134 Executive Drive, Lafayette, IN 47905, 765-448-6489

By Dr. Doug Williams
April 20, 2016
Tags: chiropractic medicine   relief   pain  

Next to neck and lower back pain, shoulder issues are one of the most common conditions people present for at our office. You can think of shoulder problems as existing on a timeline (pictured below):

Rarely do patients start out at the far end of the spectrum (rotator cuff tears). Most conditions are amendable to conservative treatment over a long period of time before surgery would be required. Except in cases of severe trauma, the majority of shoulder problems either start with or have a mal-positioned shoulder blade as the central problem.

The shoulder blade, or scapula, is a triangle-shaped bone that sits on the back side of the rib-cage and is connected to your collar bone. The upper arm bone, the humerus, butts up against the scapula to form your "shoulder socket." Surrounding the shoulder blade are several large muscles that hold the scapula to the rib-cage itself. Coming off of the scapula are four small muscles that attach to the humerus to keep it set in place when you are making large arm movements, like reaching or throwing. These small muscles are collectively known as your rotator cuff. Rotator cuff muscles are extremely efficient at doing their job (holding the humerus stable), as long as the shoulder blade is solidly locked in the correct position. It is only when the shoulder blade is either out of its normal resting position, or unstable, that things begin to go wrong.

The most common direction for the shoulder blade to mal-position is forward, which creates a rounded shoulder posture. As you can see, sitting can wreck the normal shoulder blade position! Cars, computers, soft furniture - all of it adds up and starts to shift the position of the shoulder blade. As the shoulder blade shifts, all of the rotator cuff muscles are pulled out of their normal resting position and apply tension abnormally on their attachment sites. Over time, this adds up to tears and arthritic spurs, and can often result in needing surgery. Unfortunately, if a surgery is performed to clean everything up, but the shoulder blade remains mal-positioned, the problem just continues.

The most common error in treating shoulder problems is attempting to strengthen the rotator cuff muscles first. Remember, the problem with the rotator cuff muscles usually only occurs late in the game and as a result of the mal-positioned shoulder blade. Attempting to strengthen these muscles before restoring the shoulder blade to its proper position can actually cause further damage.

The next mistake is attempting to strengthen the muscles that pull the shoulder blade backwards. The shoulder blade is a free-floating bone, which means it is anchored to the torso only by muscular attachment, not a ligament or joints. Thus, the shoulder blade reflects the posture of the rib cage. If the rib cage has an increased curve or is shifted back behind the pelvis, then the shoulder blades will flair and rotate forward secondarily to that posture. Just focusing on the shoulder blade, especially initially, is not very fruitful. Treatment needs to be directed first towards the rib cage posture.

An Effective Three-Step Protocol
to Correct a Majority of Shoulder Problems

Step 1: Determine if there is an increase in the curvature of the rib cage, or a rib cage shift behind the pelvis, and address this first. Typically, this requires a foam roller and/or a traction block.

Step 2: Relax the muscles that pull the shoulder blades up and forward (trapezius, levators and pectoral minors).

Step 3: Strengthen the muscles that pull the shoulder blades together and down (rhomboids, lower traps and infraspinatus).

After these three steps are addressed, then, if necessary, address the rotator cuff muscles.


If you, or someone you know, is having shoulder issues, come to our class on Shoulder Pain and Treatment on Monday, May 2nd at 6:30pm in our office (134 Executive Drive #3, Lafayette). We will be discussing the evaluation and treatment of shoulder conditions, and giving some practical home recommendations.

The class is free, but registration is necessary.
Call the office at 765-448-6489 to reserve a spot!