Shoulder pain. If your shoulder pain keeps coming back, even after you have fixed it, here is probably why.
Whenever we start looking at the shoulder, most of us were trained to look at it very classically. We have shoulder pain, so okay, what are we going to do? Well, we’re going to work on the musculature, we’re going to work on the joints, we’re going to work on the soft tissue, the skin, whatever it is, your kind of traditional background. We’ll do some strengthening work, we’ll do some mobility work, and we’ve probably all been through that, right? Where you’ve had a shoulder issue, you saw someone, maybe they said, hey, you know, it’s your bicepital tendon, or they said, oh, I think that your AC joint is a little stiff, or maybe it’s your sternoclavicular joint, so they give you all these mobilizations, and then you do a lot of external and internal rotation work, and maybe it helped, but then it came back.
And that’s what I want to talk about today, because whenever we start to look at pain, separately from tissue, everything changes, and from a modern neuroscience approach, here’s what you have to understand. Your shoulder pain is a decision being made by your brain. It is not coming from the shoulder itself. Now, that does not mean that your shoulder may not be involved and that you might not have some weird input coming from the shoulder, but ultimately your pain is happening, because your brain’s decided, for some reason, to protect you from your own shoulder. And so that leaves then a bunch of different options for us to start to explore. So, as an example, what I want you to do is I want you to first test your shoulder, whatever is painful for you at the moment, that could be flexion, abduction, extension, internal rotation, external rotation, like horizontal, adduction, I don’t care. Whatever it is that is problematic for you, I want you to test it right now. All right, so after you’ve tested it, what we’re going to do is we’re going to now start to look at this from a brain-based perspective, because again, I’m assuming you’ve already done a lot of stuff here. Maybe you’ve already warmed it up today, right? You did some prying and some distraction and you did your band work and you did all the stuff that you’ve tried to do in the past. So now, rather than relying on something that kind of works some of the time and then it comes back, we want to start to look at this as a systems problem, as a brain problem.
Now, before I get into exactly what that means, if you are a movement professional of any kind, a doctor, a physical therapist, a movement coach, Pilates Yoga, martial arts, tennis, whatever. If you earn a living working with people from movement, I’m getting stuff from off-camera here, people demonstrating different sports, whatever it is that you do. If you work with movement and you’re interested in blending what you’re already awesome at with modern applied neuroscience, go to the pinned comment and make sure that you contact us. We’d like to either talk to you on the phone. We can contact you via email. We have hundreds and hundreds of free videos here. We have online courses. There’s just so much we’d like to share. So again, if this is of interest to you, make sure to contact us.
Now, as I said, whenever we start talking about pain, the number one issue is that people still consider pain, something that comes from the periphery and goes to the brain. That is wrong. Pain comes from the brain and then the body reports on it. That feels incredibly counterintuitive, but this is definitive research. We know this at this point. You can get what is called threat or nociception from the periphery. Once that goes to the brain, the brain then has to integrate those threat signals. Maybe you have had an injury to your shoulder, but it has to integrate those threat signals with the rest of your body, with all of your systems. And whenever we start to approach it from that perspective, the eventual pain decision, and again, I’m going to keep using that word, can be altered through many things other than local focus.
Additionally, the thing you have to recognize is that if you have right shoulder pain, constantly working on and prodding the area and making it hurt in the therapeutic process can actually encourage the brain to protect it more. If you have worked with people for any period of time, you already know this. And if you overwork an area, they complain of it more. And I see this all the time with the shoulder. So with that said, what are some other options? Well, whenever we look at neurology, we know for sure that the shoulder relies on a tremendous amount of regulation and integration with the eyes. There are actually neurons and neuronal pathways that are very specific for my eyes move to something, my head follows, and then I coordinate shoulder, elbow, hand and wrist motion. We actually have specific neurons that do this. And what that tells us is that a lot of people that have shoulder issues may actually have shoulder issues because they have lost either good visual input, good vestibular input, good information from their neck, or they have lost stability for the shoulder in the rib cage area so that now they don’t have a solid foundation from which to move.
So I already asked you to test your shoulder. So let’s say I have for me. I did a pretty hard arm workout yesterday, shoulder workout. So I have just a little bit of soreness as I go into internal rotation. So the first thing I’m going to try is I’m going to test my eyes. Now I’m not going to go deeply into the neurology behind all this, but there are movements that our eyes have to do called smooth pursuits. And a smooth pursuit means I have a target in front of me at some distance, and it begins to move, and I follow it smoothly with my eyes without my head moving.
Now, whenever we look at the neurology of a smooth pursuit, if I start my finger here to my right, my head still, I look at it, and then it begins going to my left. All right, that is called a leftward smooth pursuit. Leftward smooth pursuits often are initiated by the hemisphere, the half of the brain on the side to which you’re moving. So if I move my finger to my left and I’m using a smooth pursuit to follow with my eyes, that’s all starting with my left hemisphere, left half of my brain. Why is that important? Because the left half of my brain controls movement on the right side of my body. So what we’re going to do, let’s say you have a right side problem, all right, could be internal rotation, flexion, extension, whatever. If you have a right side problem, what I want you to do is stand nice and tall, put your finger off to your right side, but keep your head still, focus on your finger, and then smoothly move it to your left and follow it. Now close your eyes, put it over to the right side again, open your eyes, find it, smooth pursuit across. You can do that five times. Now if you have problems on the left side, you need to do the opposite, you’ll be going to your right. Once you’ve done that five times, take a breath and then retest. And immediately for me, I get an improvement in range of motion and I have no pain. Why?
Because I’ve changed the input systems. I already said that shoulder coordination, shoulder pain, this is all related to how your shoulder’s integrating into overall neurophysiology. And I said we have specific neuronal pools that are dedicated to controlling my eyes, my neck, my shoulder, and my hand, all at the same time. So if I can stimulate my eyes, very often that will lower the overall challenge for moving my shoulder correctly. And voila, your brain says, you know what, I don’t need to protect it anymore. And your pain goes down. That’s just one example. That’s the visual system. We can do the same thing for your vestibular system. We can do the same thing for your neck. So let’s just test your neck, shall we? Whenever we look at our shoulders, obviously the nerve supply for our upper extremity is called the brachial plexus and it comes out of our neck. So often what we will find is that people that have recurrent shoulder issues have worked the hell out of their shoulder and never really addressed their neck. So obviously you can do all your basics of mobility work and motor control exercises, et cetera. But one thing that is also super helpful is just to go after the brachial plexus specifically. Here’s a very simple way to do that. You’re going to take both hands, you’re going to put them down by your side. And for this one, I’m just going to have you extend your fingers and extend your wrist. So I have my palms pointing at the floor, and now I’m going to point my fingers out to the side. Now you are going to do nothing here other than work on your neck. This is just a static position. So everything’s locked. You’re now going to think about C5. If you don’t know where your fifth cervical vertebrae is, find the big bump on the back of your neck and then come up about two fingers widths. That’s going to be relatively close to C5. Your spinal cord tends to anchor around that area. So if I tuck my chin and just lift the top of my head to the ceiling, while I’m holding this position, very often you will get a slight, nervy sensation in both of your arms.
So again, this is going to be more prominent often in the side that is painful for you or problematic because there’s often nerve tension involved in these situations. So what we’ll do is again, tuck the chin. We’re going to lift up and lift up. And literally, you probably can’t even see the motion other than a very, very small tucking of the chin and a small pressure up. That’s all that I’m doing. But you again should feel that in your hands, like I said, the small nerve tension. So do five or ten reps of that and then go back and retest. And so again, for me, I get even more range of motion than I did with the eyes. So now I have this combination of, hey, is my shoulder really a problem? So far, no, it’s my eyes and my neck.
What about the rib cage? Could we add breathing into this? The answer should be yes. Because remember, our scapula, I have to have a firm foundation to sit on, which is the rib cage. If the rib cage is sticky, not moving well because you have breathing problems, once again, it’s very, very, very common for shoulder problems to keep recurring. When we look at right shoulder pain, particularly, or upper trap pain bilaterally, that is often also driven through poor diaphragmatic function. There’s this whole thing called viscerosomatic reflexes where problems in your diaphragm, problems in your liver, problems in your gallbladder will cause referred pain into your shoulder and neck. It feels like I have a shoulder neck problem, but it’s actually coming from here and it’s often related to poor breathing. So once again, what can we do? Stimulate the ribs, challenge them with a little bit of breathing. So how I typically would do this with a client, go ahead and test to see where you’re at. Now, I’m going to have you take the painful side and I’m just going to have you rest that on top of your head. From here, you’re going to need to do a thoracic side bend. So watch this. I’m not tilting over from my low back. I’m acting like my low back is fixed. I’m just going to get nice and tall and I’m going to find the bottom of my rib cage and I’m just going to bend from there.
Now, in that position, I’m going to take a deep breath in and I’m going to try to expand the ribs all the way up and then compress them as I exhale. So a deep breath in all the way up and I’m trying to actually feel a small amount of distraction happening in the ribs. Now, after I’ve done that, I’ll do what? The same thing I’ve said before. You assess something, you change the input and you reassess it. So you’ve tested, you’ve now changed the input, now you’re retest.
So now I’ve done three things today. I’ve done a smooth pursuit. I’ve done a small mobilization of C5 going after the spinal cord and brachial plexus. And now I’ve added in a little bit of breathing. And if you remember where I started, I was about right here and it’s a little uncomfortable. And now this is my range of motion without pain and I never touch the shoulder. And this is the key piece of understanding neurology. If you want to be kind of the next level practitioner where people fly across the country to see you because you can get results that no one else can, it means you have to think in systems. And for us as Z-Health, what we’ve been talking about for almost three decades now is that if we’re going to be experts in a system, let’s be an expert in the system that controls everything in the human body, which is a nervous system. All right.
So hopefully you found this really interesting. Again, if you have shoulder pain that keeps returning, stop looking locally. Think globally. Think about the brain. Look at all these different systems. And if you don’t know how to do any of that, that’s what we’re here for. So once again, if you are a doctor, a therapist of any kind, a movement coach of any kind, you teach athletics, you teach martial arts, you teach dance, you teach yoga. I don’t really care what your background is. If you love working with people who move or you are always trying to rehabilitate people who want to move better or pain free, we would love to share information with you. So go to the pinned comment. Make sure you get in touch with us. Good luck with this material. I hope you found it really interesting.
