Bowen therapy has really good results with shoulders, whether frozen, stiff or injured; but it can be a surprise that when a client comes in with a shoulder problem, the shoulder is not the first thing to look at. That’s because the shoulders are affected by the rest of the body. Whether the shoulder is the presenting problem or not, it’s common for problems to show up in the shoulders for two reasons. Firstly because it’s so easy to identify shoulder imbalance – whether one is higher than the other. It’s also such a heavily used joint that it can be the first part to ‘break’ when there’s a problem somewhere in the body.
The main goal of most Bowen therapists is to restore symmetry in the body. When the body has returned to symmetry, it’s then possible to feel what part of the shoulder’s musculature remains as problematic. So I always treat the whole body, regardless of the problem the client has identified.
How long will it take?
For many, an initial level of improvement in shoulder mobility may come quickly, especially if the injury is acute. I gave a taster treatment to a lady whose shoulder had been very severely restricted in movement for some time, and she immediately regained full movement and became pain free.
However, some shoulder problems need time and patience. The body needs to become used to being aligned before the shoulders can be in their best neutral position. Tissues that are irritated or frozen require time to recover and function properly again. For some, regular maintenance may be needed. It depends on what the problem is and how your lifestyle is contributing to it; if you aren’t able or willing to stop doing what is giving you the problem in the first place then we need to treat regularly to make sure your shoulders stay in good shape.
Shoulders are a lot more complicated than you probably realise. They're one of the least stable joints in the body, which is the price you pay for being able to move your arms around so freely. This means that they're more susceptible to injury than other joints in the body and therefore more likely to hurt. So the rest of this admittedly long blog will explain, in far more detail than you ever thought you needed, how your shoulders work and how they affect - and are affected by - the rest of you.
How shoulders work - the joints
The shoulder is made up of three bones – the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone) – as well as a range of muscles, ligaments and tendons.
The glenohumeral joint
The main joint is the glenohumeral joint. This is where the head of the humerus attaches to the scapula at the glenoid cavity of the scapula – in other words, where your arm joins your body.
It’s a ball and socket joint. The head of the humerus is the ball, with the glenoid cavity being the socket. This cavity is dish-shaped, and very shallow. The head of the humerus is much larger than the glenoid cavity which allows the arm to have a lot of mobility, but also makes it easier to dislocate than most other joints in the body. An analogy commonly used compares the humerus and the glenoid process to a golf ball and tee.
While the glenohumeral joint is seen as the main joint in the shoulder, a number of other joints and bony prominences have an influence on its function.
The sternoclavicular (SC) joint joins the clavicle to the sternum by a synovial joint. This is the only attachment point that connects the arm to the body.
At the other end of the clavicle is the acromioclavicular (AC) joint. This joint attaches the clavicle to the scapula at the acromion (the part of the scapula that forms the high point of the shoulder). This is also a synovial joint, acting like a pivot point to allow the arm to raise above the head.
Just below the AC joint is a bony prominence worth noting – the coracoid process. This is the part of the scapula that you can feel at the front of your chest, below the collarbone and in from the glenohumeral joint. This part of the scapula is an attachment site for several muscles.
How shoulders work - the muscles
Key to shoulder stability are the rotator cuff muscles. These muscles surround the glenohumeral joint, attaching to the head of the humerus. When these muscles are at rest, they compress the head of the humerus into the glenoid cavity. The glenoid labrum is a ridge to help deepen the cavity, create a seal with the head of the humerus and increase joint stability. Ligaments help to reinforce the joint capsule.
The main group of muscles that stabilise the glenohumeral joint are known as the rotator cuff. The rotator cuff muscles join the scapula to the head of the humerus, forming a “cuff” at the shoulder joint. These hold the head of the humerus in the glenoid fossa during movement, preventing it from being pulled out of the joint by other muscles. These muscles are key to stabilising the shoulder in the joint.
The rotator cuff group is not a single muscle. The muscles in this group are the supraspinatus, infraspinatus, teres minor and subscapularis. You'll notice that none of them cross the shoulder joint, but again connect the bones to each other.
– The supraspinatus joins the upper part of the scapula to the top of the humerus, and plays a part in lifting the arm up to the side.
– The infraspinatus and teres minor joins the lower part of the scapula to the top of the humerus. They play a part in lowering the arm to by the side, and in pulling the shoulder backwards.
– The subscapularis is attached to the underside the scapula, sandwiched between the scapula and serratus anterior on the ribcage. It also attaches to the front of the humerus, playing a part in rolling the shoulder forward.
You will have already noticed that different muscles are used to achieve different movements. This is why you may find that it hurts to e.g. lower your arm but not to lift it.
The deltoid and teres major muscles are also part of the shoulder. The deltoid muscle is on the cap of the shoulder, with the glenohumeral joint underneath. The deltoid originates on the clavicle, and the acromion and spine of the scapula, inserting on the humerus. Teres major joins the lower point of the scapula to the upper part of the humerus. These muscles are key to moving the arm and shoulder in all directions.
One thing that I often see with clients as they lie down is how rounded their shoulders are. Sometimes one, sometimes both. One shoulder may be higher than the other or pulled further forward. Often their dominant hand/arm is more forward. It’s usually muscles at the front of their body that causes this – not the actual shoulder muscles.
Other muscles affecting the shoulder
The powerful pectoralis major muscle in the chest joins the sternum and part of the clavicle to the upper part of the humerus. We use this muscle to do all manner of movements when our arms are forward. But if this muscle becomes contracted and short, the shoulder(s) are often rounded as the pectorals pull the upper arm forward. Because we do so much work with our arms and hands in front of us, this is extremely common.
The pectoralis minor muscle lies under the pectoralis major. It connects the corocoid process of the scapula with a number of ribs. When the pectoralis muscle is contracted and short, it pulls the scapula (and thus shoulder) out of good alignment. The scapula may be pulled down, pulled out and/or downwardly rotated so it sticks out.
Serratus anterior is located under the arm, linking the inner edge of the scapula with a number of the ribs in the chest. This muscle is key to many scapula movements, and helps to fix the scapula in place against the ribcage. When this muscle is weak, the scapula is often seen to be “winged” – sticking out of the back.
The sternocleidomastoid (SCM) attaches the temporal bone of the skull (behind the ear) with the sternum and clavicle. A muscle that controls the head and often pulls it forward, a tight SCM also impacts the shoulder indirectly by pulling on the clavicle.
Clients often feel their shoulders drop back and start to relax following a little work over the pectorals or their SCM.
A number of muscles in the back also influence the position of the scapula, and thus the shoulder. Some are obvious, some less so.
The trapezius runs through the middle of the back, like a big wing connecting the spine (through the ribcage and neck to the occiput) to the clavicle and spine of scapula. Different parts of the muscle have different impacts on the scapula – it may be pulled up or down, pulled in toward the spine, or cause the scapula to rotate. It’s a muscle that many people say feels like a rock (although, for many, it’s the levator scapulae that’s the rock).
The rhomboid muscles link the inner border of the scapula to the spine. These pull the scapulae toward the spine, can elevate the scapula, and play a part with downward rotation of the scapula (the scapula turns away from the neck toward the shoulder). The rhomboids are often blamed for feeling sore and “tight” – but the reality is that these are more often weak than strong. When these are weak, the scapulae are often very wide on the back – other muscles are to “blame” for them feeling tight!
Levator scapulae links the scapula with vertebrae of the neck. These are often the muscles that feel very tight like rocks near the side of the neck. As well as controlling some neck movements, the levator scapulae elevate (ie raise) the scapula and rotate the shoulder blade away from the neck. As this effectively ties your head to your shoulders, it’s usually the cause of a classic ‘stiff neck’ as well.
Latissimus dorsi is the broadest muscle of the back and not often thought of by many as a shoulder muscle. It originates on the pelvis’s iliac crest - the bony bits at the sides of your hips, where hipster jeans sit - and lumbar (via the thoracolumbar aponeurosis), part of the thoracic spine and the lower tip of the scapula. Inserting on the upper part of the humerus at the front of the arm, it helps pull the arm down from overhead. It also pulls the arm into the body and pulls the shoulder forward.
Yes, you read that last part correctly – your pelvis is directly connected to your shoulder blades and arms.
And of course, your arms…
Just as the shoulder controls arm movement, the muscles of the arms impact the shoulder.
The biceps brachii are on the front part of the arm, linking the forearm to the scapula. Besides making the elbow bend and forearm turn (supinate), the biceps also contribute to flexing the shoulder (raising the arm forward). This is the muscle that bulges when you lift something.
The triceps, on the back of the upper arm, also have one part (the long head) attaching to the scapula. This muscle plays a part in extending the shoulder (lowering the arm) and adducting (bringing the arm to the body). The coracobrachialis is often known as the “armpit” muscle, deep under chest and other arm muscles. Attaching the forearm with the coracoid process of the scapula, it helps flex and adduct the shoulder.
So the most mobile joint in the body, the shoulder, is made up of three bones held in place by many many muscles, tendons and ligaments. Those same muscles also form parts of the arms, chest and back.
The scapulae are the foundation of the shoulder joint. But as there is no direct bony connection with the spine or the ribs, the scapula is held in place by a range of muscles.
Any movement of your upper arm utilises your scapula in some way. In fact without your scapula you would be unable to lift your arm any higher than your shoulder. Any weakness in the various muscles that connect to it will translate into weakness in the movement, leading to other muscles compensating. Balance of soft tissue is crucial for the scapula to maintain a neutral rest position, from where it can move to allow movement of the arm through the shoulder joint.
The muscles that hold the scapula in place are dictated by the position of the thoracic spine (your upper back) and rib cage. And the position of the thorax (chest) can influence and be influenced by the pelvis and head position. So if the body is tilted, twisted or out of balance, then the shoulders have very little chance of being in their correct position.
Helping only the muscles in the shoulder may give some relief, but that would be short lived. If the tension in the body that’s pulling the shoulder out of its best neutral position isn’t addressed, the shoulder will soon return to the compensated, uncomfortable, position.
The arms “hang” off the body via the shoulders. How well they hang is directly determined by alignment of the torso.
Your shoulders are also affected of course by things like what you carry and how; whether you use both hands or only one, and whether you hang a heavy bag off one of them or not. Leaning on one elbow while you’re at your desk can also affect your shoulders by pushing one of them up out of its natural position and stressing the muscles. So it's very easy to push them out of alignment in themselves, as well as them showing up imbalances elsewhere in the body. You can look after your own shoulders by being mindful of how you carry things and work with your arms and hands, but it's going to be quite difficult to make sure nothing ever goes wrong with them. Fortunately you can address any issues by having regular Bowen treatments before any problems become serious enough to cause you pain.
Credits
OpenStax College, via Wikimedia Commons
Anatomography, via Wikimedia Commons
Original by National Cancer Institute; SVG by Mysid [Public domain], via Wikimedia Commons
Blausen.com staff (2014). “Medical gallery of Blausen Medical 2014”. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. [CC BY 3.0 (https://creativecommons.org/licenses/by/3.0)], from Wikimedia Commons
Based on a blog ‘The shoulder - at the mercy of the rest of the body’ by Lisa published in simplybowentherapy.co.au on 10 October 2018.
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