Shoulder Health – Part 1

I’ve been getting a lot of shoulder health questions lately and decided to compile some of the information into a series of posts. This first post is about posture and subsequent posts will be on shoulder rotation, mobility work for the shoulder, and applying this information to training or sport.

The shoulder is an interesting joint because it evolved to have good mobility, but poor stability; in contrast, the hip has poor mobility but good stability. The shoulder is composed of the humerus (upper arm bone) fitting into the glenoid fossa (the socket of the ‘ball and socket joint’) of the scapula (the shoulder blade), but is primarily held together through muscles on the anterior and posterior (front and back respectively) sides. The following video is excellent at showing the musculature of the shoulder joint (though the joke at the end couldn’t be crappier).

Improving shoulder health or mobility isn’t simple; it requires an understanding of how the upper body integrates in the ability to achieve good or bad positioning. Poor mobility in the shoulder will prevent the person from getting into good position and results in bad mechanics, or inefficient transfer of force. Poor force transfer loads structures incorrectly or incorrectly and wears them down resulting in trauma. Do this enough and there will eventually be an injury or dysfunction. At the very least you won’t be strength training properly and will poorly develop musculature and strength.


The first step in understanding shoulder health is understanding posture. It starts with correct spinal positioning and finishes with proper shoulder positioning.

Most people look like “round shoulders” above. This is the “thoracic flexion, shoulder internal rotation, cervical flexion, and atlas extension” that I always talk about make fun of. The thoracic spine is the upper/middle back, and flexion means that it rounds. Shoulder internal rotation refers to the shoulders rolling forward; external rotation rolls them back. The cervical spine is the neck, and flexion means that it is rolled down towards the chest. The atlas is the C1, or first cervical vertebrae, and that flexes or extends the actual skull (named after Atlas in Greek mythology because it supports the globe of the head). Despite the fact that the cervical spine is flexed forward, the atlas can be in extension to bring the chin up (as in the “round shoulders” picture above). The result is a wormy human being who definitely doesn’t lift. To review these and other anatomy motion terms, watch this video. I will now proceed as if you know the anatomical terms.

The “correct posture” above is the goal. To do this, tighten the lower abs and lift the chest towards your chin. The chin itself will be level with the ground. You can check this relationship by making the “rock on” sign with your fingers (middle and ring finger pulled down with the thumb on top of them, the pinky and index finger extended) and place your manubrium (upper sternum) and put your index finger under your chin. That will more or less put your chin in the proper position. Your spine should now be in a “correct posture” that allows it to transfer force efficiently.

It is no coincidence that this spinal position is the same you should use while lifting. Note that the cervical position should remain the same in lifting, and therefore eye gaze will adjust depending on the back angle of the exercise (e.g. the high bar squat will have a forward eye gaze while the low bar squat will have a slightly downward eye gaze).

Since your thoracic spine is in neutral position (which may be considered “extension” if you are always hunched over), slightly pull back the shoulders. This will put them in neutral position, yet it may feel like they are “back” since they are probably routinely rounded forward. This is the alignment you should aim to have most of the time. If you cannot achieve this position, it’s likely that all of your athletic endeavors are inhibited. More importantly, you’ll never get tan as a result of being jacked.

If you have trouble with posture, make a conscious effort to improve it. The world sees posture and bases an initial assumption on it; it’s part of a first impression. If you see a guy walk in a room like “round shoulders” above, do you have a positive view of him? I don’t; it indicates a lack of self confidence and attention to detail. If someone walks in with “correct posture” above, it indicates confidence and self-assurance. A communications book I read gave the suggestion to realign posture every time you pass through a doorway. It said to imagine reaching slightly up and lightly biting a piece of leather; this lifts the chin and subsequently the chest and pulls the lips slightly back to make a smile. It gives a visual cue to set proper posture before one of the most important social challenges: giving a good first impression. Do this every time you walk through a doorway and you’ll end up doing it upwards of 30 times a day. Not only do you look like someone who actually lifts, but you’re getting constant reminders to set your posture throughout the day.

If you have poor shoulder mobility, I’d have to assume your posture is poor. Work on it with the tips above, because it’s vital for efficient force transfer in lifting as well as preventing injury.

If you have poor posture and sit down all day, also read this “Hyperlordosis” post. 

37 thoughts on “Shoulder Health – Part 1

  1. good info. I’m a bit kyphotic but not internally rotated. some PTs have literally gasped at the size of my spinal erectors (not from training i can assure you that ha)…which is leading me to believe i’m a lot less kyphotic than it looks…its just that my spinal erectors give me that illusion…however it also could be that they work extra hard to keep me in extension thus hypertrophying like a mafugga. either way i look like a piece of shit on the ground because of it.

  2. I imagine that when Dr. Ebraheim looked around for music for that video all he could find was the mix they use for massage therapy and the sound effects from Doom II for Windows 95.

    I’ve been working on my posture and duck feet issues very consistently since I attended the seminar back in February. I’ve made a lot of progress and almost completely eliminated my plantar fasciitis, but I’m still a hollow back mofo.

  3. This is a great post and it’s finally urging me to confront this (slight) nagging pain I’ve had for the last couple weeks, between the bottom vertebral border of my scapula and my spine (closer to my scapula, almost under it). It’s definitely partly caused by bad posture (sitting at my computer writing papers alot recently) but I also wonder if it’s been caused by my emphasis on benching rather than pressing (I had my first meet last month). It’s the only source of pain/soreness I have right now, and so far ignoring it doesn’t seem to be working as a treatment strategy.

    • definitely both, however the emphasis on pressing will take a bigger toll on your body due to the load than your posture. Try including ring rows, db rows, band pullaparts, etc. Anything to work on external rotation and scapular retraction.

      • Thanks! it’s mild but I don’t want it to get any worse. I prefer dumbbell rows, actually, so maybe I’ll try those instead of bb rows for a few weeks.

      • What you say isn’t false, but you’re on here making definitive statements about other people’s training in your first post. Refrain from doing so until you stick around a lot longer. People aren’t coming here for your advice.

        This doesn’t apply to regular posters who I actually know.

  4. Whenever I imagine lifting my head to bite something when I walk through a door way I imagine a piece of bacon hanging there.

    Side note – your shoulder cues video a few weeks back has let me set a new PR and my shoulders feel great! thanks for the info.

  5. I dealt with a pretty severe shoulder inflammation/tweak/problem for the best part of a year before finally finding a fix – 100% pain free now! Keys were rolling the shit out of brachialis, forearm, tricep area with an olympic barbells.

    Turns out my traps were knotted up the wazoo as well which was restricting scapula movement during pressing – hitting that mob that involves resting a bar on your traps and just moving your arm around cleared it up in no time.

    Once the whole region was a bit more mobile I worked my way up to doing a skin-the-cat on gymnastic rings – felt like I was being ripped apart the first time but now it’s a great proxy to my overall shoulder health.

    nice work on the site Justin – I’m forever lurkin’

  6. I hate my internal rotation. No matter how strong I get, I feel like a tool when I walk past a reflective surface and notice my awful posture and shoulders rolled forward.

    • They have the benefits of accumulating time with proper posture (assuming you maintain it), but it could be irritating. I’ve had situations in the past where standing up prevented pain in my back, but in retrospect I could have prevented the problem with better mobility work.

      If you know you have poor posture, do something about it. If that needs to be standing up, then figure out a way to do it.

      • What I mean is that if you were standing on my left side, I could move my arm from about halfway between 12 and 1 o’clock to around the 4 o’clock mark. The top end used to give me all sorts of trouble when I played volleyball (recreationally only), as I couldn’t get anything of a windup when serving. Is there any way to loosen that up without tearing the stuff in my shoulder?

  7. Hey,

    I’m curious how you define mobility. I have what I’ve called tight shoulders, in the sense that when having my arms straight up or down, they can’t go very far towards my back without pain. This doesn’t interfere with lifting, but does with BJJ/MMA. Are we talking about two separate things? I’m usually told I have good posture, and nothing seems glaring from what you wrote that I need to work on.


    • First, I’d define mobility in a general sense, but it seems like you’re asking how I would define shoulder mobility? In that case, I could quantify it with a goniometer, but I don’t think the goniometer tells enough of the story. For example, if I said that the shoulder needed to be able to hit 180 degrees of flexion (where anatomical position is zero), then it might be able to do that at the expense of the thoracic spine over extending (or even the hips anteriorily rotating).

      In any case, for sport and lifting, the shoulder needs to be able to achieve proper flexion for a good overhead position with the spine in netural position. We’ll talk about this more in the upcoming posts in the beginning of next week, and there’s a Kelly Starrett video that specifically focuses on this.

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  9. This post comes at exactly the right time because I feel like my shoulder’s in imminent danger of getting fucked soon. I’ve got a popping in my shoulder from what I am guessing is my proximal bicep tendon… is this a sign of tendinitis if there is no real pain? Or just a tight bicep? Should I back off of presses or focus mobs on anything in particular?

  10. Just do any and all shoulder mobs once or twice a day. I’d have to guess you’re internally rotating on the pressing movements (did you watch the vid I linked)? You could have some residual damage already caused, so it may require some specific attention (rehab).

    • I’m doing lots regular shoulder mobbing but fixing my shoulders feels like a battle against 30 years of bad posture and several years of poor lifting form. I’ll step up the mobs but what form would this rehab take? Should I just go to a PT? Finding one that doesn’t tell me to just “stop lifting weights” seems daunting.

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