Shoulder Pain? Why Your Back Might Be to Blame?
Shoulder issues are among the most common yet misunderstood reasons individuals seek my expertise. While the shoulder often appears to be the primary source of dysfunction, the root cause is typically not the shoulder itself but rather the thoracic spine and scapulothoracic joint.
The shoulder is a highly complex joint, essential for upper limb movement and function, as it relies on a finely tuned balance of muscular force relationships and joint stability. The thoracic spine and scapulothoracic joint play critical roles in maintaining this balance, directly impacting shoulder health and performance..
Muscles Involved in Shoulder Function
Seventeen muscles are directly involved in moving, stabilizing, or controlling the shoulder complex. These muscles attach to both the shoulder and scapula, each playing a specific role in movement and stabilization. Working synergistically, they enable complex shoulder movements.
- Flexion
- Extension
- Abduction
- Adduction
- Rotation (internal and external)
- Scapular stabilization
The Role of the Thoracic Spine in Scapulothoracic Joint Function
The scapulothoracic joint is a pseudo-joint where the scapula glides over the thoracic rib cage. While it lacks traditional joint structures (e.g., a joint capsule or synovial fluid), it is essential for shoulder movement and stability. More often than not, limitations in thoracic spine mobility or poor posture are the underlying issues, not the shoulder itself.
Impact of the Thoracic Spine on the Scapulothoracic Joint
Muscle Imbalances:
Poor thoracic posture, such as kyphosis, disrupts the length-tension relationships of muscles like the rhomboids, serratus anterior, and trapezius. This imbalance compromises both the stability and mobility of the scapulothoracic joint.
Thoracic Extension:
Thoracic spine extension increases shoulder flexion range and overhead reach. In contrast, a flexed (hunched) thoracic spine causes the scapula to adopt a protracted and downwardly rotated position, limiting overhead motion.
Scapular Positioning:
Proper thoracic alignment allows for optimal scapular positioning, which is essential for the effective activation of key muscles like the serratus anterior and trapezius. These muscles are critical for upward rotation of the scapula during overhead movements.
Shoulder Biomechanics:
Adequate thoracic extension creates space for smooth scapular movement, facilitating proper scapulohumeral rhythm—the coordination of scapular and humeral motion during arm movement. Restricted thoracic mobility disrupts this rhythm, leading to compensatory movements, early fatigue, and an increased risk of injury.
Conclusion
Shoulder dysfunction often stems from issues within the thoracic spine and scapulothoracic joint, rather than the shoulder itself. When posture is poor—particularly with thoracic kyphosis (a hunched upper back)—the scapula becomes misaligned, leading to compensatory movements. This dysfunction sets the shoulder up for inevitable failure, even if it isn’t the root cause of the problem. You get what you train: If you spend hours every day sitting hunched in a chair, your body adapts and becomes optimized for that “hunched-in-chair lifestyle training.” Over time, this repetitive posture limits thoracic mobility, disrupts scapular alignment, and sabotages shoulder function.
As someone who works at a desk to treat patients, work in a gym to train clients, and is the reigning strongest push-pull champion ( bench and deadlift) on the planet, I know firsthand how critical it is to reset shoulder mechanics.
I have a few go-to band exercises that I use regularly to get my shoulders ready to perform at their best. Check out the videos I’ve shared and contact me to improve your shoulder health, break free from postural dysfunction, and optimize your shoulder performance for whatever life demands.
Shoulder Activation Video:
Hyperextension Mini Band Low W (External Rotation) 2sets x 5-10
A great full-body posterior chain activator designed to warm up the shoulders and back within their functional sequential chain. This exercise emphasizes building external rotation strength and scapular engagement through focused squeezing. Perfect for preparing the entire posterior chain for movement.
Bilateral Banded Internal Rotation Flyes: Perform 2-3 sets of 5-10 repetitions to activate key muscles that may have become dormant or underactive from prolonged sitting. This exercise is perfect for re-engaging the internal rotators and stabilizing muscles, effectively preparing your body for optimal movement in your training.
“Empowering Physcial Education Today to Elevate Performance Tomorrow.”-Dr. Blake Tobin DPT