Do you or your clients ever deal with shoulder pain? Most instructors will have a client at some point who has shoulder pain. I have had a few clients who have shoulder pain unrelated to Pilates, but it makes me think long and hard about the exercises I include in their workouts. My journey to find the answers led me to a few Pilates instructors who are also Physical Therapists. I simply asked them for their “DO and DO NOT” advice for working with shoulder issues when teaching or practicing Pilates. Please hear from my colleagues who offer great advice.
Tatiana Trivellato (Baltimore, Maryland) said to me:
“The physiological shoulder biomechanics includes scapula elevation, with activation of the trapezius. and levator scapulae, during abduction and flexion. The shoulder depression is very recommended in the Pilates field, based on the idea that we are stabilizing the shoulder. However, we may be over-stabilizing it. Shirley Sahrmann, a renowned expert in the field, wrote in her book about the issue. Building upon her approach, my colleagues and I conducted a clinical trial on upper trapezius’ pain threshold in people with shoulder depression. Our conclusion is that people with scapular depression have lower pain threshold to those with normal alignment. I would be careful about emphasizing shoulder depression because it may be the cause of the problem and not the solution. Also, stretching muscles that are already in a lengthened resting position may worsen the problem.”
Trivellato published a paper on this topic titled, Influence of Scapular Position On The Pressure Pain Threshold of The Upper Trapezius Muscle Region. I had trouble linking it to this post, so please let me know if you would like to see it.
Thumper Thornton (Green Valley, Arizona: Pilates for Tomorrow) wrote:
“If it is significant pain, don’t exercise the area until there is a proper diagnosis. Do follow up after the diagnosis and see what the medical plan of action is going to be. If there is physical therapy to be done, again, DON’T utilize the area, but DO contact the therapist and explain what you can do after the acute therapy. I have great networking with many of the doctors and therapists in my area and it has worked well for us. Case in point, I have a female client who has had a double shoulder replacement (2012 and this year), and the format worked beautifully. She is in her 70’s and is back to playing golf again. The true beauty of Pilates showing through!”
Heather Brummet (Pilates Pal) wrote:
“Honestly there could be several reasons for shoulder pain; different pathologies or impairments. Pain in the shoulder can be coming from various structures in the shoulder and possibly the neck as well, not to mention visceral. I would say that the do’s: good posture, proper exercise form with good shoulder congruency, and avoid forcing movements that are painful. “Feeling” the “top” of the shoulder join is usually not a good thing. Feeling the cuff muscles and mid-back muscles is best. If a client is having pain and it is not changing or getting worse within 2-4 sessions (within 2-3 weeks) with you, then it would be best to refer them to PT or Ortho for an assessment. Then, definitely contact the PT and find out what exercises to avoid and what to focus on. Sometimes the shoulder joint or neck joints need some manual intervention and movements or stability. Once this is figured out, then the shoulder will be better aligned to tolerate movement.”
Teresa Marchok (Mountain View, California: Pilates with Teresa) wrote:
“I see a lot of clients post injury or shoulder surgery and the two things I focus on are flexibility and strength. Getting back range of motion is important so people can do their basic activities like hooking their bra or washing their hair. Stretches are particularly important because after an injury, people tend to guard the joint and with that immobility, adhesive capsulitis can set in and that takes so long to overcome. Working on strength is also important, especially being cognizant of good mechanics with the rotator cuff to avoid impingement. Many shoulder problems can be traced back to poor posture and over-utilization of the shoulder and neck muscles. Pilates with its focus on alignment, precision and control is a great tool for addressing these upper quadrant core issues.”
I LOVE this advice! I realize that no pain is the same and we are all built differently. While I believe in the power of Pilates to heal, I do not believe we instructors should ever teach exercises we do not feel comfortable with. I am learning more and more to trust my instinct and to seek advice when I need it from those who know more than me. I am personally going to be very careful of exercises that depress the shoulders when there is an injury, continue to work in my community of therapists, concentrate on stabilizing, and offer more stretching. I have included a picture of a stretch I love on the TRX Suspension Trainer. I use it for many of my clients and have found great success when focusing on range of motion. Thank you SO MUCH for the advice Tatiana, Thumper, Heather and Teresa!
Do you have any advice to add?
Healthy Please XOXO