Why You Keep Hurting Your Shoulders & Low Back

Jessica Bento, Physical Therapist (Co-creator of DVRT Restoration Certification and DVRT Pelvic Control & Shoulder Courses)

If I am driving my car and all of a sudden my tire blows, it alters my ability to drive my car. I have to find a solution otherwise I’m pretty stuck! Well, the solution is rather easy, change the tire right? That is an analogy I give people because when it comes to fixing a machine just addressing that part can often result in the issue being resolved. So, it would make sense that if a part of your body hurts we should address THAT part.

This was my thought process as a young physical therapist and being honest, I was only somewhat able to help a lot of people with that mindset. The problem was that I was treating the human body like a machine and it isn’t a machine! Our complex nervous system dictates so much of how our body functions and is the biggest reason that our body doesn’t act like a machine and addressing one body part in isolation often doesn’t make it better. That is what motivated me to discuss two areas of the body that people still address in this manner and most of the time it doesn’t cause big improvement.

Dr. Karel Lewit was one of the most innovative therapists in the world and obviously loved a good drink;) His point is powerful though!

When someone’s shoulder or low back bothers them the answer is often “train the shoulder and the low back!” I completely understand why that makes sense when you think in terms of a machine, but doesn’t at all when you realize how our body functions!

Diagrams like the one above are ones that Josh and I have shared many times because people acknowledge some of these ideas, but then their training completely ignores them. What are you looking at? These are concepts of fascial lines that Thomas Meyers, author of Anatomy Trains, has written extensively about. Fascia is soft tissue that encapsulates the entire body and allows the muscles to “speak” to on another. You don’t have to be an expert on fascia to see that our body is designed to work as a very integrated unit. What are some keys that you should take away from diagrams like these?

-Our feet are the starting point to a chain reaction that resonates up the entire body, all the way up to the head. That means our feet can impact knees, hips, low backs, and even shoulders. This leads us to realizing that if we want to truly help issues like the low back and shoulders we have to really look to integrate and train the feet as well.

-The core is the key for our upper and lower body to function together. While most go to the gym to look better and develop certain muscles (hey, we all like to have our training help us look better), your body doesn’t look at movement the same way. Our body looks to survive and be as efficient as possible. A good example that we use in DVRT all the time is how the action of just walking. During locomotion you see the opposite arm and leg swing together, the reason this occurs is to both help propel our body through space as well as creating stability for the spine through the use of our core.

If our core is perceived to our nervous system to not create stability it will do everything in its power to protect our body. How does it do so? Most commonly, it creates “tightness” in hips and shoulders so the body doesn’t become exposed to forces that it can’t control.

Core stability and “training the abs” are not the same thing as I describe in the videos below…

Many people may scoff that the core is that important to the shoulders, but a 2018 study found “Our study showed that six-week core stabilization exercise program had a significant positive effect on the shoulder MVIC strength. This result may support the use of core stabilization exercises in the early periods of shoulder rehabilitation when the shoulder muscle strengthening exercises are painful.”

The researchers go on to explain this idea of connection even better! “The mechanical linkages of body segments which allow for the sequential transfer of forces and motions when performing dynamic tasks, such as throwing or hitting, are referred as the kinetic chains.[3,4] By being located in the middle of the kinetic chain system as a box, with the abdominals in the front, paraspinals and gluteals in the back, the diaphragm as the roof, and the pelvic floor and hip girdle musculature at the bottom, the core region functions as a muscular corset where forces are generated and transferred to the extremities.[4-6] Optimal functioning of the core, leading to optimal functioning of the kinetic chain system is required for the production of strong, functional movements of the extremities.[7]”

Same can be said about the shoulders. The shoulders are suppose to be very mobile joints, therefore they require assistance of stability from other joints of the body so they can perform. If you look at the fact our bodies are meant to be upright, we see that there is a lot of the body that sits underneath the shoulders! This means that many shoulder issues are influence by what happens below the shoulders, like the core, hips, legs, and feet! Understanding the shoulders also means understanding that they gain stability by our grip as well.

THIS 1996 study explains…”The stabilizing muscles (the rotator cuff) were more influenced than the motor muscles by hand activity. Handgrip activity is important to evaluate while assessing shoulder load in manual work an in clinical evaluations of patients with shoulder pain.” (I know, 1996 is an old study, but shows we knew about this back then as well)

Another 2016 study found similar impact of grip to shoulder stability and strength…”A strong correlation between grip strength and lateral rotator strength was shown at all positions for both left and right hands, suggesting that assessment of grip strength could be used as a rotator cuff monitor of recruitment function.”

Proper grip (which I will elaborate on more in a moment) impacts the shoulder by engaging more of the lats, the core muscles, the scapula and more. This is known as irradiation which some worry that this action of activating more muscles takes away from the action of the shoulders. It doesn’t at all and only enhances how our shoulder performs, increases the loads we can handle, and helps us feel more stable in our low back during many movements because of greater core engagement.

Why did I say proper grip? The joint angles we use make a HUGE impact on whether we feel strong and stable, or we don’t end up feeling much of a difference. I try to show these concepts and how we integrate the body through movements like these…

If it doesn’t make sense why the first dumbbell press is not good it is because of the joint angles I take. By externally rotating my arms and then pressing I can’t integrate my lats and core as well. That means way more load on the shoulders and this joint is rather small and relies on other structures surrounding it to be strong and healthy. The other drills I am actively gripping in different ways, whether it is gripping the handle of the kettlebell tightly, or trying to pull the Ultimate Sandbag apart, or squeezing the handles of the suspension trainer as I try to integrate my body from head to toe.

The second drill you see in the series above where I am pressing out the super band and pressing the kettlebell is a great example of important but subtle joint angles. How I grip the band is VERY important! The position you see me hold allows me to integrate the lats and core to provide me a better “plank” to press from in the movement. However, if I turned the hand so the palm was facing down, I would LOSE all that stability that I have created. The small things make a BIG difference!

The point I am trying to share with you is that trying to isolate ANY muscle in order to improve how it functions is just an exercise in futility. That is because our body isn’t designed to do ANYTHING in isolation, that is sorely inefficient and our body wouldn’t understand why we are trying to do so! Therefore, how do we make a BIG impact in the health and functionality of people’s shoulders and low backs?

-Teach them how to engage their feet properly during the movement.

-Always have the clients standing, half kneeling, tall kneeling, sprinter stance, avoid using benches to improve functionality of the core or shoulders (this means even for low back exercises and upper back drills as well!)

-Be mindful of the joint angles you are using in both your hands and feet as they will dictate what occurs throughout the entire chain.

-Grip is essential in not only strength but helping build stability and even mobility of the shoulder and entire upper body.

-The core is always an important foundation to establish for the extremities to perform.

Below DVRT Master, Cory Cripe breaks down a highly underrated drill in our half kneeling Arc Press. What is MOST important are the cues he gives for the hands and feet. Listen to the cuing and see how the positions we take dictate the results we achieve! Is this a shoulder exercise? Yes! Is this a low back exercise? Yes! Is this even a drill that will help with issues with knees? Yes, find out why!

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