As a coach that works with powerlifters, weightlifters, strongmen (and women), and the general public that just wants to feel better, the modern day posture and activities make my job more difficult. The good part about it is I have seen a lot of people with shoulder issues over the years. With this experience I have learned quite a few things.
Mike Boyle and Gray Cook's Joint by Joint Theory was game changing for me. This theory basically states that some joints require more mobility than others, and other joints require more stability than others. If we lose that required mobility or stability in a joint, it throws the entire system off.
This made a lot more sense to me after reading Thomas Meyer's Anatomy Trains (1). In this text, Meyers explains that there are several fascial chains that connect us from head to toe. A snag along these lines can affect the rest of the system, much like a fly getting stuck in a spider web changes the structure of the whole web.
A few years back if someone would get shoulder pain, I would work to restore function by working on restoring proper movement around the joint. For example, we may have done thoracic mobility drills, scapula stabilization exercises, and maybe some gleno-humeral mobility drills.
Now, I understand that if someone has shoulder pain, chances are their hips have to be cleared as well. I have also learned that no matter where someone is feeling pain, we need to look at their feet. The majority of people are missing the 65 degrees of extension in their big toe that is required for proper gait.
The other thing that I have learned is that mostly everyone's breathing sucks and believe it or not, breathing well is where proper movement all starts. We need proximal stability of the spine in order to get mobility in distal joints. If we fail at proximal stability, those distal joints will tighten up to provide us that necessary stability.
We can stretch out all we want to try and loosen up those tight joints, but it will never work if we do not address the stability issue. In fact, we would not want it to work because it would give us range of motion that we are not capable of controlling. This is where our injury risk can increase.
Stretching has its place, but we need to identify the stability issue and correct that in order to make that stretching effective. All tightness is a lack of stability somewhere. Find that stability issue, release and stretch the tight muscle groups, strengthen the weak ones (preferably in a movement pattern), and lock it in with some stability training.
What I have found to be the stability issue for shoulder pain (especially overhead) is our poor breathing. This makes a lot of sense for a few reasons. For one, our breathing helps to stabilize our spine. Also, our scapula is attached to our ribcage.
Being able to take a big, full breath in is important to actually stretch out a lot of muscles on the ribcage. Muscles that, if they are tight, will not allow for adequate overhead motion. In order to do this we need to release the diaphragm.
In the video below I am using an Acumobility ball and I am angling it up underneath the bottom rib. I apply some pressure and Matt inhales and crunches up followed by an exhale and relaxing, letting the ball sink in deeper. Do this for 5 reps on each side. As you can see this can be quite painful.
Check your breathing before and after. Once the release is complete you should feel it is easier to take a deep breath. Now that we have increased this ability we want to practice it. I prefer the 90/90 position for this as it is an easier position to take in a good full breath.
This position has you lying on your back with your feet on the wall. Hips are flexed to 90 degrees and the knees are bent at 90 degrees. This is where the name 90/90 comes from. From here inhale with your nose filling your lower back first, then your stomach, followed by your chest, and finishing in your upper back and neck. This should take roughly 6 seconds. The exhale should be half this time and allow all of your air to come out. Make sure to push your lower back into the floor the whole time.
Once we have improved breathing and stability of the spine, as well as mobilizing the ribcage, we need to piece this together into some shoulder movement. In the same 90/90 position, keeping the lower back pushed into the floor, place your elbows even with your shoulders, bent at 90 degrees, with the forearm and backs of the hands on the floor. Keeping the arms and hands touching the floor, slide the hands overhead until the elbows are locked. Once they are locked take the same breath you were taking before, big inhale, followed by a full exhale. After the breath, return them back to the start position. Repeat for 5-8 reps.
Once we have completed this I like to lock it in with some stability. A kettlebell bottoms up carry is a great choice here as it provides stability in gait. On top of those exercises we want to make sure we address the hip. An assessment can help identify where the hip has ROM deficits and the mobilizations should be based off of that assessment.
However, if you do not have an assessment, just perform some mobilizations in all directions. A good bang for your buck exercise after the hip mobilizations is a half kneeling (one leg up and the other knee on the ground) or split stance bottoms up press. This helps lock in stabilization throughout the whole system. There is not one right exercise, but many that can fit this bill. If you constantly assess and reassess you will quickly learn what works and what does not work.
Comment: In addition to these techniques, the Éiriú Eolas breathing and meditation program focuses on diaphragmatic breathing and stress relief that can help relieve shoulder tension and pain.