Is Shoulder Pain Related to Upper Back Posture?
This blog is going to discuss some potential causes of shoulder pain. In particular, it will look at the affect of increased curvature and stiffness in the thoracic spine on shoulder dysfunction and pain.
Posture is spoken about a lot in the Physio world, but we want to delve into how it can relate to other injuries.
The spinal column and our curvatures:
– Our spinal column is made up of many inward (lordotic) and outward (kyphotic) curves – to give us an ‘S’ shape for optimal movement
– It starts with our Cervical region which is lordotic, thoracic region which is kyphotic. Lumbar region which is lordotic and sacral region which has a small kyphotic curve
What common causes can disrupt our spinal curvatures:
– Long periods of sitting (Jobs that involve desk work – an average person sits around 4 hours per day)
– Amount of time we spend looking down at our phones
A disruption to the normal curvatures of the spine, can pose a disadvantage for shoulder and thoracic movements, causing the muscles and joints to work poorly
A strong link has been established between increased curvature in the thoracic region to a reduced range of shoulder range of motion and increased shoulder pain
It has been found that increased thoracic kyphosis leads to rounded posture, with forward head and rounding of the shoulders.
This results in:
- The Subscapularis muscle become shortened as the shoulder is internally rotated
- The pectoralis muscle becomes shortened across the front of the chest
- The scapula (shoulder blade) begins to lift off and rotate laterally
- The rhomboid muscles which run between the shoulder blades to the spine,
are on stretch and constantly working to bring the shoulders and scapular back downwards in inwards
- Studies have shown a correlation between the thoracic spine and shoulder functioning
- The link has been quantified in a random controlled trial conducted in 2014 involving 2144 patients
- The RCT concluded that an increase in thoracic kyphosis can evoke the development of sub-acromion impingement syndrome, as it reduces shoulder elevation
(Otoshi, K. et al, 2014)
Subacrominal impingement syndrome:
– With an increased thoracic kyphosis and rounded posture, the sub-acromion space in our shoulder joint is narrowed
– The supraspinatus muscle runs through this space and when it is narrowed there is an increased chance it will jam and cause pain with shoulder movements
How can we address shoulder pain brought on by thoracic kyphosis?
1. Thoracic mobilisation exercises and self stretches
2. Soft tissue massage / mobilisation to decrease pain and restore proper muscular function
3. Thoracic mobilisations from a physiotherapist
4. Postural retraining – focusing on scapular positioning
5. Strengthening exercises for muscles of the thoracic, shoulder and scapular region:
6. An assessment and implementation of changes to your ergonomic set up is an effective intervention in re-training posture.
Consider the prolonged time you spend in your working position… the average person spends approximately 4 hours sitting per day!!
At Wellbeing, our approach is on restoring optimal MOVEMENT…