When your shoulder problem might not be coming from your shoulder

Written by:  Paul Kochoa, PT, DPT, OCS, CKTP, CGFI

This week I’ve had at least 2 patients come in with shoulder problems, specifically having pain with overhead reaching at their end range.  They were both active and fairly strong, but had nagging pain at the top of their shoulders when they lifted their arms overhead.  Just like my other post about “regional interdependence”, I looked at other areas of their body connected to their shoulder.

Classic shoulder problems can involve the collarbone (clavicle), the shoulder blade (scapula), and the upper arm (humerus).  Also involved are the soft tissue structures around that joint: the rotator cuff muscles, the bicep muscle, the chest muscles, etc.  However, one area that can be overlooked is the thoracic spine.

The spine is divided into three sections:  the cervical spine (the neck), the thoracic spine (mid back), and the lumbar spine (low back).  The thoracic spine is flanked on both sides by the ribs.  Some of the muscles that control the shoulder and arm are connected to the ribs and the thoracic spine itself.  Traditionally, there isn’t a lot of movement that goes on in the thoracic spine compared to the other two spine sections.  That’s because of the way the segments link together in the mid back and how they’re all linked to the ribs.  It’s held together in there pretty tight.  But if you look at the system as a whole, you start seeing the connection.

Let’s try an experiment.  Sit down in a chair, slouch down, rounding out your low back and chin jutting forward.  Now try and raise your arm as high as you can over your head.  Next, sit up straight and as tall as you can.  Now try the same thing, lift your arm over your head and see how it feels.  If you did it correctly, you’d probably notice that the motion was much easier to do when you sit up straight.  Same thing goes for the thoracic spine and the shoulder complex.

Both my patients that I saw really lacked any thoracic spine extension, they were pretty tight through the mid back structurally through the joints and the soft tissue.  Once we started mobilizing and working on their mid back, they started to get better flexibility and range of motion overhead.  They would come in with pain, and then leave feeling a lot looser and have no pain when reaching to end range overhead.

What can you do?  Well, if you’re having shoulder pain, you should go see a medical professional like a physiotherapist that can evaluate you and diagnose the exact problem.  If you would like more information, please call Professional Physical Therapy and Training at 973-270-7417.  Our offices are located within the YMCA locations in Madison and Summit, NJ.  You do not need to be a member of the YMCA to visit with us.  In the meantime you can try working on your midback.

Here’s some stretches that you can try via YouTube:

Thoracic Spine Mobility

Thoracic Spine Rolling