Shoulder anatomy geniuses: what is tight/wrong?

Triathlon Forum
1

When I put my right arm behind my back, for example to reach into a jersey pocket (or if I were to be handcuffed by the cops), my shoulder rolls/rounds forward. The left doesn’t do that at all. You can really see that the right shoulder is more forward than the left all the time. Hardly a coincidence that my right shoulder stopped me from swimming 3 years ago.

Now, you’re thinking… tight pecs. Well, I can do the doorway stretch perfectly fine. I can reach overhead pretty well (not great, but well enough). I can also hold my arms straight out to the sides and internally/externally rotate both sides equally.

So what the heck is tight?

I’ve been doing stretches by putting my forearm behind my back, and the sleeper stretch. I made some progress for awhile, but have kind of stalled out. I need to get at what’s actually tight, not just what feels like a tough stretch. I test it in the pool once in awhile and it’s soooooooo close to being swimmable again.

2

possibly supraspinatus, esp if you have full range internal/external rotation (which would rule out other cuff musculature). Reaching back to a jersey pocket is more or less the position that puts the supraspinatus on stretch. Also, the fact that you have some trouble getting your arm over your head definitely supports the supraspinatus theory… A typical static stretch position for this muscle:

http://www.google.com/...UQ9QEwBg&dur=250

EDIT → that alone would not necessarily explain your right shoulder being more forward all the time though… that part of the equation could be anything from a muscle imbalance to a tight/fibrosed (or loose/unstable) joint capsule in the Anterior/Posterior direction, to any number of other pathologies…

3

This is an absolute and complete shot in the dark. Maybe it is not a tightness, but rather a weakness of the rhomboids. These are the muscles that help to keep you shoulder blades back and in place. Do you have any pics of what your talking about with your shoulder rolling forward?

4

Thanks for the ideas.

When I reach overhead, as far as possible, my ribcage starts to come up about 5 degrees from my arms pointing vertically. It’s the same on both sides. I stretch with my hand grabbing the casing over a doorway for distraction, and then lean into it. The serratus gets a good stretch, and I feel it in the joint. I can then reach overhead better. But the shoulder roll thing is unchanged.

When reaching back, I’d think the supraspinatus would be in a shortened position, not stretched (given how it looks on anatomy charts). It would be stretched when overhead. Can it actually be both?

As for the rotated forward position at rest… 46 years of bad posture and motion? For example, whenever I need a lot of strength, say to take a stuck lid off a jar, that shoulder rolls forward instinctively. It doesn’t HAVE to, because I can stop it if I brace and think about it.

Tight/fibrosed capsule is definitely a possibility. Countless benchpress and dip reps over a lifetime until 7 years ago. And then a few hundred thousand yards of freestyle! Likely not laxity. The various chiros/PTs I saw over the years all said pec minor, but then I pass the doorway stretch and the wall slides tests with no problem.

BTW, the stiffness of that rolled shoulder is incredible. If I put my arm behind my back, lay down on the floor, that shoulder is off the floor. My wife can plant her foot on that shoulder and press down and not really push it down. I stretch it by wedging my shoulder under the bed’s frame and then working my arm out from under it. Can’t even get remotely close to getting my arm behind my back that way. No problem on the left!

possibly supraspinatus, esp if you have full range internal/external rotation (which would rule out other cuff musculature). Reaching back to a jersey pocket is more or less the position that puts the supraspinatus on stretch. Also, the fact that you have some trouble getting your arm over your head definitely supports the supraspinatus theory… A typical static stretch position for this muscle:

http://www.google.com/...UQ9QEwBg&dur=250

EDIT → that alone would not necessarily explain your right shoulder being more forward all the time though… that part of the equation could be anything from a muscle imbalance to a tight/fibrosed (or loose/unstable) joint capsule in the Anterior/Posterior direction, to any number of other pathologies…

5

This is an absolute and complete shot in the dark. Maybe it is not a tightness, but rather a weakness of the rhomboids. These are the muscles that help to keep you shoulder blades back and in place. Do you have any pics of what your talking about with your shoulder rolling forward?

Interesting. That shoulder blade is sliiiiiiiightly winged. A sports chiro has said it isn’t significant, but I feel the asymmetry if I lean against a wall. About the only strength training I do is ring rows, which I’d think help that? They are done with your feet on the floor, and rings hanging from straps about 2’ above the floor. Grab them and pull yourself up. 15 reps is pretty hard, though.

No pics handy, but I’ll try to get one on here soon.

6

haven’t read your whole reply yet but one important thing about the supraspinatus… look where it attaches to the humerus. behind the back DOES stretch it and overhead IS contracting it. I’m not sure how to explain in words why this is but the key is to look at the distal attachment point and how it gets pulled when you bring your arm behind your back.

EDIT - ok now I have read it all… not sure what you mean by “roll forward”. can you describe it differently? This is possibly/probably a key thing here…

btw I’m a 2nd year DPT student and just finished a lengthy shoulder diagnosis part of an orthopedics class so this is actually some good practice for me, thanks for posting

7

EDIT - ok now I have read it all… not sure what you mean by “roll forward”. can you describe it differently? This is possibly/probably a key thing here…

btw I’m a 2nd year DPT student and just finished a lengthy shoulder diagnosis part of an orthopedics class so this is actually some good practice for me, thanks for posting

The roll forward… If I stand and put my fists on my hips, chest out, shoulders retracted, upper arms/elbows pointing straight to the sides, my left shoulder will be back, lined up as it should be. The right is different. That shoulder is rounded forward slightly, and if viewed from the side (the sagittal view, to you medical types), you can see that the upper arm is not in the same plane as the body; the shoulder is forward of the elbow (the upper arm points backward toward the ground).

If I pull hard to get that shoulder no longer rolled forward, that upper arm is now pointing well behind me. So if I lean forward and look into a mirror, my shoulders will be in line with each other, but to get there, my right arm is now pointing straight behind me while my left is still pointing out to the side. In other words, I cheat to get to that position by internally rotating my right arm less.

Going back to standing, hands on hips… If I then put that arm behind my back, I can get there no problem, and in fact I can touch the scapula on the other side. BUT that right shoulder has now hunched/rolled even farther forward for me to get there. If you looked at me from above in that position, you would see that right shoulder well forward of the left.

Here’s another way of describing it. Laying on my back, arms externally rotated up as if being robbed. Both shoulders are against the floor. On the left side I can internally rotate until that forearm is about 30 degrees from the floor. The back of the shoulder stays firmly against the floor to that point. On the right side, that shoulder comes up off the floor at about 45 degrees from the floor, may be even higher. And if I press that forearm further, the shoulder comes even further off the floor.

8

Looking again at what you wrote, I confuse subscap with supraspinatus. I see now. Yes, it looks like if it’s tight it would force the whole shoulder to roll forward if you wanted to put your arm behind your back. BUT, it if was tight, it looks like it would pull your shoulder back at rest (e.g., tilt your arm so that your hands point forward/head of the humerus point backward of your body line when viewed from the side).

9

Take a look at (or have your friendly neighborhood medical professional look at:) adhesive capsulitis/frozen shoulder. The posterior capsule tightens pushing the head of the humerus forward (my shoulder looked like I was really slouching, but only on that side) and limits range of motion

Now I’m guessing you are not the typically demographic-- but it can come on post- injury or in a past- injured shoulder too. What you are describing is very similar to what I went thru/am going thru as part of my shoulder injury

Good luck!

10

One of my shoulders (my R) is pitched forward similarly but not to the extent that it sounds yours is. I keep trying to strengthen my rhomboids and trapezius muscles to pull them back.

Hope you figure it out.

11

how’s your internal rotation? If you hold your elbow even with your shoulder, how far can your hand turn down?

12

This is an absolute and complete shot in the dark. Maybe it is not a tightness, but rather a weakness of the rhomboids. These are the muscles that help to keep you shoulder blades back and in place. Do you have any pics of what your talking about with your shoulder rolling forward?

Interesting. That shoulder blade is sliiiiiiiightly winged. A sports chiro has said it isn’t significant, but I feel the asymmetry if I lean against a wall. About the only strength training I do is ring rows, which I’d think help that? They are done with your feet on the floor, and rings hanging from straps about 2’ above the floor. Grab them and pull yourself up. 15 reps is pretty hard, though.

No pics handy, but I’ll try to get one on here soon.

Something like a ring row, depending on how you are doing it can actually contribute to this. With a long lever (if you have long arms) then the wrists and arms can end up taking over for the movement, especially if you are as horizontal as you say relative to the floor. Then, every time you lower yourself and have to stop, your shoulder needs to rotate forward to stop the movement. I’d start with limiting range during that movement and see if your shoulder can actually pull itself back without having rotated forward (if that makes any sense). Or, switch to a more vertical row.

13

Impingement from scapular winging.
Stop going to a chiropractor and find a physical therapist who is big on shoulder.
Rehab rehab rehab. And it will get worse before it gets better.
Then you will slack and start to impinge again repeat periscapular strengthening.
Dominant shoulder at rest is always held lower. If your winging is really bad may need to start with an s3 brace as periscapular muscles are too week to rehab.
USsa swimming site has good exercises. But supervision is a must.

14

Posterior shoulder capsule immobility, thoracic spine immobility, pec minor weakness, scapular stabilizer weakness.
Stop exercising your shoulder, you’ll increase compensation pattern.
Go to PT.

15

Three significant things to look at:

  1. serratus anterior - actively keeps the scapula from winging and therefore the uppermost portion of the shoulder blade from tipping forward
  2. pec minor tightness versus pec major tightness - minor will pull the top of the scapula forward (anteriorly) without the major being tight and depending on the type of “door stretch” you may not be stretching it with your positioning
  3. posterior capsule tightness - shifts the glenohumeral head anteriorly, a lot of people are at least a little tight here

Also, your dominant side scapula will tend to rest at and become accustomed to a slightly more protracted position than the non-dominant.

None of these things are going to kill you! But maybe you might consider working on your serratus anterior strength, stretching the posterior capsule and also on the scapular retractor strength as other people have suggested.

16

Something like a ring row, depending on how you are doing it can actually contribute to this. With a long lever (if you have long arms) then the wrists and arms can end up taking over for the movement, especially if you are as horizontal as you say relative to the floor. Then, every time you lower yourself and have to stop, your shoulder needs to rotate forward to stop the movement. I’d start with limiting range during that movement and see if your shoulder can actually pull itself back without having rotated forward (if that makes any sense). Or, switch to a more vertical row.

Yes, I’m as horizontal as possible – back is just barely off the floor at the bottom. I do some ring “shrugs” on my last set, pulling my shoulders back as far as possible while at the bottom. Usually something like 15 reps. For the rows themselves, my arms definitely do a lot of the work, as I have to really concentrate on using lats, and they rarely feel fatigued/pumped.

17

One of my shoulders (my R) is pitched forward similarly but not to the extent that it sounds yours is. I keep trying to strengthen my rhomboids and trapezius muscles to pull them back.

Hope you figure it out.

TC (good to see you here, BTW)…

Are you actually able to get your R shoulder pitched properly? Can you put your arm behind your back without making it pitch more forward than the left?

18

As with everything this thread would work better with pictures. Send me an email; I am not sure I have yours anymore.

19

Take a look at (or have your friendly neighborhood medical professional look at:) adhesive capsulitis/frozen shoulder. The posterior capsule tightens pushing the head of the humerus forward (my shoulder looked like I was really slouching, but only on that side) and limits range of motion

Now I’m guessing you are not the typically demographic-- but it can come on post- injury or in a past- injured shoulder too. What you are describing is very similar to what I went thru/am going thru as part of my shoulder injury

Good luck!

Very interesting. I haven’t had any acute injuries. Just the usual age 17-35 weightlifting, volleyball hitting, baseball throwing, etc. And then a few years of swimming (with a nagging shoulder annoyance throughout those times). Eventually it just crapped out, and it hurt like hell to reach across my body (pulling arm across neck, or reaching for the seatbelt in the car). My low point came when I spilled coffee on the passenger seat and reach over to wipe it up. ZAPPP. It has taken me 3 years to get to where I think I can start to swim again (rest, then some band exercises, then ring rows/pushups for the last year+, then aggressive internal rotation stretching for the last 4 months, etc.). I’ve improved that rolled shoulder some, but I suspect it’s indicative of something that needs more work before I start swimming more than a few hundred yards here and there.

Can you tell me more about what you did and how you’ve approached the problem so far?

20

Posterior shoulder capsule immobility, thoracic spine immobility, pec minor weakness, scapular stabilizer weakness.
Stop exercising your shoulder, you’ll increase compensation pattern.
Go to PT.

I’ll try to comment on all the other posts in this reply.

I’ve been to PTs, including an excellent one. I have seen chiros as well, getting Graston and ART. I saw a couple surgeons a few years ago, and had two MRIs. One showed a SLAP tear, the other didn’t - I obviously chose to avoid surgery. “Typically athlete’s 40-something year old shoulder,” is how one doc described it (minor tendinosis of the supraspinatus, infraspinatus, IIRC).

Thoracic spine has reasonable mobility (I use a pair of baseballs taped together and do something like a crunch over them).

Internal rotation… Standing against the wall, upper arms to the sides and rotated so the forearms point forward (= 90 degrees). I can rotate my forearms about 30-45 degrees further toward the floor. Of course, the right one want to lift off the wall when I get close to that limit. The left stays against the wall. But NOTE, the left and right are about the same in this test.

Posterior capsule tightness… I test about normal on that, using the sleeper stretch or by lying on my back, internally rotating my arm and bringing it across my chest (elbow goes well past my sternum).

Serratus… I do pushups with a plus now and then. They are very easy. I can do just the plus part all day. Doesn’t mean it’s doing it’s job right, though, just that I can do that movement with ease!

Pec minor tightness… This is what many have pointed to as a likely cause. I thought the doorway stretch debunked that, but maybe not?

Someone mentioned USA Swimming’s exercises. Yes, I did those for awhile, got nowhere. They’re conservative for sure. I know they wouldn’t like some of the things I’ve done!

Thanks to everyone for sticking with this thread.