Physiotherapy with 8 rear shoulder structure stretching options

It is possible that the most common image of shoulder stretch must be “the cross body stretch” which has been online and offline. Shoulder Stretches are various poses and directions to involve front and rear muscles. Physiotherapists use shoulder stretches to contribute treatment with shoulder pain and shoulder health promotion. 

Rear shoulder structures stiffness or posterior shoulder tightness are related to many shoulder disorders and shoulder pain. They are muscles and shoulder capsule that can be impaired by disease such as frozen shoulder (shoulder capsulitis), rotator cuff injuries, rotator cuff repaired, etc or activities, such as, swimming, tennis, golf, baseball, volleyball, etc. 

“Posterior Shoulder Tightness has been defined in terms of reduced glenohumeral joint internal rotation and/ or glenohumeral horizontal adduction compared to the contralateral shoulder.”

Referring to this definition, I have seen more clinical cases that are able to develop limited shoulder elevation and glenohumeral head anterior translation. 

According to public articles, defining posterior shoulder tightness is considered a side-to-side difference ranging from 7 degrees to 20 degrees as an indication that posterior shoulder tightness is present. In the clinic, some of my patients with both shoulders internal rotation deficit, I compare to the normative range of motion. If shoulder internal rotation deficits greater than 10 % of normative, I will imply posterior shoulder tightness. By the way, the normative of shoulder internal rotation is 90 degrees. 

The relatively high incidence of posterior shoulder tightness in both athletic and nonathletic populations suggests its relevance to musculoskeletal shoulder pain. Posterior shoulder tightness is considered a contributor to posterior impingement, rotator cuff tendinopathy, subacromial impingement syndrome, collectively termed rotator cuff–related shoulder pain. Additionally, I have found in frozen shoulder (shoulder capsulitis) which is the stiffness of posteroinferior capsule and impaired rotator cuff muscle that accompany the posterior deltoid and triceps. 

This article demonstrates VIDEO to stretch rear shoulder structure for shoulder pain treatment in my clinic and can be patient instruction as a home program. 

Static stretching is the best way which I always suggest. Stretching to the point where “tightness without pain” or “noticeable tension without pain” will hold at that point for 30 seconds of 3 - 4 repetitions in each muscle.

8 rear shoulder structure stretching options 

Exercise #1: Sleeper stretch 

Exercise #2: Infraspinatus stretch 

Exercise #3: Cross body stretch

Exercise #4: Eagle pose stretch

Exercise #5: Traditional tricep stretch

Exercise #6: Modified triceps stretch

Exercise #7: Rhomboid stretch

Exercise #8: Shoulder pendulum: this is a special stretch of rotator cuff because it is a dynamic stretch which needs to draw clockwise and anti- clockwise circles 15 reps each direction for 3 - 5 sets. 

Reference: 

https://www.researchgate.net/publication/343293262_Posterior_shoulder_tightness_an_intersession_reliability_study_of_3_clinical_tests/link/5f298f6692851cd302dbe69f/download 

https://nismat.org/wp-content/plugins/zotpress/lib/request/request.dl.php?api_user_id=2488608&dlkey=VUJJ5786&content_type=application/pdf 

https://www.jospt.org/doi/pdf/10.2519/jospt.2007.2337

https://www.jospt.org/doi/pdf/10.2519/jospt.2018.0605 

Physiotherapy with 9 stretching exercise to improve rounded shoulders

            

Rounded shoulders
(Ref: Singla D., et al. Association Between Forward Head, Rounded Shoulders, and Increased Thoracic Kyphosis: A Review of the Literature. J Chiropr Med 2017;16:220-229)

            Rounded shoulder posture is one of the most common poor posture characteristics in physiotherapy clinics. In my experience, I see both cases of rounded shoulders accompanied with a forward head and only rounded shoulder alone. Chief complaint never talked about rounded shoulders; but, it is about muscle pain of neck, shoulder, upper back, and scapular. 

Rounded shoulder posture refers to a posture characterized by acromion protraction in front of the line of gravity, shoulder protraction, and downward rotation as well as anterior tilt.

    External cause factors, for example, computer and smartphone lifestyle, job characteristic, workstation, or temperature, ect. As internal cause factors reveal soft tissue impairment; include, weakness of scapular stabilizer muscles, upper back, rotator cuff, and shortening of chest muscle, upper arm muscle, some shoulder ligaments. 

In this physiotherapy article presents shortening of front upper part soft tissue shortening; and, how to stretch them.    

3 Major muscles involved rounded shoulders

            1. Pectoralis major

                The pectoralis major is a large, flat muscle of the pectoral girdle of the upper limb. It is a fan shaped that appears with 3 heads or portions: the clavicular, the sternocostal, and the abdominal head. This distinct tendon enters in contact towards the insertion on the humerus. Rounded shoulders is related to the shortening pectoralis major which pulls the humeral head anterior. It needs stretching and manual release from a physiotherapist to correct the posture.

Pectoralis major muscle
(Ref: https://link.springer.com/article/10.1007/s00064-021-00760-5)

            2. Pectoralis minor

                Pectoralis minor located between lateral 3rd, 4th, 5th rib to the coracoid process of scapular. When this muscle shortens, the scapular wiil be changed posture to be scapular anterior tilt, scapular internal rotation, and scapular downward rotation. It needs stretching and manual release from a physiotherapist as well.

Pectoralis minor muscle 
(Ref: https://www.orthobullets.com/anatomy/10007/pectoralis-minor)

            3. Biceps brachii

                Biceps brachii affects the shoulder joint becasue there are 2 different attachments of muscle; include, long and short heads. The long head of the biceps brachii is attached from the supraglenoid tubercle of the scapular and passes through the bicipital groove, and the short head of this muscle is attached from the coracoid process of the scapular.

      

Biceps brachii
(Ref: https://fitmachtgesund.de/en/musculus-biceps-brachii/)

The rounded shoulder posture as a result of lower trapezius muscle, serratus anterior muscle, and rhomboid muscle is prolonged lengthening that develops weakness and pain. In my experience, stretching and massaging them cannot improve pain. I always massage and stretch all 3 muscles which we talked about above. To exercise scapular stabilizer muscle is one of crucial treatments; but, it is not my point in this article. 

I prefer static stretching the most because it is more effective than dynamic stretching and easier than PNF stretching. The way to stretch is simple: stretch to the point where “tightness without pain” or “noticeable tension without pain” will hold at that point for 30 seconds of 3 - 4 repetitions in one muscle. 

Remark: If you feel neck and head discomfort from these stretching, you should decrease stretching range of motion. While these 3 muscles are very tight, the scapular and neck muscles try to beat them to achieve a range of motion that increases stress on scapular and neck muscles. Therefore, start at a small tension point and go further gradually.  

9 poses of stretching to improve rounded shoulders 

Exercise #1: Horizontal doorway pectoral stretch

Exercise #2: High doorway pectoral stretch

Exercise #3: Double shoulder external rotation stretch

Exercise #4: Active anterior deltoid stretch

Exercise #5: Chair anterior deltoid stretch

Exercise #6: Single horizontal pectoral stretch 

Exercise #7: Single shoulder external rotation stretch

Exercise #8: Half wall (chair) hang stretch

Exercise #9: Biceps brachii stretch

Reference:

https://he01.tci-thaijo.org/index.php/NurseNu/article/view/178634/143838 

https://www.researchgate.net/publication/318858178_Relationships_Between_Rounded_Shoulder_Posture_and_Biceps_Brachii_Muscle_Length_Elbow_Joint_Angle_Pectoralis_Muscle_Length_Humeral_Head_Anterior_Translation_and_Glenohumeral_Range_of_Motion/link/59a6a1ccaca272895c1671f2/download 

https://www.researchgate.net/publication/320543998_Changes_in_rounded_shoulder_posture_and_forward_head_posture_according_to_exercise_methods 

https://www.researchgate.net/publication/335136115_A_Detailed_Review_on_the_Clinical_Anatomy_of_the_Pectoralis_Major_Muscle/link/602e4fdb92851c4ed57c6f02/download