Would you believe that your shoulder pain may be related to your breathing and your gut?
We’re going to look at how shoulder pain when breathing is connected.
If you watched my blog last week, I talked about kind of modern pain science, and discussing the idea that many different inputs into the central nervous system, if your brain thinks they are a problem, can eventually create pain.
Now I’m going to talk about one of my favorite ones when it comes to the shoulders today. This is stuff that I looked at many, many years ago when I was in school.
It’s been well known for probably the last hundred years or so, but very few people actually talk about it, so I want to just discuss it with you really quickly, and the simple idea here is that issues within the diaphragm and the abdominal wall, and the abdomen itself can actually create shoulder pain when breathing in.
In medicine, we talk about what are called head zones. These are called, basically, reflex zones, where problems in the liver, or the stomach, or the gall bladder et cetera can create recurrent pains in different areas of the musculoskeletal system.
Now, physicians are very familiar with this, but a lot of people haven’t heard about it, and so often people come to us, they go, “Hey, I have this kind of chronic right-shoulder pain, or left-shoulder pain. It comes and goes, and I have a really hard time getting rid of it, and I’ve done every exercise under the sun, and it never seems to fix it.”
Well, there may be a reason for that. So let me explain to you, really quickly, how to, first of all, decide if what we’re about to go through may help you. All right?
Whenever we see pain, particularly in the shoulders and neck region, so traps and shoulder, that are primarily have a history pattern that sounds like this: They say, “You know, I have this kind of recurrent shoulder pain,” and if you ask them about it, they’ll say, “Well it’s kind of deep. It’s achy.” And if you ask them, “Where do you feel it the most,” they’ll do this. They’ll go, “Well, it’s kind of in this area right here.” All right?
So whenever we talk about deep, diffuse, achy pain, very often that is synonymous with referred pain from somewhere else. You want to compare that to, if you’ve ever had a bad fall or a sprain, you know that when someone asks you to move your shoulder, if you’ve ever really hurt it in a fall, you can go, “It hurts right here.”
So the difference that you want to first ask yourself is when you have your shoulder issues, would you describe it as, “It’s kind of here,” or would you put your finger on it? If you say, “It’s here,” then the exercises we’re about to do, particularly focused on the abdomen, may be really beneficial for you. All right?
So the concept here, like I said, is that irritation, and I’m not saying there’s a disease process, I’m just saying that irritation in the diaphragm, liver, gallbladder area, stomach on the opposite side, can cause chronically referred pain into the shoulders.
For the right shoulder, we’re usually interested in the right side of the diaphragm, the liver, and the gallbladder. Now people that have had issues here, they will complain of diffuse right-shoulder pain. They’ll often also complain of pain right beside the inside border of the shoulder blade. It feels like a rib constantly goes out. They’ll say things like that all the time.
So if you have, again, this kind of presentation that I’m talking about, one way to work on testing this is to see whether good diaphragmatic breathing on that side actually changes the pain pattern. All right?
We’re just going to use the right side as an example. This is very, very easy.
If you have pain in right shoulder blade when breathing, then we’re going to work on right-side breathing. If you have pain in left shoulder blade when breathing, we’re going to work on left-side breathing. No more complicated than that.
So simple thing that we’re going to do first is we’re going to test your shoulder. Go ahead and test different ranges of motion that are potentially problematic for you.
If you have problems with internal rotation, external rotation, abduction, flexion, extension, it doesn’t matter. I just want you to see how your shoulder feels. Notice how tight it is. Notice how far you can move it in different ranges and also what level of pain you’re experiencing.
Let’s say, for me, let’s say I’m imaginary and have this problem, and I have pain here, and it’s a level four, and in this motion this is as far as I can move. All right? So that would be my test.
What we’re going to do next is we’re going to go do a little breathing exercise. As soon as we’ve completed the breathing exercise we’re going to come back and retest the shoulder.
Very simple idea to see if the breathing exercise actually impacts on your shoulder motion. The breathing exercise that we’re going to do is called stair step breathing. All right? Super-simple idea.
And what I’m going to do, again, because we’re imagining that I have right-shoulder issues, so we’re going to focus on breathing on the right side of my abdomen.
Good abdominal breathing, what we want to do, is we want to imagine that there is a belt, or maybe a weight sitting on the right side of my abdomen.
As I take a breath in, I want to expand my lower ribcage and abdomen against that pressure.
Now what we like to do is bias the body in order to really target that area, so I’m going to come over here, and you can do this with a door frame or anything else.
I’m going to come over here and as long as it is comfortable, I’m going to reach up over my head with my right arm. I’m going to left-side bend my body. I’m going to bend my trunk to the left, rest my arm on something, my right arm up high, and now I’m going to start by bending my knees, and I’m going to take a deep breath in with a whole goal of being able to feel a stretch and a filling in my lower abdomen and lower ribcage. All right? And then I’ll breathe out.
Breathe in again, and breathe out.
Don’t really care how many seconds you’re breathing in, breathing out right now. This is more a mechanical motion than anything else, so try to, again, imagine creating a three-dimensional, front-to-back, and side-to-side expansion in your lower ribcage as you breathe in and out.
Expand and contract. All right? You do that maybe three to five breaths, relax, stand back up, and then all that you have to do is retest your shoulder again.
Again, in my imaginary example I was a 4 out of 10 pain here. Maybe now I’m a 1 out of 10 and I can go further. I was stuck here. Maybe now I can go into a full internal rotation.
Again, the idea is to look at your history. Meaning when you have pain, do you feel it all over, or is it one spot?
And then two, test an input, an input focused on areas that we know reflexively cause problems in the right shoulder to see if some good, basic, breathing exercises change your pain, change your range of motion. A very, very simple concept.
Now, remember this, right shoulder, breathe on the right side.
Left shoulder, breathe on the left side.
That’s all that you need to focus on.
This is a very, very powerful intervention for a lot of people. Breathing by itself takes care of a lot of issues in the neck and shoulder when done well, so spend a little bit of time with this.
If it works well for you, aim for somewhere between three and five sessions a day, three to five breaths, nice and easy, or any time you start to feel that pain creeping in.
Give this a shot. If you have any questions about it, let us know, otherwise good luck.
Why does my shoulder blade hurt when I take a deep breath?
Issues within the diaphragm and the abdominal wall, and the abdomen itself can actually create shoulder pain when breathing in.
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