One Huge Cause of Shoulder Pain

There is one thing that I see over and over again with people that have shoulder pain. It’s one of those things that is so prevalent that you can pinpoint it (with pretty good accuracy) before even looking directly for it.

So what is it? Lower trapezius weakness.

The trapezius (or trap for short) is a very large muscle as a whole but when you break it down into its component parts, the lower trap is actually pretty small in comparison. But don’t let that fool you because this is an extremely important muscle when it comes to shoulder health.

Not only does it help with proper motion of the scapula, it also helps with stability.

And without a proper ratio of mobility and stability, you start to see some issues pop up.

With weakness, we see the scapula (shoulder blade) start to ride upward and tilt forward, which depresses or lowers the coracoid process. The coracoid is a small bone that sits on the front of your shoulder and is attached to the scapula. Several muscles and ligaments attach to this bone including the pectoralis minor, coracobrachialis, and short head of the biceps brachii. The ligaments that attach here are the coracoclavicular, coracohumeral, and coracoacromial and transverse scapular ligaments. Long story short, this is an important part of the shoulder.

When the lower trap is weak and we get elevation and a forward tilt of the scapula, the muscles on the front can get in a short and tight position. We see this a lot, especially in people that sit at a desk for an extended period of time.

All of this together can lead to a problem called scapular dyskinesia and is oftentimes accompanied with scapular winging, or an outward tilt of the shoulder blades. When this happens, people often get pain in the front or side of their shoulder, especially when reaching or lifting overhead.

Example of scapular dyskinesia with arms overhead.

Scapular winging in push-up position.

How to fix shoulder pain

So how do we fix this and prevent it from coming back? It’s important to strengthen the lower trap in a variety of positions as well as with open-chain and closed-chain exercises. We also want to focus on a few other key muscles including the middle trap, rhomboids, and serratus anterior.

Here are just five examples of great exercises to get you started:

Shoulder pain can be frustrating and stressful, especially if you have seen other providers in the past and only had temporary relief or even if you have been told to stop doing things. If this sounds like you, know that there is hope and you aren’t doomed to have shoulder pain for the rest of your life. The shoulder is complex, and it responds to a plan built around what your evaluation actually finds, not a generic sheet.