Two Of These Aren't Even At Your Shoulder
If your shoulder keeps flaring up, no matter what you do, it's usually one of four things. And two of them aren't even at your shoulder. They're on your chest, and under your armpit.
Here's the quick version. Tight pecs — your chest muscles pulling your shoulder forward, closing the space down before you've even moved. Tight lats — the big muscle under your armpit, pulling the shoulder forward and down and stopping you getting overhead. A weak rotator cuff — so the ball rides up in the socket instead of staying centred, and squashes the tendon. And a shoulder blade that doesn't move properly — so the space never opens when you lift. Four things, all of them squeezing the same space, every single day.
In the last video I gave you the four causes: impingement, rotator cuff tears, frozen shoulder, labral tears. But those are what's damaged. These four are what damaged them. And that's why you can have all the treatment in the world on the sore bit, and it comes straight back — because you're treating what's damaged, instead of what's damaging it.
My name's Joe. I'm an ex-professional football head physio and multi-clinic owner here in the UK. As always, this is a guide to help you understand what might be going on. It's not a diagnosis.
Tight Pecs
Your pecs are your chest muscles, and they attach onto the front of your shoulder. When they get tight — and in most people they're tight — they pull the shoulder forward.
Your shoulder is supposed to sit back, stacked underneath the shoulder blade. Tight pecs drag it forward, so the whole joint sits in a rounded, forward position. When that shoulder rolls forward, the bit of bone that sits over the top of your tendons comes forward with it. So the space where your tendons run is already reduced — before you've even lifted your arm. You're starting every single reach from a closed-down position.
Almost everyone has this, and here's why: everything we do is in front of us. Sat at a desk, driving, on the phone. Even in the gym, everyone benches and does press-ups, and nobody stretches the front. The chest gets shorter and shorter, and the shoulder gets pulled further forward.
Tight Lats
This one gets missed all the time, and it's a big one. Your lat is the big muscle that runs from your lower back, up the side of your body, and attaches right under your armpit onto the top of your arm. That attachment point matters, because it means a tight lat pulls your arm down and forward.
To get your arm overhead, that lat has to lengthen and let go. If it's tight, it physically restricts you — it won't let the arm come all the way up. But you've still got to reach that shelf, still got to lift that weight. So the shoulder finds that range from somewhere else. It gets it by jamming the joint up at the end of the movement, and that's exactly where it gets pinched.
You'll see this constantly in people who lift, in swimmers, in anyone who does a lot of pulling — and honestly, in most people who sit all day too.
A Weak Rotator Cuff
We talked about the cuff in the last video as the thing that tears. But it's got a job to do as well: holding the ball centred in the socket. Your shoulder is a really shallow joint — built for movement, not stability — so it relies on the cuff muscles to keep everything sitting where it should.
When the cuff is weak, that control goes. As you lift your arm, instead of the ball staying centred and rotating in place, it rides up in the socket. And when it rides up, it squashes everything above it. So a weak cuff closes that space down from the inside.
Here's the frustrating bit: it becomes a cycle. The cuff's weak, so the ball rides up. The ball rides up, so the tendon gets compressed. The tendon gets sore, so you use it less. And it gets weaker still. That's why so many shoulders quietly get worse over months and years without any single injury.
Poor Shoulder Blade Control
Here's what most people don't realise about lifting your arm: your arm doesn't lift on its own. Your shoulder blade has to move with it. As the arm goes up, the shoulder blade should rotate upwards and glide round on your ribcage, and that movement is what opens up the space for your tendons to pass underneath.
If the muscles controlling that blade are weak, it doesn't rotate up like it should — it lags behind. And if the blade doesn't move, the space doesn't open. So every time you lift, you're compressing those tendons underneath. Over and over, every single day.
Why Treating The Sore Bit Doesn't Hold
So there are your four: tight pecs pulling the shoulder forward so the space is closed before you start; tight lats stopping the arm getting overhead so the shoulder jams at the end of the range; a weak cuff letting the ball ride up and squash the tendon from the inside; and poor shoulder blade movement meaning the space never opens when you lift.
Notice the thread through all of them. Every single one is closing down the same space, or overloading the same tendons — not once, but thousands of times, over years. Do that long enough and the tendon gets irritated. That's your impingement. Leave it long enough, and it can start to tear. The damage is the end of the story. These four are the start of it.
That's exactly why treating just the sore bit so often doesn't hold. You can rest it, inject it, even operate on it. But if your chest is still tight, your lat is still tight, your cuff is still weak, and your shoulder blade still doesn't move, nothing's changed about why it happened in the first place.
If your shoulder keeps coming back no matter what you try, this is where I'd be looking. Get your pecs, your lats, your cuff strength, and your shoulder blade control properly assessed.
This article is a guide to help you understand what might be going on with your shoulder pain. It's not a diagnosis. If your shoulder pain is persistent or keeps recurring, get properly assessed by a professional to identify which of these mechanical factors is driving it.
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