top of page

The Real Reason For Shoulder Pain

Updated: Sep 24, 2021

If you have ever experienced shoulder pain, then there is no doubt that you have been told you need to improve your “scapular stabilization”. Or at the very least, “strengthen the muscles around your shoulder blades”. The shoulder blades provide a stable base for the arm to move on, so it makes sense that many people who have shoulder limitations would need to improve their ability to keep that base stable. While important, this approach is missing a significant piece of the puzzle that is the human body.


Cannons & Shoulders: A Metaphor

It would certainly be impossible to shoot a cannon if it didn’t have a stable foundation to shoot from. It would also be pretty difficult bench press, push-press, or do a push-up or pull-up well if the shoulder didn’t have a stable shoulder blade.

But what makes that foundation stable in the first place? No matter how strong they are, if the posts holding a cannon are placed in a canoe, it isn’t shooting anything anywhere. But place those posts in solid ground and you’re in business. The same concept applies to the shoulder and arm as well.

But what would be the metaphorical solid ground for the shoulder blades?

The rib cage.

For the shoulder blades to truly provide a solid foundation for the shoulder, they need to be stable themselves on the rib cage. That stability can only occur if the rib cage is able to move dynamically through its full range of motion.

This is the piece that most people miss when addressing shoulder pain. Your shoulders will not have their full movement capabilities, and thus more potential for experiencing pain, if there are limitations in rib cage movement.

Rib Cage Movement

The rib cage as a whole should be able to move and expand in a full 360 degrees when you breathe in, and then compress a full 360 degrees when you exhale. However, many people will present with a rib cage that is not able to expand fully in one or many directions. This prevents the shoulder blades from being in a stable position on the rib cage, which in turn means they provide less stability for the arm during movement. Just like trying to shoot a cannon from a canoe, you are now trying to bench press without a solid foundation.

A Common Example: What is the Real Culprit?

“Scapular Winging” is often seen in people who experience shoulder pain. This term is used when the inner borders of your shoulder blades are visibly pushed out away from your body.

Many people will see this and assume there is a problem with the shoulder blades and attempt all the rowing and back exercises in the world to try and “pull” the shoulder blades back in towards the body. But what if it’s not a shoulder blade problem and actually a rib cage problem?

In this instance, the problem is not that the shoulder blades are tipped outwards but that the rib cage (and thoracic spine) are too flat. The ribs do not expand backwards. Therefore, the shoulder blades cannot sit on the ribs in a stable position and thus are unable to provide a stable position for the arm.

Fix Your Shoulder Pain

To improve your shoulder stability and reduce or prevent pain, you can perform exercises that increase your ability to expand your rib cage in all directions. This can be accomplished with breathing exercises in specific positions. The mechanics behind why that works is enough information for an entire series of blogs, but put simply, breathing in air creates pressure in the lungs underneath the ribs, and in specific positions you can control where that pressure expands into in order to improve the ability of your rib cage to move. A better moving rib cage leads to better moving and more stable shoulder blades, in turn leading to pain free movement of the entire shoulder.

How do you know where your rib cage is limited and what to work on? Two simple tests are measuring shoulder internal and external rotation. Watch the videos here and here to see how to measure each.

If you are limited in shoulder internal rotation, your rib cage does not expand well in the front. Here is one exercise you can use to improve that:

If you are limited in shoulder external rotation, your rib cage does not expand well in the back. Here is one exercise you can use to drive air and pressure in that direction:

If you are limited in both internal and external rotation, your rib cage is likely compressed in multiple directions. Use this exercise to expand it all the way around:


If you are currently dealing with shoulder pain, it is important to note that there are many factors that could be impacting that, including but not limited to rib cage movement. An assessment by a qualified professional is needed to know exactly why you are in pain. If you are ready to learn what is causing your shoulder pain and how your rib cage may be affecting it, then call us at (469) 626-7254 to schedule your assessment.


bottom of page