourage you to go and have a look at the website or inquire more about how you will get into this and start feeling what you’re doing with your shoulders in your body. And I can only tell you that once you have got that ability that it’s a lot of fun. So yeah,

Ben James 28:59
Yeah. I think that A great point, I think once you start to have a better awareness of some of these things, then activity exercise does become a lot more interesting just become a lot more fun because you you’re not worried about are you doing the right thing, you doing the wrong thing. So the the knowledge is is hugely beneficial if you’re looking to get in better shape and to train. So it’s a great point. And, you know, if there are any questions specifically around any specific injuries, or you want to ask specific questions, and we’ve got a, an opportunity for you to do that on the website, just go to the Contact Us page, have a look around and add in any comments and we’ll we’ll get an email through and we can certainly look to to answer those and give a little bit more individual information. So thanks again, Jacob. And, again, just to reiterate, head on over to the website to look at some of the videos because there’s a lot of complex information that we’re talking about that but for the layman, and maybe it’s difficult to contextualize so the videos and the visual aids will will certainly help. Thanks again for listening guys, and we’ll be back soon with another episode. So, listen in, come back. Thanks again Jacob. Speak again soon.

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