This post is in response to a reader request for more details on the RE™ approach to shoulder health. In order to have this discussion, it is necessary to talk first about shoulder anatomy.
Shoulders and feet are pretty much my favourite topics anatomically. They both have a lot in common: they are complex structures that are both fundamentally underused and overused! We can stand on our feet all day, or run a marathon (overuse) but we can’t spread our toes or lift them individually (underuse). We type/hold a steering wheel, carry bags and lift weights (overuse) but we don’t have the strength to hold up our own weight, nor can we achieve full range of motion (ROM) in the shoulder without spinal distortion (underuse) leading to friction and wear of the spinal discs. There is huge potential to increase the health of the tissues in both feet and shoulders from their current state.
I’ve had a lot of problems with my own feet and shoulders, so I’ve spent years trying to understand and rehabilitate them. I was successful at it (ongoing) and look forward to having not just pain free feet and shoulders, but really incredibly strong structures with full ROM.
If I ask you to point to your shoulder, you’d point to the area where your arm meets your body. This is the glenohumeral (GH) joint, where the humerus (upper arm bone) sits in the glenoid fossa. This is a concave or dish-shaped structure on the side of the shoulder blade, or scapula. Our arms don’t hang on our ribs, they hang from the scapula, which sits on the ribs. Thus, the position of both the ribs and scapula will need to be assessed for proper shoulder mechanics.
This is a picture of the L scapula from the side, the bean shape of the glenoid fossa is the socket part of the ball&socket jt. Please refer to the wikipedia page for some more pictures/animations.
The nice thing about RE™ is that we have alignment points or markers; objective placement of the bones that allow us to see just what is going on. So we would start with placing the rib cage in a position that would allow for a correct relationship between the rib cage and the scapula…
and then we would put the scapula in anatomical neutral. At first this is done with some difficulty, because the resting muscle tension in 99% of us precludes our ability to do this easily. (I’d go so far as to say 100% because I’ve never seen anyone with a neutral scapula on a neutral rib cage but they might exist.) NOW we can see what the arm is doing!
One of my favourite exercises for assessing all this in the RE™ repertoire is called the Rhomboid Push Up. Don’t get caught up in what it’s called. It should be called “Full shoulder assessment allowing us to see residual tension residing in all structures from the trunk to the fingers in a partially loaded position” but that’s an awfully long name. The nice thing about RE™ assessment tools, is that they are also the prescription. If you can’t do it, do your best until you can do it better, which might take a while but I think it’s the only thing you can do to really truly get to the bottom of what is keeping you from optimal health of the shoulder (or whatever body part you are addressing, and in RE™ there is no isolated body part – as a matter of fact, if you came to me with a shoulder issue I’d start at your feet and lower legs!).
The ball part of that Ball&Socket joint is of course, the head of the humerus.
This is a L humerus. The ball part articulates with the socket part on the scapula, but the scapula has other structures that the head of the humerus can rub against, particularly in a situation where things aren’t residing where they should be. There are muscles, tendons, ligaments, nerves and bursa also residing in the spaces around the head of the humerus that in an ideal situation slide around without impingement. It’s this impingement that can be a creator of many problems, pain and torn tissues.
So getting this bone to be optimally situated within its socket is key. Typically the humerus lives a little too far forward and rolled inward (called internal rotation) than it should. This changes the orientation of the ball and socket articulation and can create problems for those structures I mentioned before.
Try this: stand up and face a mirror. Let your arms dangle by your sides. In the most relaxed state you can achieve, where there is no muscle engaging to hold your arm in the socket some way, where does your elbow “pit” face? This is the crease on the inside, opposite the pointy bit of the elbow joint.
Now look at your hand – which way is the palm facing? Is the back of your hand in view?
In an optimally placed humerus, the elbow pit faces front – towards the mirror, and the thumb faces forward. Can you move your arm so that this is the case? Can you do that without moving your scapula also, or did it move too? How much work are you doing to keep your arm in that position? It should be there by default, in a relaxed state.
Now turn to the side and still looking in the mirror, start to raise your arms to the front and see how high you can reach them, all the while keeping your eyes on your spine. At what point does your spine have to extend in order to get your arms higher? Back down to the point just before that happened: this is your true ROM in shoulder flexion. Oops, are you using your abs to hold your ribs down while you raise your arms? Stop doing that, and see if you can raise your arms without creating tension anywhere else. My bet is that you don’t get very far.
So far we’ve addressed the arm in its position as it hangs down from the body, but our arms were made for more than just swinging by our sides. If you study the muscles that attach the arm to the trunk, you will notice that they are proportioned and positioned to organize the trunk and lower body weight as we hang from our hands. We are primates, and hanging and swinging is part of our birthright. We will reflexively grasp and hang on as infants when given the opportunity. It is the traction that is provided from hanging our body weight from our hands that provides the opportunity for optimal positioning of the scapula and optimal length in the chest and trunk musculature. You can stretch your pecs till the cows come home, but only with a hanging practice will you enjoy the real state of health that your shoulders are capable. As mentioned in this post, hanging will encourage remodelling the bony and ligamentous structures of the scapula to provide more space and thus decrease or eradicate impingement.
It is important to progress slowly and carefully when it comes to hanging. Start by hanging from a door frame with your hand at shoulder height (or lower if necessary) only partially leaning away from the hand. It is traction you are after, or a pulling out of the humeral head. After a slow progression you might eventually hang your full body weight with feet off the ground. Eventually you work towards a one arm hang and swinging from bar to bar. That might never happen for me with the poor shoulders I started with, but I can go as far down that road as safely possible and still reap untold health benefits, and so can you.
Try hanging like this from your doorframe or bannister post several times a day. The closer your feet are to the post, the more weight on your arm. Step out and come in gradually. I usually start people mid-way from the wall and vertical.
Using my affiliate link to the right, you might want to try a Shoulder themed Alignment Snack or two. Let me know how it goes.
ps in Episode 13 of the Katy Says podcast (14:19), she answers a listener question about hanging and a torn labrum. Her answer: “It’s not helpful and it wouldn’t be the appropriate step.”