Fountain of Youth IV: Skeletal Alignment and Muscle Pain 3

August 4, 2009 at 10:03 AM | Posted in Fountain of Youth, Health and Fitness | 3 Comments
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Almost everyone I know complains of some kind of upper body pain – usually shoulder pain. Shoulder pain is pretty classic, and the trouble with it is that it’s incredibly difficult to get to the root of the problem. The musculature of the leg is designed for stability. The knee has one degree of freedom: flexion, and it’s not even much range in terms of degrees.

The musculature of the shoulder is designed for mobility rather than stability. Whether you look at it from an evolutionary standpoint or a creation standpoint, we kind of got shorted in the design of our shoulders. While it is an amazing collection of joints that produces our huge range of motion in the arms, it is this that is our downfall in both contracting and fixing shoulder mechanics problems.

The good news is this: even though it’s rather difficult to find out what is wrong with your shoulder mechanics, it’s easy to fix. I know that sounds weird, but believe me. If you don’t know what’s wrong with it, fix everything, right? Ok, so that’s a little oversimplified. Let’s get down to business here.

I hope that some (and I know that this is in actuality probably none) of you have been following along or have at least TRIED some trigger point therapy in your lower body. If you have a residual pelvic tilt, short or long legs or any muscle knots in your legs, you’re probably never going to be able to permanently solve your upper body problems. The therapy that I will outline here will only provide a temporary fix until you dig into the lower body issues you have.

That said, I am going to structure this part of the series in exactly the same manner that I structured the lower body portion: first, a rundown of all the major trigger points and problems they can cause, then a quick visual tutorial on hitting the main points. Since most of you probably have shoulder pain, I’ll start with that.


In old-school (traditional) medicine, if you come to the doctor with a complaint about shoulder pain, the doctor most certainly examines the shoulder joint. But that’s where this goes wrong: we must be precise in the definition of what the shoulder joint is. Most of you probably think the shoulder is the skeletal joint: the part where your arm connects to your torso, right? This is the glenohumeral joint, so named for the glenoid fossa and humerus making the connection. However, from a mechanical standpoint, almost all of your shoulder motion is controlled by an entirely different bone: the scapulae (shoulder blades).

So it is here we begin. First, you have the deep layer of muscles:

The deep muscles of the posterior shoulder are mainly the rotator cuff muscles and the triceps.

The deep muscles of the posterior shoulder are mainly the rotator cuff muscles and the triceps.

You may or may not have heard of these muscles. The first three – teres minor, infraspinatus and supraspinatus – are rotator cuff muscles. The other muscles you see here you should already recognize: teres major and latissimus dorsi (lats) both work together. The triceps also connect very deep in the arms and thus are shown here.

The deep muscles of the anterior shoulder are pectoralis minor, the main feature of the picture, and subscapularis, seen far in the back.  The biceps tendons also connect very deep.

The deep muscles of the anterior shoulder are pectoralis minor, the main feature of the picture, and subscapularis, seen far in the back. The biceps tendons also connect very deep.

In the front of the shoulder, the pectoralis minor muscle and some biceps tendons attach deeply. The pec minor is an extremely important muscle because if it is tight or stuck, it may cause you to have rounded shoulders. Further back you can see the subscapularis, which is the fourth rotator cuff muscle, and it is a sheet of muscle that sits on the inside of the scapula. The serratus anterior muscle is very important because it is responsible for keeping the scapula near the ribcage.

What’s the point of all this anyway? Well, remember all that fascia business I talked about in my first post? It’s around each and every one of these muscles and, worse, it can stick together pretty good. If you’re a weightlifter and you’ve managed to cause hypertrophy in the shoulder girdle (you probably have to some extent), you’re even more prone to having sticky muscle syndrome. And to top it all off, there are a lot of really important nerves that pass through the various openings between these muscles, and they can very easily be compressed due to poor posture or trigger points.

While the number of problems you can have in your shoulders is absolutely staggering, and most peoples’ shoulder problems are a result of more than one or two conditions, I’ll attempt to hit the big ones here.

If you’ve learned anything by now, I hope it’s that the body compensates as an entire unit, not just as one single problem (thus my continuous lecturing about how lower body problems cause upper body problems). Anyways, this picture here shows a lot of the really big points:

Take this with a grain of salt: the middle image still doesnt show GREAT posture.

Take this with a grain of salt: the middle image still doesn't show GREAT posture.

A lot of people (and I mean A LOT) exhibit the first and last frames to some extent. Obviously this guy is exaggerating the stance so you can clearly see the difference, but most people have one of the two. You should be able to see what a forward head is. This normally comes with rounded shoulders and scapular winging. Sway back and flat back are results of a pelvic tilt, which may or may not be present, though it usually is to some degree.

Anyways, most people end up with rounded shoulders, tight internal rotators and weakened, lengthened external rotators. What? Ok, so here’s the list (it’s not exhaustive):

Internal Rotators: Pec major and minor, subscapularis, anterior (front) deltoid, biceps, lats, and teres major.

External Rotators: Infraspinatus, posterior deltoid, teres minor, rhomboids and lower trapezius.

For those of you who know anything about anatomy, you know that the total combined mass of the muscles responsible for external rotation is FAR less than the same statistic for internal rotators. English: you have way more power in internal rotation than external rotation. Worse, most guys who go to the gym only work on their internal rotator strength, and they end up with a HUGE imbalance between internal and external rotation of the shoulder. Result? Scapular winging and rounded shoulders, not to mention pain, trigger points and terrible shoulder mechanics.

By the way, while we’re talking about scapular winging, let me define that term for those of you who don’t know: scapular winging is when your shoulder blades stick out, usually at the bottom. If you back up against a wall and you feel your shoulder blade “points” hit the wall first, you have poor posture and winging.

So, even if you hit the weights hard and train your external rotation strength, you won’t be able to get anywhere in terms of your posture until you get all of the trigger points out. Let’s take a look at some common trigger points in the shoulder.

Rotator Cuff Muscles

I want to draw your attention to the upper right part of the picture.

I want to draw your attention to the upper right part of the picture.

You’ve seen this picture a thousand times, right? The upper right shoulder shows where most of the trigger points in the shoulder are located. You’ll see that most of these are on your rotator cuff muscles, and that’s no coincidence. Because of the way we are built, with so little strength in external rotation, and because most peoples’ internal rotators are far too strong, most people develop trigger points in their rotator cuffs as a last ditch effort by the body to preserve joint function. Since you, the uninformed user, are neglecting to pull your shoulders back where they belong and keeping your glenohumeral joint aligned over your center of gravity, the rotator cuff muscles physically shorten by developing trigger points and painful spasms in order to keep some function.

Note that infraspinatus trigger points actually refer pain to the front of your shoulder, and some to the medial border of the scapula.

Most people have trigger points in their supraspinatus muscle. It sits below the trapezius and causes pain in the deltoid. Extreme tightness may cause clicking of the joint.

These are the two most commonly overused and most commonly injured of the rotator cuff muscles. They can best be reached by laying on a tennis ball and rolling around on it. Supraspinatus can be a pain to get to, and you may have better luck by manually massaging it with your fingers. In fact, I recommend this approach over tennis balling it.

Internal Rotators

Most peoples’ internal rotators are extremely tight and shortened. This leads to scapular winging, protracted shoulders and a depressed posture look. In order to resolve this, you’ll need to foam roll, tennis ball and stretch like crazy. You may even need help stretching from a physical therapist, or active release work done by a certified chiropractor. In any case, here are the big ones.

Pec minor length is critical and alone can control the resting position of the scapula. It is problem number one with rounded shoulders.

You can see that this muscle, while small, can tighten and cause the entire shoulder girdle to “hunch” forward. The scapula will be stuck in an anterior tilt and most of your external rotators will be compromised. The trigger points can be difficult to hit with a tennis ball. I suggest you foam roll the entire pec region first, as it will guide you to the location of trigger points. Most of the time, pec minor can only be worked on by an expert, but you can stretch it and sometimes get the trigger points yourself with some diligence.

Pec major trigger points are a little different. They have a tendency to occur frequently in a few locations, but they occur anywhere in the muscle. Technically, all muscles can have a trigger point just about anywhere, but most muscles develop trigger points in “set” locations. The pec major has more tendency than any other muscle to develop trigger points wherever it pleases. That said, here’s a picture of the most common ones:

You can see that most of the trigger points occur near the insertion to the humerus.

Like I said, foam roll these babies before you hit them with the tennis ball for MUCH better results.

The deltoid muscle is a fairly powerful sheet of muscle situated at the top of the humerus. It is the one you see most of the guys in the gym attempting to build up, but most people go at it all wrong. Instead of working the entire muscle equally, people tend to bench too much and do too many front shoulder presses, resulting in an overdeveloped anterior portion of the muscle, shortening and, once again, protracted shoulders. Releasing the anterior deltoid will allow for a much more effective stretch and lengthening of the muscle. The big trigger point is shown in figure A. The other parts of the deltoid can also develop trigger points and those locations are shown as well.

Self-explanatory here. Use the tennis ball to get these. For deeper pressure, try a golf ball.

Finally, the last powerful internal rotator is the latissimus dorsi. It is an incredibly powerful muscle because it attaches your arm to your hips directly. Shortness or tightness here causes vague mid-back and posterior shoulder pain. You should DEFINITELY foam roll the lats first, as they are huge sheets of muscle that can develop points anywhere. Once you’ve foam rolled, you should know where the worst places are.

You can see that a trigger point in the lats causes a dull ache virtually everywhere with concentrated mid-back pain.

Rotator Cuff and External Rotators

Once you’ve gotten all of the trigger points out of your internal rotators, you’ll want to focus your attention on the external rotators. This part here will probably relieve a lot of the pain you are suffering from. Because the rotator cuff and external rotator muscles are all fairly small and very weak in most people, they tend to tighten, spasm and immobilize to avoid injury. You’re informed about your body and its mechanics, so you’re going to release these muscles and then take good care of them, right? Well, it’s ok if you don’t, they’ll just go back to hating you and getting all stiff again.

Anyway, the rotator cuff muscles are all very easy to hit with the tennis ball. Lay down on the ground and place the tenins ball on the outside of your back just below the shoulder. Here’s a good picture via Lauren’s Fitness:

Lauren has creatively captioned this image for me.

Lauren has creatively captioned this image for me.

Note the area that is slightly redder than the rest of her skin. This is where the arrow points to, and this is where you can place the tennis ball. Be careful in here, there are some delicate nerve structures in this area. If you put too much pressure on them, they’ll respond by getting angry and shooting an “electric” pain down your arm. Not to worry, so long as you back off and try again at a slightly different location.

Lauren goes on to talk about doing internal and external rotation actively with your arm while laying on the tennis ball. This is something you should look to do as you advance your tennis ball prowess. Rather than trying to explain it all over again, I simply refer you to the source: .

The rhomboids are responsible for pulling your shoulder blades in towards your spine. A LOT of people complain of pain in this area, and when I give a massage, on the rare occasion that I do, almost everyone responds favorably to pressure on the rhomboids group. Here’s a picture:

Trigger points in the rhomboid cause pain along the medial border of the scapula. It's a deep, dull ache that can get really annoying.

Hitting these is really easy. Lay down and pull your shoulder blade outwards by taking the involved arm and holding it across your upper body. By moving the scapula outward, you stretch the rhomboids and they are ready to be hit by the tennis ball optimally. You might also find that a deeper muscle, the serratus posterior superior for those of you interested, is also tight and immobilized. If you have deep posterior shoulder pain upon forced breathing (read: heaving, out of breath, sprints, etc), you will probably benefit greatly from this particular move.


The trapezius muscle group is massive. It is so big, even medical specialists are willing to separate it into three parts, each having fibers oriented in a different direction and being responsible for a different kind of movement. The parts are creatively named the lower, middle and upper trapezius. The lower trapezius is responsible for scapular depression, the middle trapezius is responsible for scapular retraction, amongst other things, and the upper trapezius functions to move the skull and shoulders. Of course, this means there are a TON of trigger points to find in your trapezius. Trigger points here can cause shoulder pain, neck pain, headaches and migraines, (ever heard of a tension headache?) thoracic back pain and a few more goodies.

The difficulty in hitting the trapezius trigger points cannot be understated. I mean, don’t get me wrong, it’s really easy to lay down on the tennis ball, roll around and note where your points are. But it wasn’t until I stood up that I found a lot more of them. Here’s a picture to get the light bulb lit up:

Once again, Lauren enlightens us on the nature of tennis ball therapy against a wall.  Dont limit this idea to the traps alone.  I found all kinds of points in my back were much easier to hit with this position, and even some of the lower body points can be dominated like this.

Once again, Lauren enlightens us on the nature of tennis ball therapy against a wall. Don't limit this idea to the traps alone. I found all kinds of points in my back were much easier to hit with this position, and even some of the lower body points can be dominated like this.

If you’re really having trouble getting started, this tiny picture should help give you some ideas (if you can see it).

Apologies on picture size...couldnt find anything much better.

Apologies on picture size...couldn't find anything much better.


You may or may not have heard of your erector muscle group. They are massive stabilization muscles that run along the length of the spine and attach to every bone along the way. You should be able to feel them just by feeling the bulges that run along either side of your spine, all the way up. In the lower back, they are very prominent and you can find them quite easily. As you move upwards, they tend to get buried under all the other muscles and you don’t find them again until you start manning up and lifting weights ;-).

At any rate, these tend to get stiff, though I’ve never found an actual trigger point in the erectors themselves. It’s pretty easy to get these with a tennis ball, but when foam rolling, only foam roll the thoracic spine (stay away from the lumbar (lower) and cervical (upper) spine as these areas could get injured with the foam roller). With a tennis ball, we can hit all of the spine safely. Tie two tennis balls in a sock. They should be the perfect width apart to hit both sides of your spine without actually being ON the spine. This is important stuff…don’t roll the spine itself!! Just lay on the tennis balls and position each over the erectors. You can roll up and down, though I find it easier to sort of just “shift” their position up the whole way. Be careful around your neck. I don’t usually use the tennis balls up here.


One place people don’t ever suspect trigger points, but where almost all have them, is in the forearms. A lot of us do a fair amount of typing, lifting, gripping or otherwise beating down the forearms. They are a lot like the calves: a lot of really tough muscles packed into a fairly small place. The picture below shows the forearm “sweet spot.”

There is almost ALWAYS a trigger point in people at this location. Whether it be from typing, gripping, lifting, or just living, it's almost guaranteed to be there and angry.

This point is really easy to hit: simply put your weight on your forearm and position the tennis ball below that point.

It is also worth mentioning that a fascia release in the forearms does wonders. If you want to avoid or treat problems like tennis elbow, carpal tunnel, wrist pain or “forearm splints,” (the term I use to describe the pain a lot of weightlifters feel, while curling or something similar, along the forearm bones), you can foam roll the forearms. This is also very simple and can be done in the same manner as the tennis ball treatment.

Foam roll the forearms first, then use the tennis ball to hit the trigger point in the picture. Sometimes there are trigger points near the wrist too, and they aren’t usually difficult to find simply because there isn’t a whole lot of meat up there. Check the top inner part of your wrist. You can sometimes find tight muscles or even trigger points in your hand. Use your other hand to manually palpate (feel the muscles) your hand muscles to see. If you work with tin snips, scissors or some other kind of tool that requires a squeezing motion, you probably have some trigger points in your hand (along with phenomenal pinching strength?).

Alright! That about wraps this post up. Some upper body disorders that can be fixed with the tennis ball and foam roller include (but are not limited to) carpal tunnel, wrist pain, tennis elbow or other kinds of elbow pain, tendinitis in the shoulder, quadrilateral space syndrome, thoracic outlet syndrome (this bastard requires some specialist work though), shoulder girdle rotations, forward head, anterior tilt of the scapula, winging, loss of thoracic mobility, pec minor syndrome, pelvic tilts and rotator cuff injuries.

In my next post, I will do the pictures again and show you some great ways I’ve discovered to work with the muscles. It shouldn’t take me too long to get that up. Here’s Lauren’s rundown. It’s a bit shorter and somewhat less complete, but it’s a great way to get started. The therapy itself is pretty self-explanatory too, if you’re having trouble waiting (which I just KNOW you are).

Thanks all for reading and check for updates.



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  1. Hey, I found your blog in a new directory of blogs. I dont know how your blog came up, must have been a typo, anyway cool blog, I bookmarked you. šŸ™‚

  2. […] standing or sitting, the human body is built to turn inward; naturally possessing more muscle mass that turns us inward than outward. Perfectly formed to slump […]

  3. You have been the first to help identify the left shoulder pain I have been having for the past 20years. Its the pec minor trigger point caused by exactly what you said- hypertrophied, tight, shortened internal rotators and weakness (neglect) of the external rotators from years of lifting weights. Incorrectly or imbalanced I should say. I have a plan of attack. Strength balancing and focused stretching. Thanks for providing more information and help than multiple doctors, prescriptions, and MRIs have offered over the years.

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