anatomy, exercise therapy, informative

Got shoulder pain? Here’s why I want to look at your spinal mobility first…

Let’s set the scene… You’ve been struggling with shoulder issues for years… you can bearly remember when it started to bother you. Initially, it was just a niggle – maybe the odd twinge here and there, or a dull ache. It didn’t used to get in the way of your favourite activities. But over the months or years since it first started it’s slowly come to become such a nuisance that you started to avoid certain activities. In fact, at some points it’s even stopped you from doing simple day to day tasks, like household chores or completing tasks at work.

Now imagine this… you’ve booked in at a therapy clinic to get your shoulder checked out. Perhaps you’re a bit pessimistic – you’ve been to a few therapy professionals before. Maybe it helped:  the pain was managed in some cases – at least for a while. Maybe it didn’t help for long… or maybe it didn’t help at all. Despite this, you are still somewhat hopeful. You’ve heard great things from other visitors to the clinic. You’ve seen the ‘Client Testimonials’ – there has to be some hope!

If this doesn’t work, then you don’t know what possibly will

You arrive at the clinic for an initial assessment. One of the first things you do is talk to the therapist about your shoulder pain. You discuss in detail how long you’ve had these pain symptoms, what kind of pain it is, how often you experience, how well you’ve responded to other therapy treatments. You describe how you’ve had sleepless nights, and even considered surgery and cortisol injections just to get a full nights rest for the first time in months… or even years. You spell out just how disruptive it’s been to your life. If this doesn’t work, then you don’t know what possibly will – you’ve tried everything else.


So, imagine your dismay – after spending the best part of an hour pouring over every last detail of your nightmare shoulder situation –  the therapist spends maybe less than 2 minutes assessing your shoulder. In fact, he/she reports that your shoulder doesn’t seem to have anything really wrong with it – aside from your pain, there’s no sign of an obvious injury. All is well and good. They give your shoulder a quick massage treatment and run through a handful of shoulder exercises with you, before booking you in for a follow-up appointment (… or a costly block of 10 appointments). You still don’t really know what’s happening with your shoulder.

Firstly, let talk about the complexity of an issue like this…

The truth is – the therapist in this scenario might be right. Pain in general is quite complex – it’s an experience that is influenced by many factors, including: sensory input, our emotions, our beliefs and thoughts about pain/injury, our stress responses, our history of injury and fear or anxiety. If you have experienced a shoulder injury in the past you might have a heightened sensitivity to input from some of these factors. Therefore, it’s quite possible that you may experience pain despite the fact that the injury has long healed.

But that’s not what I’m here to talk about… I want to talk about your spinal mobility.

Every single person has asymmetries in their ranges of motion. This is regardless of their day job, chosen sport, or daily activity levels. In my clinical experience, I have found that shoulder pain issues are often effectively resolved by improving range of motion in the spine. In particular, the range of motion that I find most closely linked to shoulder issues is a limit in rotation of the upper and mid-thoracic spine on the same side as the shoulder pain issues. The most effective way to do this is to balance out your range of movement in both directions (rotation to the left and right) with a programme of progressive (slowly increasing load) strength based exercises. It’s important that these exercises utilise your full spinal range of motion in both directions.


One of the most enlightening activities my clients can undertake is monitoring their most frequent patterns of movement. Interestingly, many of my clients find that when they are doing every day tasks, such as driving or lifting or reaching for items  (or all three of these things at once!), they favour one side. This is when they usually experience the most acute pain. So, of course, they adapt the movement to avoid the pain. However, this only works to reduce their pain in some cases, and if it does the respite from pain rarely lasts long.

I will give you an example: if you drive a car in the UK, you will sit behind the wheel on the right hand side of the car. If you want to grab a bag or item from the back of the car you will need to reach with your left arm. If you have a good range of motion in spinal rotation to the left – and your spine is strong in this position – you place less strain on your left shoulder as you reach back to lift the item towards you. However, if you have poor spinal mobility in this direction your shoulder will end up doing the legwork – no pun intended… ;). So, over time you might find that your shoulder becomes overloaded on a frequent basis. This might just leave you with short term pain, but it can lead to persistent pain issues in the long run , for example: an overload injury like a shoulder tendinopathy.


Either way, the best solution is to use regular strength exercises for your shoulder AND spine that utilise your full range of motion. The effects of this are much longer lasting than sports massage or joint manipulations – they can also prevent you from sustaining further injuries. The most awesome thing about this solution is that you can implement it yourself when you get a flare-up – without needing to fork out for dozens of expensive appointments at a clinic. You can also learn the limitations of your body and directly influence them too!

If you are experiencing shoulder pain then you are warmly invited to enquire about assessment and treatments available at the Move Well Clinic locations across the East and West Midlands, UK.


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