When Shoulder Pain is Not Just the Shoulder: How Posture Could Be the Real Culprit

Meet Diana, 34 years old, Data Analyst

Diana works as an analyst at a firm in Toronto. She enjoys her work, but it does require her to spend long hours sitting in front of a computer. Even on her work from home days, her sitting habits don’t change. In fact, they may get worse.

Diana enjoys running and lifting weights. She also goes to a nearby spin studio and yoga classes.

Her issues with right shoulder pain began gradually. Both shoulders had always been a little stiff, but the restricted range of motion on the right side had worsened in the last few months. She also noticed tightness in her chest and twinges of pain throughout her shoulders and neck. She started to notice more difficulty with lifting weights and soreness on the days after her workouts.

Diana tried to ignore her symptoms at first, thinking they’d eventually go away on their own. Instead, they became more frequent, worsening enough that Diana struggled to sit at her desk long enough to get any work done. That was when she came to visit us.

Finding the “Foundation”

Diana booked her initial assessment with a physiotherapist. She underwent a health history, intake of her lifestyle and movement habits, and a history of prior injuries. The second half of the assessment focused on testing her movement and strength, including a postural screen.

The postural screen revealed a few things. After reviewing Diana’s posture while she was sitting, standing up, and moving around, her physiotherapist noticed the following:

• She held her head forward in relation to her shoulders, a stance called “forward head posture.”
• She tended to round her shoulders, giving her slight kyphosis, or a hunched posture, in her upper back.
• Her shoulder blades were protracted away from her spine.

The objective assessment revealed the following:

• Tenderness and stiffness in her upper back (or thoracic spine)
• Reduced range of motion on her right shoulder compared to her left, especially in positions stressed above the head
• Significant weakness of her right shoulder muscles, including the biceps, and rotator cuff (supraspinatus)
• Positive impingement tests (when the shoulder joint is stressed, this caused pain)

The signs were clear: Diana had developed upper cross syndrome. Even though her symptoms were in her shoulders, her neck and upper back were major contributors as well.

Upper cross syndrome is a condition marked by postural changes that have a waterfall effect throughout the body. The physiotherapist determined Diana’s postural impairments had impacted the muscles in her upper back and shoulder girdle. As a result, the movement in her upper body became impaired, leading to her pain and mobility restrictions.

Diana’s “Live Better” Treatment Plan

Now that we understood why Diana was experiencing shoulder pain, we could develop a full-body approach to correct her posture and address the muscular impairments and imbalances that had led to her symptoms in the first place.

The foundation to Diana’s recovery was in treating more than Diana’s shoulder. Addressing her neck and upper back, along with commitment to her treatment plan, were key to recovery.

Weeks 1-3
– Physiotherapy 2/week, focusing on improving range of motion and reducing pain
Treatments used during this phase were: regular postural correction, reducing sitting, manual therapy to the shoulder and neck muscles, mobility exercises, education, and pain management

Weeks 4-6
– Physiotherapy 1/week, focusing on improving strength and being monitored as she progressively returned to the gym
Treatments used during this phase were: manual therapy to the thoracic spine and shoulder blades, strength exercises, stretching post workout and movement corrections
– Started Massage therapy in week 5 to relieve muscle tension and reduce stress.

Weeks 8-12
– Physiotherapy every other week, focused on increasing her strength and reassessing shoulder, neck and upper back strength, as she returned back to her activities and normal workload
– Started Chiropractic in week 12 to address the regular stiffness in her upper back as a result of sitting

Monthly
– Continues with her chiropractor monthly to relieve stiffness and pain in the joints of the thoracic spine and neck
– Follows up with her physiotherapist monthly to discuss new goals, have her exercises reviewed and progressed, and gets manual therapy to improve flexibility in her shoulders, chest and necks
– Continues with massage therapy every two months to take care of her stress and tension

Diana is no longer in acute pain or an inability to move. She chooses to continue with physio, massage and chiro as both an accountability tool and recovery tool to manage her posture and function in her upper body.