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In this article, we are going to discuss what other movements to consider if you are dealing with movement related neck discomfort and chin tucks have not helped. If you are not sure what a chin tuck is or whether it might be useful for you, refer back to the previous article in this series to see if your neck pain solution might be that simple. At the end of Part 1, we discussed how chin tucks are an exercise that extend the lower cervical spine while expanding the back side of the upper cervical spine. This relationship is shown in Picture 1. [caption id="attachment_1580" align="aligncenter" width="790"] Picture 1: The orientations of the two regions of the neck in a chin tuck position, live in action.[/caption] A key concept introduced earlier is that this position is not harmful. In fact, it is commonly used by individuals who are producing large amounts of force. When the goal is to be strong or generate force, the body often limits available movement to improve output. Think about the last time you helped someone move a couch. If you tightened your body and lifted straight up and down, the task likely felt easier. If you lost tension, twisted, or had to reposition yourself mid lift, your strength and leverage were reduced. When the body moves away from positions that limit rotation, it becomes harder to generate force efficiently. This is why strength athletes such as powerlifters compress certain regions of their body during lifts like the bench press. They pinch their shoulder blades together and extend the lower back to reduce unnecessary movement and improve force production. For them, this is a performance adaptation. Over time, however, this adaptation can contribute to a reduced ability to rotate or turn the head. To move into any position, the body must be able to expand into that space. Chin tucks extend or compress the lower neck. To turn your head to the right, the right side of the lower neck must expand while the left side compresses. The opposite must occur to turn left. If your head and neck naturally sit in a chin tucked position even when you are not lifting or producing force, and you struggle to turn your head in either direction, chin tucks are unlikely to improve your neck mobility. In these cases, exercises that promote expansion of the lower neck are often a better starting point. An Alternative: The Alternating Frog Crawl A great movement to begin restoring this ability is the alternating frog crawl, shown below. A video of the alternating frog crawl exercise. This exercise offers several benefits for individuals who have difficulty turning their head or who have experienced neck pain for an extended period of time. First, it teaches you how to create pressure through the ground to expand the space between your shoulder blades and the base of your neck. Second, it challenges you to maintain that expanded position against gravity, which helps build endurance in the muscles that support your neck and head. As you step one arm and the opposite leg forward, one side of the neck experiences compression while the other side expands. These are the exact biomechanical demands required to rotate the head side to side. Key Takeaways There is nothing inherently wrong with the chin tuck position. It can be helpful in specific situations, but it is not a universal solution for neck pain. The goal is to have a neck that can move into positions that resist motion when strength is required and positions that allow movement when rotation and flexibility are needed. If you have been relying on chin tucks without improvement and still feel limited by neck stiffness, it may be time to try a different approach. Focus on exercises that restore your ability to expand, rotate, and adapt so your neck can move freely again.

Chin tucks, a common exercise that involves drawing the head straight back as if creating a double chin, are frequently prescribed for people experiencing neck related symptoms. Video 1 above demonstrates one of our physical therapists performing the movement. Video 1: The “Chin Tuck” exercise. Chin tucks can be effective for symptom relief in individuals with neck pain, neck pain that travels into the arm, headaches, or general aching in the back of the neck. Some people notice improved neck motion and a reduction or complete resolution of pain when performing chin tucks. At the same time, we regularly meet patients who have been doing chin tucks for years and are still seeking help for ongoing neck discomfort. The goal of this article is to make sure your time and effort are spent on strategies that actually move you forward. So let’s get into it. When is doing chin tucks useful?  There are a few key heuristics we use to determine when chin tucks are likely to be a good investment of time. 1. You Have a Directional Preference for Your Neck or Arm Pain Many individuals with neck pain also experience symptoms that travel into the arm or hand. A directional preference means that moving your neck in one direction makes symptoms worse, while moving it in the opposite direction makes symptoms better. For example, looking forward or down may increase neck or arm pain, while moving the head backward reduces it. If performing chin tucks and holding the end position for a few seconds improves your symptoms, that is a good sign. Continue performing them and monitor whether your discomfort decreases and your neck movement improves over time. Even if chin tucks do not reduce neck pain directly but lessen arm or hand symptoms, that is still a positive response. This phenomenon is known as centralization and is strongly associated with improved outcomes in neck pain. 2. Your Neck Endurance Needs Improvement When neck pain has been present for a long time, it is common for people to move their neck less. Over time, this leads to reduced capacity and endurance in the muscles that support the neck. The Neck Flexor Endurance Test, shown above in Video 2, is a tool sometimes used to assess how well someone can maintain a specific neck position. [embed]https://www.youtube.com/watch?v=0JEWM_McBmM[/embed] Video 2: The Neck Flexor Endurance Test  If a person struggles to hold this position for less than 30 seconds, or especially less than 10 seconds, it is often worthwhile to focus on building endurance of the deep neck flexor muscles. In these cases, chin tucks can be a helpful way to improve local neck strength and endurance. However, if someone does not demonstrate a directional preference and performs well on both neck flexor and extensor endurance tests, chin tucks are unlikely to significantly move them closer to their goals. When is doing chin tucks not useful?  I frequently see individuals who already hold their neck in a chin tucked position during standing or other upright activities. They often resemble the position shown in the image above. [caption id="" align="aligncenter" width="681"] Graphic 1: Doing more chin tucks won’t be useful here.[/caption] The lifter shown above is already performing a chin tuck due to the demands of the bench press. If this same neck position shows up during daily life and the individual also has neck pain, reinforcing that position with more chin tucks is unlikely to change the outcome. In these cases, the more important question becomes why high force activities like the bench press drive the neck into this position in the first place. We will dive deeper into that topic in the next part of this series. Key Takeaways Chin tucks are not a magic exercise. They are simply a tool that moves the body toward a specific position. They can be helpful if you have a directional preference that improves neck or arm symptoms when moving into a chin tucked position. They can also be useful if you have poor endurance of the deep neck flexors and need to rebuild local capacity. The most important takeaway is understanding your unique starting point and matching the intervention to that presentation. In Part 2, we will discuss when chin tucks are unlikely to be the answer and what to consider instead.

In today’s world of technology and working from home, posture has become a buzzword with a largely negative reputation. We are constantly surrounded by messages about what makes posture good or bad and why it is supposedly the root cause of all aches and pains. You have probably heard it all. Pull your shoulders back. Stand up tall. Stop looking down at your phone. Or the personal favorite, posture correctors that promise to fix everything by doing the work of your muscles for you. Have neck or back pain? It must be your posture. Fix your posture and the problem goes away. With so much information floating around, it can be difficult to separate what actually helps from what does not. You can spend hours researching neck pain and still walk away without a clear solution. The truth is that the body is far more complex than finding one perfect posture to solve every issue. We are built to move, adapt, and function dynamically. Everything in the body is designed to work together. Because of that, the solution to neck pain is rarely as simple as just having better posture. Take a look at picture 1 above. Every time you move your shoulder, your shoulder blade, also known as the scapula, must move as well. If we look at the muscles that surround the scapula, particularly the levator scapulae and upper trapezius, we can see that they attach on one end to the scapula and on the other end to the cervical spine. This means that every time you move your shoulders and use these muscles, you are also influencing your neck. If you are dealing with neck pain, pause for a moment and consider a few questions. Do you feel stressed and notice that you hold tension by keeping your shoulders shrugged? Do you spend hours typing at a keyboard that is positioned too high, forcing your shoulders upward all day? Do you feel limited when trying to reach overhead or behind your back? If any of this sounds familiar, the true contributor to your neck pain may be the position of your shoulders and the constant tension in those surrounding muscles. The second picture above shows the muscles of the neck from the front. This includes the sternocleidomastoid muscles, the scalene muscles, and again the upper trapezius. In addition to helping move your neck, these muscles also assist with breathing. Before diving deeper into this, it is important to understand what normal breathing should look like. Ideally, during an inhale, the rib cage should move outward and upward. During an exhale, it should move downward and inward. When breathing with the diaphragm, there should be noticeable rib cage movement with each breath. Sometimes this breathing pattern becomes inefficient. The rib cage no longer moves as it should, and the diaphragm is not used effectively. When this happens, the body often relies on the neck accessory muscles to help drive breathing instead. These muscles are relatively small and not designed to handle high demand. If they are asked to assist with roughly twenty two thousand breaths per day, they will struggle to keep up. Over time, this leads to increased tension in the neck and upper shoulder region and eventually pain. While bad posture is an easy explanation for neck pain, it is often an incomplete one. The body is far more interconnected than posture alone. Many muscles attach different regions of the body together, meaning dysfunction in one area can show up as pain somewhere else. Understanding this makes it clear why neck pain is rarely as simple as it is often presented. If you are dealing with chronic neck pain, it is important to zoom out and look beyond posture alone. You may listen to the advice to pull your shoulders back, but if your rib cage mechanics or breathing patterns are contributing to your pain, that solution will fall short. If this sounds like you, consider being evaluated by a licensed professional who can assess how your entire body is moving and help identify the true root cause of your neck pain.

There is much more to elbow pain than blaming the sport you play or the equipment you use. If you have experienced elbow pain, you have likely heard terms like tennis elbow or golfer’s elbow. Despite being named after sports, neither condition has much to do with the sport itself. Yes, golfers and tennis players commonly experience elbow pain, but there is another major common factor these sports share that is far more relevant to elbow pain. That factor is often the key to finally resolving it. When searching for solutions, you will find no shortage of advice. Stretch your forearm. Perform isometrics. Strengthen your grip. Unfortunately, many of these recommendations miss the real issue and often fail to resolve the pain long term. Anatomy Overview Golfer’s elbow, also known as medial epicondylitis, refers to stress and pain in the wrist flexor tendons that attach to the inner portion of the elbow. Tennis elbow, or lateral epicondylitis, involves stress and pain in the wrist extensor tendons that attach to the outer elbow. While symptoms vary depending on which side of the elbow is affected, common aggravating activities include gripping, pushing or pulling, and throwing motions. A commonly referenced concept in physical therapy is the joint by joint theory. This theory suggests that joints throughout the body alternate between primarily requiring mobility and primarily requiring stability. For example, the wrist and hand need a high degree of mobility to perform daily tasks. The next joint up the chain, the elbow, is designed more for stability. The elbow is primarily a hinge joint, meaning it mainly moves through flexion and extension and has limited rotational capacity. When excessive motion occurs outside of this hinge function, problems tend to arise. This contrasts with the shoulder, which sits above the elbow and requires a large amount of mobility to function properly. This creates a challenging situation. The elbow, which is not built for large amounts of movement, sits between two highly mobile joints. When mobility is lost where it is needed most, the body compensates by finding motion somewhere else. Often, that compensation shows up in the joints closest to the restriction. A Shoulder Issue Masked as Elbow Pain  One of the most commonly missed components in resolving stubborn tennis or golfer’s elbow is shifting the focus away from the elbow itself and asking why the elbow is being overloaded in the first place. Frequently, limited shoulder motion in specific directions forces the elbow to make up for that lost movement. This results in increased stress and strain at the elbow joint and its surrounding tissues. A helpful example of this can be seen in baseball pitching mechanics. A pitcher who lacks adequate shoulder external rotation to reach the proper arm position during the throwing motion often compensates by creating excessive motion at the inner elbow. This results in a gapping force that places high stress on the wrist flexor tendons. Over time, this excessive load can lead to tendon irritation, tendonitis, or even damage to the ulnar collateral ligament that may require surgical intervention such as Tommy John surgery. In this scenario, the elbow is not the true problem. The lack of shoulder motion forces the body to find movement in the next available place, which happens to be the elbow. Addressing factors like forearm flexibility and tendon strength may provide temporary relief. However, those components are usually far more effective once the underlying shoulder mobility limitations have been identified and addressed. The next question then becomes how and why shoulder mobility was lost in the first place. To learn more, refer to our article on the missing piece in resolving shoulder pain.

Wrist pain, especially on the thumb side of the wrist, can range from a persistent nuisance to something truly limiting. For some people it is an annoyance, while for others it becomes debilitating and interferes with daily activities. You may have already tried stretching the muscles on the front of the wrist, icing the area, or even wearing a brace or splint. While these strategies can provide temporary relief, wrist pain often requires a more deliberate assessment to ensure you are addressing the right components at the right time. So where do you start? Use the simple screens below to begin understanding what movement options your wrist and hand currently have available. This helps prevent wasting time chasing the wrong issue. Understanding How Your Wrist Moves  Below are simple self exams you can use to get a clearer picture of how your wrist moves and which motions may be limited. [caption id="" align="aligncenter" width="1500"] Figure 1: Movements at the wrist. Source: https://www.crossfit.com/essentials/movement-about-joints-part-3-wrist.[/caption] The wrist is capable of flexion and extension, as well as radial deviation, which is movement toward the thumb side, and ulnar deviation, which is movement toward the pinky side. The wrist joint itself is formed by the connection between the carpal bones of the hand and the radius and ulna of the forearm. (Figure 2) [caption id="" align="aligncenter" width="1024"] Figure 2: Bony Anatomy of the Wrist and Hand. Source: https://www.assh.org/handcare/servlet/servlet.FileDownload?file=00P5b00000tFPX8EAO[/caption] Step 1: Assess Your Wrist Motion Take your wrist through each of the motions listed above. Pay attention to whether any movement reproduces discomfort near the radius. Also notice which motions feel limited compared to the others. In many cases, wrist pain near the radius is associated with limited wrist extension and limited radial deviation. To better understand why those limitations exist, it is important to consider the position of the hand relative to the wrist. This brings us to the Pistol Test. If you have a positive Pistol Test, your hand is positioned in more internal rotation relative to the radius. This biases the wrist toward flexion rather than extension. Many people with this presentation notice wrist pain when trying to extend the wrist, such as at the bottom of a pushup or during weight bearing positions through the hands. When the hand is internally rotated relative to the wrist, it is like starting wrist movement partway up the range instead of from neutral. Imagine the wrist as an elevator in a ten story building. Starting on the fourth floor and trying to go ten floors higher quickly leads to a hard stop. That same type of constraint can create a jam where the wrist meets the hand when end range extension is challenged. Instead of relying solely on icing or bracing to avoid painful positions, it is often more effective to address the movement limitations creating the problem. In other words, take the elevator back to the ground floor. Step 2: Restore Hand Position The first goal is to improve the ability of the hand to externally rotate relative to the wrist. Staggered stance curls are a useful exercise for this. Use a light weight and hook your thumb behind the dumbbell handle. This helps lock in external rotation of the hand while you perform the movement. [embed]https://youtu.be/N4WWxUmvcw8[/embed] Step 3: Rebuild Wrist Motion and Load Tolerance Once hand position improves, restoring wrist extension requires learning how to internally rotate the radius relative to a fixed hand. The low oblique sit with pronation is a helpful drill for this. This side plank variation uses a towel to keep the hand fixed while the forearm rotates. [embed]https://youtu.be/D7LhuuTcMD0[/embed] After you have recaptured hand position and learned to move the radius relative to the hand, it is time to challenge wrist position under load. Bear crawling is an effective progression at this stage. [embed]https://youtu.be/1HdyUZsZr_c[/embed] As you load one side, focus on feeling your weight shift from the outside of the hand toward the inside without losing contact along the outside edge of the hand. Start by understanding what motions your wrist can and cannot perform, then train the specific movement strategies needed to restore those motions. Giving your wrist more freedom to move is often the key step toward lasting wrist pain relief.

If you were to assess how great a pitcher in baseball truly is, you might find yourself looking at a lot of statistics, most notably ERA or earned run average. With the goal of striking out every batter who steps into the box, pitchers must not only possess elite skill and talent, but also the ability to generate an incredible amount of power. That power is repeated roughly one hundred times per game. Across sports, very few athletes are required to produce such high levels of force as frequently as baseball pitchers. When athletes specialize as pitchers at a young age and play across multiple teams each year, the volume of throwing and cumulative stress placed on the elbow and surrounding structures can take a serious toll. For a long time, this was believed to threaten a player’s future in the sport. These issues often begin as lower level conditions such as Little League Elbow, which is typically the result of inadequate rest between pitching outings, or acute bursitis, which involves inflammation of a localized fat pad. Over time, the elbow must repeatedly absorb tremendous force across seasons. This repetitive overhead throwing stresses the tendons and ligaments responsible for elbow stability and increases the risk of more serious injuries, including damage to the ulnar collateral ligament. As UCL injuries have become increasingly common in younger athletes over the past several years, organizations such as the American Sports Medicine Institute, USA Baseball, Little League Baseball, and Major League Baseball have implemented pitch count guidelines in an effort to protect developing players. Despite these efforts, higher level athletes continue to face significant risk. The Ulnar Collateral ligament (UCL) injury The ulnar collateral ligament is one of the most commonly injured ligaments in repetitive overhead and throwing athletes. To tolerate the high forces required to throw a baseball sixty feet, the ligament gradually stretches and elongates. Eventually, it may no longer be able to maintain the structural integrity of the elbow. Like most ligament injuries, UCL damage exists on a spectrum. Injuries can range from a mild sprain with inflammation to a complete tear that compromises elbow stability. UCL Symptoms Include:  Pain with throwing or inside of the elbow Instability  Decreased strength or power in throwing Increased sensitivity around the ulnar nerve “funny bone” causing numbness and tingling in the ring and pinky finger Diagnosis and Treatment A UCL injury is diagnosed based on a combination of clinical presentation, physical examination findings, and diagnostic imaging such as X-ray or MRI. The next steps depend on the severity of the injury, healing potential, inflammation levels, and response to rehabilitation. Further assessment by a physical therapist or athletic trainer is often necessary to determine whether throwing mechanics, body positioning, sequencing, or compensatory strategies are placing excessive stress on the elbow. In many cases, limitations in shoulder mobility prevent a pitcher from generating force efficiently. When this happens, the body looks for power elsewhere. That power often comes from the inside of the elbow. Normal pitching mechanics already place approximately 300 newtons, or about 67 pounds, of torque on the inside of the elbow. Now imagine how much additional stress accumulates when mechanics are inefficient and that load is repeated one hundred pitches per game over the course of an entire season. Tommy John and His Influence Named after former Los Angeles Dodgers pitcher Tommy John, this surgical procedure has dramatically changed the outlook for throwing athletes. Once considered a career ending injury, UCL reconstruction is now a well established option for athletes who fail conservative treatment. Tommy John surgery involves replacing the damaged UCL with a tendon graft, often taken from the forearm or hamstring. This is followed by an extensive rehabilitation process that progresses through multiple phases and typically lasts between six and twelve months. What was once viewed as the end of a pitching career is now often seen as a pathway back to competitive play. Today, UCL reconstruction is commonly performed and heavily emphasized in rehabilitation and sports medicine education. If you have questions about UCL injuries, Tommy John surgery, or elbow pain related to throwing, consult your primary care physician or visit Next Level Physical Therapy. We are always happy to discuss your concerns and help guide you in the right direction.

Carpal tunnel syndrome is one of the most common causes of hand numbness, tingling, and discomfort. The symptoms most often appear in the: Thumb Index finger Middle finger People commonly describe symptoms such as: Tingling in the fingers Numbness in the hand Aching in the wrist or palm Burning sensations Symptoms that worsen at night Difficulty gripping objects Most carpal tunnel syndrome symptoms occur because the median nerve is experiencing prolonged compression as it passes into the hand through the carpal tunnel. The carpal tunnel is a narrow passageway formed by bones and connective tissue near the wrist that also contains several tendons and muscles alongside the median nerve. Because this space is relatively small, even subtle changes in positioning or tissue behavior can increase pressure on the nerve. [caption id="" align="aligncenter" width="600"] Figure 1: Anatomy of the carpal tunnel region and the median nerve. The nerve in the middle that runs to the thumb and middle finger is the median nerve. Source: https://qph.fs.quoracdn.net/main-qimg-2effc0be8c4ff02f065339aebda08596-c [/caption] What Causes Carpal Tunnel Syndrome? Carpal tunnel syndrome develops when pressure increases around the median nerve as it travels through the wrist. This pressure can be influenced by: Repetitive hand and wrist movements Poor wrist positioning Prolonged gripping Swelling around the tendons Limited movement variability Nerve irritation Compression within the carpal tunnel itself Traditional treatment approaches often focus heavily on the muscles and soft tissues surrounding the wrist and forearm. The most common treatments we see recommended include: Static stretching of the wrist flexors Wrist mobility exercises Thumb stretching Tendon gliding exercises Nerve gliding activities The goal behind these treatments is understandable: reduce pressure on the median nerve and improve movement around the carpal tunnel. Nerves thrive on: Movement Blood flow Adequate space Even surgery for severe carpal tunnel syndrome is designed to create more space around the nerve by cutting the connective tissue that runs across the tunnel. Why Stretching Alone May Not Help Carpal Tunnel Syndrome While there is nothing inherently wrong with stretching or mobility work, not all interventions produce the same effect. If the goal is to reduce compression around the median nerve, it is important to consider the relationship between the position of the hand and the wrist. Many of the muscles and tendons that influence pressure inside the carpal tunnel either: Cross directly through the tunnel Attach to the bones of the wrist and hand That means wrist position and thumb orientation can significantly affect how much tension is placed on the median nerve. Another important consideration is that static stretching primarily increases a muscle’s tolerance to being lengthened. According to current research, stretching does very little to permanently change how muscles or tendons behave during daily movement. In addition, applying prolonged tension to a nerve that is already irritated can sometimes make symptoms worse. If a nerve is already compressed, aggressively stretching the surrounding tissues may feel similar to repeatedly stretching an already tight rubber band. More tension does not necessarily mean less stress. How Thumb Position Can Affect Hand Numbness Rather than focusing only on muscles that feel tight, it is often more effective to focus on the positioning of the bones in the hand and wrist. This approach may help reduce tension around the median nerve while giving it more space to move freely. The image below shows an example of a thumb that is internally rotated relative to the wrist, highlighted in yellow. The blue arrow demonstrates a thumb that is better able to externally rotate relative to the wrist. [caption id="" align="aligncenter" width="960"] Figure 2: An example of differing thumb and wrist orientations. Source: https://i2.wp.com/plasticsurgerykey.com/wp-content/uploads/2020/06/10-1055-b-002-98003_c049_f001.jpg?w=960 [/caption] Can you see how stretching the muscles of the yellow hand might produce a completely different result than stretching the blue hand? Applying the same treatment to two different presentations does not always lead to the same outcome. Sometimes improving positioning and movement quality creates better results than simply increasing stretch intensity. A Different Approach to Carpal Tunnel Treatment If the median nerve is irritated, the goal should not simply be to stretch everything harder. Instead, treatment should focus on: Reducing unnecessary compression Improving wrist and thumb positioning Restoring movement variability Improving nerve mobility Allowing the nerve more space to move In many cases, this creates a more effective long-term strategy than relying solely on stretching interventions. This does not mean stretching is useless. It simply means the context matters. When to See a Physical Therapist for Carpal Tunnel Syndrome If your hand numbness, tingling, or wrist discomfort keeps returning despite stretching or self-treatment, it may be time for a more comprehensive evaluation. You should consider working with a physical therapist if: Your symptoms wake you up at night You notice worsening numbness or tingling Your grip strength feels weaker Your symptoms interfere with work, training, or daily activities You continue having symptoms despite rest or stretching A proper evaluation can help identify whether wrist positioning, movement mechanics, nerve irritation, or other contributing factors are influencing your symptoms. Frequently Asked Questions About Carpal Tunnel Syndrome What fingers go numb with carpal tunnel syndrome? Carpal tunnel syndrome most commonly affects the thumb, index finger, and middle finger because those areas are supplied by the median nerve. Can thumb position affect carpal tunnel symptoms? Yes. The position of the thumb relative to the wrist can influence tension and positioning around the carpal tunnel, which may affect pressure on the median nerve. Why does my hand go numb at night? Many people sleep with their wrists bent for prolonged periods, which can increase compression around the median nerve and worsen symptoms during the night. Can stretching make carpal tunnel syndrome worse? In some cases, aggressive stretching can increase tension around an already irritated nerve. Treatment should focus on improving positioning and reducing unnecessary compression rather than simply stretching harder. What is the best treatment for carpal tunnel syndrome? The best treatment depends on the individual and severity of symptoms. Improving wrist positioning, movement mechanics, nerve mobility, and reducing compression are often important components of treatment. Final Thoughts on Hand Numbness and Carpal Tunnel Syndrome Carpal tunnel syndrome is more complex than simply having “tight muscles” in the forearm or wrist. The relationship between the thumb, wrist, tendons, and median nerve all influence how much compression exists within the carpal tunnel. Rather than focusing exclusively on stretching, it is often more effective to improve positioning and movement quality in order to create more space around the nerve. In the next part of this discussion, we will explore how to create a more effective strategy to improve movement and space around the median nerve. Need help with hand numbness, wrist pain, or carpal tunnel syndrome symptoms? Request an appointment with Next Level Physical Therapy and get a treatment plan designed around your symptoms, movement patterns, and goals.

Are you Treating the Problem or The Result?  Shoulder problems are incredibly common among the athletes and active adults we see. As therapists, we regularly encounter diagnoses such as shoulder impingement, tendonitis, and rotator cuff injuries. These conditions are often blamed on weak rotator cuff muscles, scapular winging, or muscle imbalances. One major thing to understand about these diagnoses is that they are not the actual problem. They are the result. They are the result of deeper rooted movement habits and mechanics that often go unaddressed in traditional rehabilitation. Common solutions for these issues are often just as short sighted. Stretching, rotator cuff strengthening, and general strength training are frequently prescribed, yet they often miss the mark when it comes to truly resolving pain. Why? Because they address symptoms rather than the cause of the faulty mechanics, overuse of certain muscles, or positioning muscles in disadvantaged positions. To understand the biggest missing piece in resolving shoulder pain, we first need to understand how the shoulder actually works. A Quick Anatomy Lesson of the Shoulder Complex  The shoulder complex is made up of four major components: the glenohumeral joint, which is the ball and socket, the scapula or shoulder blade, the sternum and clavicle, and the rib cage. Shoulder movement in any direction requires rotation of the humeral head within the glenoid socket. Because the shoulder has so much freedom of movement, stability of the joint must be maintained. This is why every shoulder movement is accompanied by scapular movement. Since the socket of the shoulder joint is part of the scapula, its motion is essential for keeping the humeral head centered within the socket during movement. When the humeral head does not stay centered, issues such as shoulder impingement, proximal biceps tendonitis, and rotator cuff injuries can occur. For the shoulder to move well, the scapula must move in coordination with the humerus. The scapula has a natural curvature and sits on a rib cage that also has curvature due to normal thoracic spine shape. The rounded rib cage and curved scapula allow these structures to stay congruent and permit normal scapular rotation in support of shoulder movement. The position of the rib cage and its ability to expand properly to support the scapula is essential for normal shoulder motion without compensation. Rib Cage Position and Expansion  Under normal circumstances, the rib cage should be able to expand in all directions during breathing. With each inhale, the lower ribs should move outward in what is known as bucket handle motion, while the upper ribs and sternum move up and outward in a pump handle motion. The back side of the rib cage should demonstrate similar movement, particularly in the upper ribs. When the rib cage lacks these normal movements, scapular position and shoulder mobility are negatively affected. For example, when the back side of the upper rib cage becomes restricted or flattened due to chronic tension in the upper back, scapular movement becomes limited. A curved scapula resting on a flat surface cannot move or rotate the same way it would on a rounded, congruent rib cage. Without proper scapular movement, the shoulder either loses access to normal motion or must rely on compensatory mechanics. Repeatedly moving into ranges you do not truly have or compensating for restrictions is exactly what leads to repeated stress in the same tissues. This often shows up as shoulder impingement, biceps tendonitis, or gradual wear of the rotator cuff tendons. How Rib Cage Mechanics Are Lost Loss of normal rib cage mechanics is commonly seen in resistance training. Many gym movements emphasize pulling the shoulder blades back and down for stability. Whether pushing, pulling, squatting, or deadlifting, rib cage and scapular position often remain the same. A similar issue comes from the common advice to pull the shoulders back and down for good posture. Spending excessive time in a retracted scapular position limits normal scapular motion and flattens the upper rib cage. This forces the shoulder to compensate to achieve desired movements. The Solution To truly resolve shoulder pain, you must start at the source. While factors such as rotator cuff strength, dynamic stability, and local tissue irritation matter, they should not be addressed in isolation. If you do not resolve what led to these issues in the first place, you are simply treating symptoms. To improve shoulder joint mechanics and motion, proper scapular movement must be restored. Normal scapular movement depends on a rib cage that is positioned correctly and able to expand in all directions to provide a stable foundation. Once this foundation is in place, other components of shoulder rehabilitation can be addressed with much greater success. Below are 2 examples of drills to implement into your program to improve ribcage expansion: Seated Zercher Breathing Video [embed]https://www.youtube.com/watch?v=3CtDqIZnC_U[/embed] Seated Back Expansion Video  [embed]https://www.youtube.com/watch?v=24K6f7OMDXE[/embed]

The shoulder is one of the most mobile joints in the body, which also makes it one of the most demanding. Whether you are lifting weights, throwing, pressing overhead, playing sports, or simply reaching into a cabinet, your shoulder needs strength, coordination, mobility, and stability to function well. When shoulder pain or injury develops, many people immediately think of resistance bands and light exercises. While bands absolutely have a place in rehabilitation, they are often only the starting point. If the goal is to build a shoulder that feels strong, stable, and confident under real-world demands, rehabilitation eventually needs to progress beyond lightweight band exercises. The key principle that guides effective rehabilitation is the SAID Principle, which stands for Specific Adaptations to Imposed Demands. Simply put, the body adapts to the specific demands placed upon it. What the SAID Principle Means for Shoulder Rehab If you perform enough aerobic exercise, your heart adapts by increasing the size and efficiency of the muscles in the left ventricle. This allows more blood to be pumped with each contraction, lowering resting heart rate over time. Sprinters develop increasingly stiff tendons as they train because those tendons become better at storing and releasing energy efficiently. The same principle applies during rehabilitation. When an injury occurs to a muscle, tendon, ligament, or another joint structure, it is often because that tissue experienced a level of stress that exceeded its ability to adapt positively. For example, when someone rolls their ankle unexpectedly, the ligaments and muscles on the outside of the ankle may become injured because the force happened too quickly and exceeded the tissue’s current tolerance. Meanwhile, there are martial artists who spend years gradually adapting their bodies to tolerate high compressive forces without injury. [caption id="" align="aligncenter" width="652"] Image 1: Despite this being Klay Thompson of the Golden State Warriors, my left ankle was in this same exact situation about a year ago.Source: https://i2.wp.com/b-reddy.org/wp-content/uploads/2016/07/klay-thompson-right-ankle-sprain.jpg?ssl=1[/caption] How This Applies to Shoulder Injuries If we want to restore shoulder function and help the joint tolerate increasing physical stress without negative adaptations like pain or injury, rehabilitation needs to apply the correct amount of stress. This is sometimes called the Goldilocks Principle of rehab: Too little stress will not create adaptation Too much stress can create setbacks The right amount creates progress The chart below is a useful way to visualize the relationship between training volume, intensity, and adaptation. Image 2: Volume vs intensity threshold for gaining an adaptation. (Joel Jamieson’s “Ultimate MMA Conditioning”) Why Resistance Bands Are Used in Physical Therapy Resistance tubing, often referred to by the commercial name Theraband, is one of the most common tools people associate with physical therapy. Despite the title of this article, resistance bands are not bad. For individuals in the early stages of shoulder rehabilitation, bands can be extremely useful because they: Provide lower levels of resistance Allow gradual reintroduction to movement Help restore confidence Improve awareness of shoulder position Create less joint stress during painful stages Bands can also provide valuable external feedback, helping people feel their shoulder move into different positions while restoring range of motion. Early on, that can be exactly what the shoulder needs. When Resistance Bands Stop Being Enough However, if the long-term goal is to build a shoulder that can tolerate lifting, pressing, throwing, sports, or daily physical demands, resistance bands alone are usually not enough. At some point, the shoulder needs progressively heavier loading to build: Strength Force production Load tolerance Stability under stress Confidence during movement The body adapts specifically to the demands placed upon it. If rehabilitation never progresses beyond low resistance exercises, the shoulder may never fully adapt to higher demand activities. This is one reason many people feel fine during rehab exercises but still experience pain or instability when returning to lifting, sports, or overhead activity. Best Shoulder Strengthening Exercises Beyond Bands Once basic shoulder motion and tolerance improve, exercises that involve greater loading and control can be extremely helpful. 1. Sidelying Kettlebell Arm Bar Sidelying Kettlebell Arm Bar Exercises like the kettlebell or dumbbell arm bar are excellent for retraining shoulder rotation with heavier loads while improving shoulder control. They also help retrain coordinated movement of the shoulder blade, allowing smoother and more controlled arm motion. 2. Hooklying Dumbbell Pullover Hooklying Dumbbell Pullover The hooklying dumbbell pullover is an effective way to improve overhead range of motion while simultaneously building strength through a large arc of movement. This exercise is commonly used to help people regain overhead motion without compensating through excessive lower back arching. It also builds confidence when holding weight overhead. 3. Staggered Stance Landmine Press Staggered Stance Landmine Press Landmine pressing is one of the most effective ways to progressively load the muscles around the shoulder while improving coordination between the ribcage and upper extremity. This variation can also be modified easily for athletes and active adults who are returning to pressing, throwing, or overhead training. How to Build a More Resilient Shoulder If you are returning from a shoulder injury, it is important to understand the purpose behind each exercise you choose. Not all rehabilitation needs to look like bands and two-pound weights. Your rehab program should eventually become challenging enough to prepare your shoulder for real-world demands. That means progressively building: Strength Control Confidence Movement tolerance Capacity under load The goal is not simply pain reduction. The goal is helping the shoulder tolerate the activities you actually want to return to. When to See a Physical Therapist for Shoulder Pain If your shoulder pain keeps returning despite rest, stretching, or band exercises, it may be time for a more structured rehab plan. You should consider working with a physical therapist if: You feel weak or unstable during lifting You cannot return to workouts comfortably You have pain during overhead movement Your shoulder feels unstable or unreliable You are recovering from a sports or gym injury A well-designed rehab program should gradually expose the shoulder to increasing demands while improving mobility, strength, coordination, and confidence. Frequently Asked Questions About Shoulder Rehab Are resistance bands good for shoulder rehab? Yes. Resistance bands can be extremely helpful during the early stages of shoulder rehabilitation because they provide lower resistance and allow gradual reintroduction to movement. Can resistance bands build shoulder strength? Bands can help build initial strength, but long-term shoulder resilience often requires progressively heavier loading using dumbbells, kettlebells, barbells, or other resistance methods. What are the best shoulder strengthening exercises? Some effective shoulder strengthening exercises include kettlebell arm bars, dumbbell pullovers, landmine presses, rows, carries, and progressive pressing variations. The best exercises depend on the individual and their goals. How do you build shoulder stability? Shoulder stability is developed by improving mobility, control, strength, coordination, and the ability to tolerate force through different positions. When should shoulder rehab progress beyond bands? Once pain decreases and the shoulder can tolerate basic movement, rehab should gradually progress toward exercises that involve greater loading and more real-world demands. Final Thoughts on Shoulder Rehab Resistance bands absolutely have a place in rehabilitation, but they are often only the first step. If the goal is to build a strong, resilient, and confident shoulder, rehabilitation eventually needs to include progressive loading and movements that prepare the body for real-world demands. The shoulder adapts to what it experiences. Make sure your rehabilitation is creating the adaptations your body actually needs. Need help rebuilding shoulder strength or returning to lifting after an injury? Request an appointment with Next Level Physical Therapy and get a plan designed around your goals, lifestyle, and training demands. References Farrell C, Turgeon DR. Normal Versus Chronic Adaptations To Aerobic Exercise. [Updated 2021 Jul 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK572066/