The shoulder is a huge unit in reality with connections to the rib cage, sternum, clavicle, scapula, humerus, thoracic spine, lumbar spine, and into the rest of the body.
Many times with shoulder problems, the shoulder is naturally blamed, but it’s not just the shoulder’s fault! It’s really “the hip, through the trunk, through the scapula (shoulder blade), through the humerus (upper arm bone). It’s the whole Kinetic Chain.
When we functionally analyze the shoulder, it’s important to understand how the shoulder does what it does. We want to take a look and see how it relates to the scapula, spine, hips and down to the legs. We want to create a successful environment for the shoulder to function. We need to understand the integration between the shoulder structures, the trunk structures, and the hip structures. In other words, you guessed it, we have to look at the shoulder as part of the whole bodies kinetic chain.
It becomes logical to look at the next “link” in the chain: the thoracic spine (upperback) and rib cage (thoracic cage). In watching functional arm movements, it becomes clear that the thoracic cage moves in a coordinated manner with the scapula and arm, providing important contributions to the global movement.
If the thoracic cage is critical to upper extremity movements, then dysfunction in thoracic spine movement (often asymptomatic) can be the cause of shoulder pain and tissue damage.
This is a pretty common issue today as many of us spend a lot of time sitting, at computers, in front of TV’s, at a desk, etc. Consistent sitting can tighten up the upper back (thoracic cage) as well as tighten up the hips, both of which are critical to a healthy shoulder.
In functionally analyzing the shoulder, we want to focus on all three planes of motion and at both ends of all three planes of motion. We want to be able to understand how mobile and stable the shoulder is for the loading and unloading it goes through, to understand enough about function, and enough about integrated isolation to be able to utilize the hip and the foot and the knee as a friend of the scapula and the shoulder, and to know enough about tweaking to accomplish what will restore your shoulder function and help you heal.