Anterior shoulder pain can be frustrating. If you have anterior shoulder pain and it’s lingering, there’s a good chance that it isn’t being treated appropriately. State of Fitness applies a proven approach to helping our community to overcome anterior shoulder pain, and this article will help you understand what’s causing your anterior shoulder pain, and we can go about treating it for you.
To understand the approach and treatment, we need to dive into what causes anterior shoulder pain and the two approaches we take. Either approach is based on how you’re moving, and therefore what you need. Enough rambling – let’s get into it!
Article Summary:
- What is anterior shoulder pain, and when does it occur?
- 3 Things that prevent anterior shoulder pain
- Resting posture – Effects on anterior shoulder pain
- Exercise technique – Effects on anterior shoulder pain
- Stability and strength – Effects on anterior shoulder pain
- Mobility and tissue quality – Effects on anterior shoulder pain
- Conclusion
- Book a free consultation
What is Anterior Shoulder Pain, and When Does Occur?
Anterior shoulder pain typically presents with a sharp or dull ache at the front of the shoulder at rest, or more commonly during loaded movements in the gym because the nuisance occurs typically with the head of the humerus migrating forward in the shoulder joint (more in this in section 2). When assessing members at State of Fitness, they usually present with symptoms during pressing moving. Think Barbell Bench Press, Overhead Press and Push-ups. But anterior shoulder pain can still become problematic during pulling movements (Seated cable row and pulldowns, etc.) and during movements where the shoulder typically supports weight in a static (isometric) sense, like dumbbell walking lunges, Barbell Back Squats and Deadlifts.
It can be debilitating and triggered by the slightest movement that can stop us from doing the things we love, like playing with our kids, participating in sports and doing what we enjoy in the gym. Now, look at what triggers anterior shoulder pain from an anatomical perspective.
3 Things That Prevent Anterior Shoulder Pain
I love the functional anatomy of the shoulder so bare with me while I resist the urge to geek out like a Brunswick barista talking about a deconstructed almond latte at 60 degrees for 20 minutes.
Anterior shoulder pain is typically brought on by the head of the humerus migrating forward in the glenoid (shoulder joint). Simply put, it’s when the shoulder pops forward.
Below: The head of the humerus and the shoulder joint (glenoid fossa) (reference)
We have three main anatomical structures that help resist the humeral head migrating forward:
1. Joint capsule of shoulder shoulder (consisting of ligaments wrapping around the humeral head and glenoid fossa);
2. Bicep tendon (crossing directly over the front of the shoulder and attaching to the humeral head);
Above: The ligaments that make up the joint capsule and the bicep tendon (Link)
3. Rotator cuff (muscles attaching from the scapular to the head of the humerus)
Above: The anatomy of the four shoulder rotator cuff muscles (Link)
Such little structures directly prevent the head of the humerus from migrating forward, resulting in anterior shoulder pain. How you start (resting posture and breathing), how you move (exercise technique), how strong you are (shoulder stability) and how “tight” (shoulder mobility) you are will have a significant influence on how you get out of pain. Now, we will look into these three to find out what “bucket” you fall into, but typically it will be a combination of all three.
Resting posture & breathing – Effects on Anterior Shoulder Pain
Pain is far more complex than saying, “Your poor posture results in your pain occurring”. Based on the current research, there is no direct correlation between “poor posture” and pain because what good posture is is very hard to quantify. Although lousy posture may not be causing your pain, improving posture (your starting point) and how you breathe (reducing sympathetic muscle tone) can help reduce pain.
At State of Fitness, we start from the ground up. Or more accurately, from the inside out.
Breathing
We’ve all heard of the “fight or flight” response, which refers to activating two responses and pathways of the autonomic nervous system: 1) the sympathetic nervous system (fight) and 2) the parasympathetic nervous system (flight or rest and digest). Based on the studies you read, you’ll do 20,000 to 25,000 breaths a day on average. If you’re stuck in the “fight” (parasympathetic nervous system), you’ll tend to breathe through your “accessory breathing muscle (see image below), which results in these muscles being under constant tone, which is an issue when you’re dealing with Anterior Shoulder Pain and any upper extremity issue.
Image 5: This isn’t a blog post about diaphragmatic breathing, which you can easily Google, but it’s an important topic to touch on because how you breathe significantly impacts how you move and feel.
Resting Posture
After assessing how our members breathe, we’ll look at the resting posture of our client’s spine: do they live in flexion (rounded upper back), extension (arched spine) or somewhere in the middle? From here, we will do active and passive tests to see how the thoracic spine (upper back) rotates, flexes and extends, while also looking at the starting position of the shoulder blade and how it moves through space (does it move when the arm moves?).
Once we have looked at how someone sits at rest, it’s time to look at how they move!
Try my top 5 posture corrective exercises here:
1) Foam roll Thoracic & lats (Video Link)
2) Thoracic rotation (Video Link)
3) Side-lying external rotation (Video Link)
4) Serratus wall slide (Video Link)
5) Back-to-wall shoulder flexion (Video Link)
Exercise technique – Effects on Anterior Shoulder Pain
There’s no such thing as a “bad” exercise. Well, there is one exception to the rule which is burpees. Why would anyone with common sense ever want to do them?! Now I’ve gotten that off my chest, let’s get back on topic.
I’m not sure who said it, but “it’s not what you do, it’s how you do it” resonates with what we do at State of Fitness and is a big reason our personal trainers have a job. Good quality strength training alone can help people move and feel much better.
Are you starting your exercises in the correct position? How is your shoulder blade moving (or not)? Is the head of the humerus migrating forward when you do a bench press, push up or row? How you move in the gym needs to be investigated, so please do yourself a favour and hire a professional to assess how you move. Even a new Cert 4 personal trainer will pick up things up that you can’t see and feel so make it happen.
Image: Showing correct push-up technique (Link)
Stability & Strength – Effects on Anterior Shoulder Pain
The shoulder itself is an incredibly unstable joint. It is a ball and socket joint like the hip but without the added stability of the head of the femur sitting inside the hip joint (acetabulum) 70%. So when it comes to elevating anterior shoulder pain, stability and strength are key to help add some much-needed control from a functional standpoint (making it more resilient) and from a motor control perspective (telling the nervous system that it’s safe to move).
We have three main structures that help move the shoulder blade, which must accompany the arm through motion to maintain glenohumeral congruency (a fancy way of saying “keeping the ball in the socket”).
Image: Correct scapular function (Link)
After assessing the strength and function of the above three, we must examine the rotator cuff. which is more commonly looked into when prescribing shoulder rehabilitation exercises. See image 3 above, can you feel your rotator cuff while doing your prescribed exercises? is the cuff rotating the humerus or are other muscles overcompensating? A lot goes into strengthening the specific shoulder stabilisers listed in this section, but the most important thing is to ensure you can “feel” the muscles working.
Mobility & Tissue Quality Effects on Anterior Shoulder Pain
Last but not least, we will look at releasing the shoulder, and what structures may result in your anterior shoulder pain. You might be surprised that this is not the first. This is because the shoulder is a joint like no other. It thrives on correct movement, strength and stability because it is so unstable. Plus, if you’re breathing your neck, ribs and chest 25,000 times a day it becomes really hard to reduce tone in these areas until you’ve been made aware of your breathing.
Here are our go-to releases to help the shoulder move more congruently while releasing specific muscles that attach directly to the front of the shoulder.
Infraspinatus
Coming from the shoulder blade and attaching directly to the front of the shoulder, this is a hot spot when trying to release it for the first time and I apologise in advance.
Pec Minor
Attaching from the ribs onto the shoulder blade, a restricted pec minor pulls the shoulder blade forward, pushing the head of the humerus forward and restricting overhead movements.
Biceps
The bicep tension directly crosses the front of the shoulder and attaches to the head of the humerus and the shoulder blade. If the bicep is restricted causing loss of elbow extension, it can have a direct correlation with anterior shoulder pain
Latissimus Dorsi
The lat is typically overlooked which is strange because it is a very large muscle spanning from the lower back/hip, all the way up just south of the head of the humerus. When re-stretches, it internally rotates and depresses the shoulder, limiting overhead movement.
Upper Trapezius
People love to blame the upper traps for everything. My dog doesn’t come back to me when I call her, my car won’t start, and my eggs are overcooked can all be seen to be the cause of the upper traps… But in all seriousness, if your collarbones are elevated past 20 degrees (it looks like you’re always struggling) then it’s worth looking at some specific release.
Let’s wrap it up!
I know what you’re thinking…
“Dylan, I thought I would just be told to do a handful of exercises and then I would be fine?”
I wish it were that easy, but pain is extremely complex, and layer that on the human body’s organism and you have a recipe for driving yourself crazy. It’s hard to systemise an approach to help people get out of pain, but this approach can help, and I hope you can help make sense of some stand-out factors that may be resulting in your specific case.
If you need help with your anterior shoulder pain, please get in touch with us at State of Fitness. We understand that getting our members out of pain is not as simple as “do this stretch” or “do this silly banded exercise”. It takes a multilayer and ever-evolving approach which needs the support of trusted allied health professionals like osteopaths and myotherapists.
That’s it for now, and I thank you for your time!
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