Have you ever had nagging upper back pain from being a therapist? 

Perhaps pain in the actual shoulder joint or the rotator cuff. 

If you’ve been a therapist for a while, the answer may likely be yes. 

You see, a lot of what we do as therapists, especially those of us who practice more western modalities happen to be very anterior shoulder dominant because of techniques like myofascial release and deep work. 

These techniques are not inherently bad of course – there just needs to be a deeper dive into how we actually approach these techniques and see if there is perhaps a better way to effectively perform these techniques. 

What you will learn 

But first – we are going to cover some issues that can arise from ASD. We will abbreviate it for this article just to make things easier.

Read on further to find out what can happen. . .

Postural issues that can arise

chronic shoulder flexion

This is a no brainer but this can result because of tight and overused pecs and deltoids and in a lot of cases flexion of the actual thoracic spine from poor posture.

Perhaps it’s a social norm to look comfortable 24/7 or it’s just a bad habit attained from years of slouching but having a spine continually in flexion can cause the pecs and deltoids to become chronic tight and fatigued.

This causes the traps and rhomboids to stretch resulting in pain and adhesions to try and maintain normalcy in these tissues.

I think this is the body’s defense mechanism which means well, but it just ends up causing more harm than good.

Forward head posture

The neck can also become effected as well. The more slouched over you are, the more work the posterior cervical neck tissues have to work in order to keep your head upright.

This places a lot of unnecessary and undeserved tension on these neck muscles resulting in posterior neck disc issues in some cases.

Did you know that for every inch your head is away from it’s neutral position it adds 10lbs. If you think about how often you look at your cell phone and how much your neck is in actual flexion to do that, your head will be an extra 50-60 lbs! 

 

kyphosis 

Your low back tends to follow suit when your shoulders and t-spine are in flexion by curving the spine into more of a kyphotic shape rather than having a nice natural curve.

This will eventually place stress on stress on the posterior discs of the lower back, and you know the implications of that. 

So what can we do to help some of these issues from occurring? 

#1 Changing habits that cause shoulder dominance

How do you complete your techniques?

Are your shoulder blades retracted or protracted?

Is your spine in flexion when it should be neutral?

Should you be more upright rather than bent over to do deeper work?

These are the questions you should be asking yourself. 

The way you do things may work best for your clients and may get you that extra $5 added to your tip, but is it really worth it to chip away at your posture and your shoulder health long term?

If you think about how long you are actually in these positions, it amounts to many many hours per month and when you add that up over years, you can really start to see why people get injured.

As I always say, you can strength train and do all the manual therapy techniques on yourself but that only amounts to a few hours a week of total work to combat this.

You will never outwork the actual habit.

Engaging shoulder blade retraction

If you are a therapist that has a tendancy to have your shoulder blades more protracted that what you can do is start out each session with a Y and T shoulder exercise.

Simply put, you start by raising your arms overhead to form a Y, keep the shoulder blades retracted the entire time and hold that position for 45 seconds. Immediately after, go down to 0 degrees to form a T and hold for 45 seconds.

This works to activate those traps, rhomboids and rear delts and if you do this before every session, this will develop a long lasting good habit to help you get into the proper position each and every time. We are developing muscle memory and this will help with protraction.

Staying more upright with the use of power stance

When it comes to having your thoracic spine too often in flexion and bending over to do deeper work with elbows and forearms, what will really help is using the power stance to stay more upright with deeper strokes

If you aren’t accustomed to this, it can be kind of awkward at first but this is where your feet are shoulder width apart to begin with. From here have your leading leg forward and your pushing leg in the back, with each foot about 2 feet apart from eachother.

Picture you’re working on the right side of your client’s body. . . 

Have your right foot in front and left in back to push off of. From here, start your stroke with the left arm, with most of your weight on the pushing leg and transfer to the leg in front of you as you start to feel your body weight transfer.

This power and weight transfer I have found has been way more helpful than bending over to use elbow, especially when the table is in the right height.

This works particularly well with myofascial and deep sustained strokes and is easier on the body because you can put more of your bodyweight into your stacked arm in a straight line to do the stroke, taking much less effort. 

#2 Strengthen Upper back

Like I mentioned earlier, we are very anterior dominant as therapists anyway because of the type of work that we do (aside from therapists that regularly practice Ashiatsu).

The muscles that we want to strengthen to combat ASD are traps, rhomboids, rear delts, lats, external rotators of the rotator cuff and serratus anterior. 

What I will do in this article and episode is list some exercises for these muscles so that you can start to strengthen these areas.

I strongly recommend becoming a member of Successful Bodyworker because there is a therapist specific exercise index as well as a strength training program for therapists called the MT Hybrid Athlete Program. These will definitely take your physical self care to that next level and you can only find it within the members area as well as personal help from me personally if you have any questions!

Traps

I would say, the most important part of the trap fibers are the middle and lower, as the upper fibers will elevate your scapula and that isn’t exactly what we want either. 

The exercise I recommend here is a facepull.  This is where a tricep rope is lined up on a weighted pulley at face height and all you do is extend the shoulder while externally rotating the shoulder joint. Check out the tutorial below.

 

This counts as a rotator cuff and rear delt exercise because it activates these two muscles to a great degree as well.

This also is one of the safest options for shoulder exercises as the angle provides for a full range of motion usage that is safe for rotation.

To start out, I recommend completing 15 reps with a slow and controlled tempo of movement so that you start feeling a burn right away.

Rhomboids

As far as the rhomboids, a really good exercise that doesn’t require any equipment is a wall slide.

This will be best completed with your back against a wall, and raise your arms up to an overhead press position where you are starting to reach for the sky.

Start by raising your arms up to form a Y and go all the way back down as far as your can.

The more you can tuck your shoulder blades the more the rhomboid will stretch and activate. Since the rhomboids are more of a trap assistant to retract the shoulder blades, heavier resistance isn’t really necessary to be effective. 

It’s important to note that if you have had prior shoulder injury that this may be difficult to do, so just play around with it and if you have any shoulder joint pain then back off immediately. 

Lats

For this exercise, you need a cable pulley and a straight bar attached above the height of the head, this will ensure that you can fully extend your arms at the top.

This can be done with your arms shoulder width apart or slightly wider, and all you are doing is pulling the bar towards the line of your hips in a diagonal line without bending the arms. You are using solely your lats to extend the humerus.

I do these with more resistance than any of the other exercises as the lats are a bigger and stronger group and can handle more resistance load placed on the shoulder. 

 

Serratus Anterior

Another muscle that isn’t commonly talked about is the serratus anterior, and this muscle’s main job is to stabilize the shoulder joint and acts sort of as a shock absorber to reduce ballistic wear and tear on the AC joint. 

This is incredibly important to the integrity of the shoulder joint and will help aid in combating a lot of the wear and tear that we place on the shoulder joint from working with clients.

A good exercise that you can do for this is shoulder protraction with a strong emphasis on the end range.

What I mean by this is holding the actual protraction of the shoulder for an extended period of time, say 10 seconds each rep.

You can do this without any equipment just by getting into a pushup position. If you can’t hold your body weight, try starting out on all fours and just push your shoulder blades away from your body to get into protection and hold the top for 5-10 seconds.

Really feel those serratus muscles working. A good rep range to shoot for here is 5 reps. These may be pretty humbling at first so I recommend doing these no more than twice a week. 

#3 Manual release techniques

You’re a massage therapist so you likely know what to do in this department, so we’ll keep it short and sweet for this one.

Ball tack and stretch for pecs

One of my favorites for manual release is using a ball to tac and stretch my pec. You can start by using the corner of a wall where you can freely move the arm of the side you are working through flexion and extension bring the arm up behind you to stretch the pec.

This is going to be the most effective for getting the fascia and muscle tissue to really stretch and release any knotted or adhered tissue that is causing discomfort in the shoulder joint. 

Anterior deltoid stretch

To effectively do this stretch, find a surface that is slightly below waist height.

For this, I use a table and place my hand on it in a supine position with the back of my hand facing down and lean forward so that my humerus is turned upward.

This will reallllly stretch that anterior deltoid fiber and is a great way to fight that forward posture.

Summing it up

I hoped that this episode helped you to understand how ASD occurs and also some ways that we can help prevent it from happening in the long term. 

Some highlights of this article include: 

  • How changing specific habits like staying more upright in your strokes as opposed to bending over can really help to the tendency for your shoulders to rotate forward.
  • Strengthening the traps, lats rhomboids and serratus anterior with the use of specific exercises can reorient the scapula. 
  • How manual release techniques aid in reducing those painful adhesion’s that can potentially cause ASD. 

Therapist Challenge

I invite you to give one of these three fixes above a shot, and let me know of the effects in the comments below. 

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About Me

My name is Zack Mayfield and I am in the constant pursuit to help each and every therapist achieve strength, better self-care and longevity in their career!

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