Why Posture Can Cause Shoulder Pain

For most of our lives we have been hearing, “Stand up straight! You’re slouching!” So naturally we take a deep breath in, squeeze our shoulders back and maybe up toward our ears, feel some nice relief and let out a long sigh. Then 30 seconds later we return to our slouched posture. So why are we comfortable with a slouched posture? If it doesn’t hurt, then why does that put us at risk for other musculoskeletal issues? Many of us spend time sitting at work, school, or spend countless hours looking down at our various electronics. According to the CDC 25% of Americans sit for at least 8 hours a day and this number continues to grow. Without educating ourselves of the importance of proper posture then we are leading ourselves down a potential path to a multitude of musculoskeletal impairments, especially in the shoulder.

Diving into the anatomy of posture we begin at the head, neck, shoulder, and mid back region. Our head and neck should be in a slightly extended position or what is known as a lordosis. This will transition into our mid back or our thoracic spine which has a natural flexed position or what is known as a kyphosis. Our shoulders should be extended back with our shoulder blades slightly pinched and resting on our ribcage.  With prolonged sitting or electronic use we tend to let gravity win which will then increase the thoracic kyphosis in our mid back, our head will begin to shift forward, and our shoulders will become rounded. Over time this can cause muscle imbalances which can be seen below: tight shoulder/neck/chest muscles, weakened muscles in the front of the neck and mid back region near the shoulder blades.

So how do these anatomical compensations lead to various injuries in the shoulder? These posture changes ultimately change the way our muscles can function and over time can change the physical bone structure of our shoulder. When our head is shifted forward, shoulders rounded, and shoulder blades tilted forward similar to the picture above we close down the amount of space the upper arm bone, the humerus, can freely move. The shoulder is a ball and socket joint which means it is a very mobile joint and moves in every plane of motion. With the above postural changes the shoulder has a reduced amount of space to move because the shoulder blade and collarbone are now in the way preventing the humerus from freely moving. Despite this we still accomplish all of the motion we require but we do so via compensation patterns through our upper neck and shoulder muscles such as the upper trapezius and levator scapulae. Over time you may start to feel stiffness or burning in your neck and shoulders – your first sign of this anatomical and physiological change. This discomfort can become unrelenting and a literal pain to your day to day function.

Another common injury that may result from this posture change are rotator cuff injuries. Now that the space between the humerus, collarbone, and shoulder blade are reduced we are more likely to irritate the rotator cuff tendons as this is exactly where those tendons pass. Every single time we raise our arms overhead with this type of posture we could be rubbing against those rotator cuff tendons which are intended to be contained within a frictionless environment. As you could imagine if you add friction to this over and over and over again then it is only a matter of time before we start getting aches, pains, tendinopathies, or potentially worse, a rotator cuff tear.

Posture is key for proper shoulder movement and is something we should focus on with every rehabilitation and strength training program. The primary areas that need to be addressed are reducing the work and stress placed on the upper trapezius, levator scapulae, and pectoral muscles, and recruit the middle and lower trapezius as well as the serratus anterior muscles so they can join the party in our day to day tasks that involve the shoulder and neck. When we are better able to recruit the middle and lower trapezius and serratus anterior we can optimize the space between our shoulder blade, collarbone, and humerus to successfully move with reduced friction in the region and take that stress off of the rotator cuff and the overactive upper trapezius and levator scapulae. Give us a call at 3 Dimensional Physical Therapy for your posture screen and learn some stellar exercises to help engage those under active muscles. We want to provide you with tools that will help you for a lifetime!

And remember, in New Jersey you do not need a referral from a physician to make an appointment with our Physical Therapists. Direct Access allows us to evaluate and treat you without a physician’s referral so give any of our offices a call to make an appointment today!

Check out this video to see 3 exercises that can help strengthen your shoulders to prevent bad posture!

Resources:
https://time.com/5459319/americans-sit-too-much/