Shoulders, shoulders, shoulders!! It is an area of the body that we get asked to work on quite a bit. I have written in the past about what we call “the perfect storm”, which happens when the upper ribcage pushes posterior moving the scapula into abduction. This instantly tightens serratus posterior superior, serratus anterior, and pectoralis minor and can be the root cause of thoracic outlet symptoms. This week I saw 2 clients who have another shoulder pattern that I find to be fairly common. The scapula moves anterior, as do the ribs, while the clavicle moves posterior. The coracoid process of the scapula, which should sit below and slightly posterior of the clavicle, moves anterior to the clavicle. At the same time, as the clavicle pushes posterior it moves inferior and becomes locked behind the coracoid process. Range of motion is limited in full flexion or extension. The pain from this can be intense and can encompass the posterior shoulder, the superior shoulder, the base of the neck, and the upper arm.
For both clients the pain was felt in multiple areas and multiple muscles. This is a pattern that requires work with all structures in the area. By working with the position of the coracoid process and the acromioclavicular joint first, I was able to soften pectoralis minor, the deltoid, teres major, and latissimus. But this particular pattern causes shortening in the rotator cuff, particularly supraspinatus and subscapularis. When palpating the axilla, I clearly felt a distinct adhesion between the upper fibers of subscapularis and the first and second digitations of serratus anterior. I could have instinctually worked with the muscles and that adhesion site, but I would not have gotten very far and I would have caused the clients quite a bit of pain. Instead I chose to follow the position of the shoulder girdle and use the scapula as a handle to create a position that allowed the scapula to move posterior and the clavicle to move anterior. This created space in the axillary area and significantly reduced the adhesion. The reduction of the adhesion helped to lessen tension in both subscapularis and serratus anterior, while the additional space in the shoulder girdle reduced the shortening of supraspinatus.
The shoulder pattern was changing and this allowed me to focus on the muscles in a way that was comfortable for the client and created lasting results. At the end of the session there was very little pain with full range of motion in flexion and extension. Both of these clients will need a few more sessions. This is a stubborn shoulder pattern, but in my experience this treatment usually holds until I see them next.