People complain of pain in the front of the shoulder when lifting the elbow above the shoulder or back at shoulder level. This pain is less distinct and focused unless the person has a specific activity that they need to do and cannot adapt their movement. For instance, one case was a weightlifting enthusiast who could not incline bench or do front dumbbell raises above shoulder level. Another case was a woman who could not reach up to get plates off of a high shelf that she could reach before.
People may complain primarily of pain in the upper forearm. There aren’t many muscles that have a focus of pain in this area, but when it occurs, it is often pectoralis minor or the sternal division of pectoralis major.
These days, this problem is most common among students that carry a backpack. It can create some blunt trauma to the pectoralis minor while trying to flex it to keep the backpack on. This problem can also be created by slumping at a low desk or pushing down. One client who had this problem performed ultra-sounds all day while seated and pressing down.
In severe cases, this muscle compresses the neurovascular bundle that feeds the arm contributing to thoracic outlet syndrome. In this case, weakness and/or swelling occur in the arm and hand along with the previously mentioned restriction in raising the arm up or back.
First, try to correct the perpetuating activity of wearing a backpack, slumping at a desk or pressing down. Often, that is not possible as it is a part of activities of daily living. A good shoulder stretching routine or shoulder strengthening routine is useful to build opposing muscles.
The breathing exercise in this post is great for this, especially when the magazines are high enough to allow the shoulder blades to drop back on either side of the magazines. Doorway stretches need to be done gently at first with the elbows slightly above the shoulder on the door frame. As the pecs release and lengthen over several sessions, raise the elbows on the door frame. Two things will speed this process; using the ice and stretch method or making this a regular habit by doing it several times a day for just a few seconds each time. I had notable changes over several weeks just from demoing this for a few clients a day.
A chronically shortened pectoralis minor produces the distinctive protracted shoulder that does not lay down like the other shoulder when the client is on their back. It is easy to release with a little posterior static pressure on the greater tubercle while lifting displaced ribs off the upper thoracic vertebrae. Even in chronic cases, this is not so difficult to release in session.
The greater problem is in resolving the weakness of the muscles that oppose the pectoralis minor, especially lower trapezius. The pectoralis minor will returned to its shortened position and require ongoing self-care without resolving displaced joints and treating opposing muscles that lead to a chronically imbalanced shoulder girdle.
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Tony Preston has a practice in Atlanta, Georgia where he sees clients.
He has written and taught about anatomy, trigger points and cranial therapies since the mid-90s.