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Shoulder Pain in Pregnancy: How to Support "The Girls"

This is the third post (Weeks 11-12) in the series "What you don't expect when you're expecting".


Boobs, amiright?


Here is the order of people who learned about my first pregnancy:

  1. My husband

  2. My bartender (it’s was St Patrick’s Day and I need a convincing looking Jameson & Ginger)

  3. The ladies at the bra store

  4. My parents (sorry mom haha)

Often the first outward sign of pregnancy is bigger boobs, especially if it’s your first pregnancy when you don’t show as quickly as in later pregnancies. As soon as your hormones start signaling “PREGNANCY!”, fatty tissue and blood flow to your breasts increases. This helps the milk ducts and mammary glands grow, so not only do they get bigger (sometimes a cup size in just a few weeks) they get heavier, too.


And that extra mass is not immune to gravity. It pulls everything it’s attached to (pectorals, shoulders, even your head) forward and down.


“I wish my boobs were on my back.”


I’ll never forget when my friend Kristin uttered this phrase when she was about half way through her pregnancy.


Now hear her out. There’s so much additional weight growing out the front of you that in order to keep your balance, your body takes on some compensatory postural patterns. Now if your boobs grew on your back, that could help balance everything out!


Buuuuut we all know that isn’t really an option.


So what can we do?


Well, it’s all physics. Think of it like a pulley system...just like a bra!


When you wear a bra, the weight of your boobs tries to pull the cups down, but the straps pull UP on the cups by running up over your shoulder and down your back. I’m sure we’ve all experienced when the bra band is too loose and it rides up your back. When you pull the band back down, the boobs go up!


While we can’t put the weight of our boobs on our back, we can still create enough force using the muscles of our back to keep the weight of the boobs from collapsing our shoulders and chest forward and down. If you spend too much time with your shoulders hunched forward, an imbalance can occur. On one side of the body, over-activity or tightness is seen while on the other, inactivity or lengthening. In the case of heavy boobs, the imbalanced pair is the pectoralis major and minor in the front, and the rhomboids on the back. After a while, the imbalance cycle self-perpetuates.


Before we get to what you can do to keep those girls perky, a little anatomy lesson, courtesy of a paper I wrote for my Functional Anatomy grad class a few years back:


The pectoralis major and minor are located on the front of your rib cage, under the breast tissue. The pectoralis major originates from the medial third to half of the clavicle, sternum, and costal cartilage of the first through sixth rib, and inserts on the bicipital groove of the humerus. The pectoralis minor lies deep to the pectoralis major and originates from the third through fifth rib. It inserts on the medial surface of the coracoid process of the scapula (Acland, 2013; A.T. Still University, 2014; Moore, Dalley, & Agur, 2014).


The pectoralis major is responsible for shoulder…

  • flexion

  • adduction

  • extension from a flexed position

  • horizontal adduction

  • medial rotation

The pectoralis minor is responsible for scapular (shoulder blade) motion.

  • anteriorly tilting

  • depression

  • protraction

  • downward rotation

The pectoralis major and minor are prone to being short and tight.


The rhomboids are located on the back of the rib cage. Rhomboid major originates from the spinous processes of T2 to T5, and inserts at the medial border of the scapula, between the spine of the scapula and the inferior angle. The rhomboid minor lies superior to rhomboid major. It originates from C7 and T1, and inserts in the upper portion of the medial border of the scapula, at the level of the spine of the scapula (Acland, 2013; A.T. Still University, 2014; Moore et al., 2014).


The rhomboids, both major and minor, are responsible for scapular…

  • retraction

  • downward rotation

  • leads to external rotation of the humerus


Both the rhomboid major and minor are prone to being lengthened and weak.


When their efforts are combined, active rhomboids and lengthened pecs bring the shoulder into optimal alignment and allows for full range of motion of both your shoulder blade (scapula) and shoulder (humeral ball-and-socket). However, when weakened rhomboids are combined with tightened pecs, the scapula is protracted and anteriorly tilted, while the humerus becomes medially rotated.


The activities of our daily lives can lead to bad postural habits. Long hours working on a computer, driving to and from work and everywhere in between, and relaxing over our cell phones can all lead to rounded shoulder posture (RSP) and forward head syndrome (FHS). This posture is a result of tightened pectoralis major and minor, and inactive rhomboids (A.T. Still University, 2014; Kim et al., 2016). As scapular anterior tilting is the primary function of the pectoralis minor, tightening of this muscle would work against posterior tilting of the scapula. Posterior tilting is important for overhead motions, as well as extensions movement that occur behind the back (A.T. Still University, 2014). A tightened pectoralis major will also make itself apparent in the form of increased medial rotation of the humerus, and difficulty in performing extension and horizontal abduction. Shortened pectoralis major and minor and inactive rhomboids can also cause the head of the humerus to glide anteriorly if the subscapular muscles cannot create enough counterbalance. This can also make overhead movement problematic (Kim et al., 2016).


Did you just skip to here?!

...it’s cool, I get it. Not everyone nerds out as hard as me.


Here are the Cliff’s Notes:

  • Front of the shoulder gets tight

  • Back of the shoulder gets stretched

  • Both are a form of weakness

  • Must both stretch the front AND strengthen the back to restore balance

So, how can you tell if you could benefit from the exercises I’m about to share with you?


Here’s a quick test:

  • Close your eyes and march in place, arms swinging for about 5 seconds

  • Stop and notice how your body “falls into place”

  • What way are your palms facing?

  • They should be facing your thighs but I’m gonna guess they probably are facing behind you.

  • This indicates that the front of the shoulder is probably tight.

As I mentioned before, the antidote is two-fold; release the front and reload the back.


Start with the release part first so you can get more out of the reload. This list starts with the most passive and gradually gets more active/intense.


Releases


1. Passive Bolster Stretch

  • Lay down with your shoulders and head supported by a bolster or really big pillow.

  • Bring your arms into a Goal Post, trying to get the back of your hands to touch the floor.

  • Take 5 slow deep breaths (or more)

  • Enjoy gravity doing the work for you

2. Foam Roller Snow Angels

  • Lay down lengthwise on the foam roller, tail and head fully supported

  • Arms down by your sides, palms up. Knees bend, feet flat.

  • Make gradually larger snow angels over the course of 8 breaths

  • For the last one, sweep your arms all the way back then circle them to the ceiling and back down by your sides

  • Try to keep the backs of your hands in contact with the floor the whole time

3. Standing Doorway Stretch

  • Stand with one arm in a Goal Post

  • Stand in a doorway and place your entire forearm against the wall

  • Rotate your body away from your arm

  • Hold for 3 seconds, release, the hold again

  • Repeat on the other side

4. Myofasical Ball Release

  • This one requires laying on your stomach on the floor or leaning against a wall while using a myofascial release ball. I would suggest finding a Yamuna Bodywork practitioner to guide you through this release. But in the mean time, enjoy this photo of me staring at a wall.

After opening and releasing the front of the body, you now have a fuller range of motion. However, this effect is only temporary. Now it’s time to reload (or strengthen) the back to help keep your new found alignment.


Reload


This series of exercises can be done with an elastic band, but you’ll see me using my Fletcher Towel. This red braided towel is my favorite small prop for shoulder strength and mobility!


1. Shoulder External Rotation

2. Anterior Range of Motion (shoulder flexion)

3. Taught Towel Pulls (shoulder horizontal abduction)

4. W Pulls - horizontal (modified rows)

5. W Pulls - vertical (lat pull down)

6. Posterior Range of Motion (shoulder extension)


Now there is a secret third step to this process.


Do you spend a lot of time on the computer? Looking down at your phone? Driving?


A lot of daily activities can put our bodies into the posture we are working to undo. So spend some time simply being aware of how you’re holding and using your upper body throughout the day.


Those boobs are only going to get bigger. And no matter how you choose to feed your impending bundle of joy, you’re going to take on a rounded, protective posture after delivery as well. This series of releases and exercises will carry you right into the fourth trimester - a time when feeding and cuddling can become a literal pain in the neck.


So practice taking care of yourself now. And keep taking care of yourself once your baby arrives!


Resources

Acland, R. (2013). Volume 1: The Upper Extremity. In Acland’s video atlas of human anatomy. Retrieved from http://www.aclandanatomy.com/browse/101


A.T. Still University (2014). Functional anatomy of the upper extremity transcripts. [PDF Document]. Retrieved from https://atsuni.blackboard.com/bbcswebdav/pid-30921-dt-content-rid-42924_1/institution/CGHS/Course%20Documents/KINE/KINE5003/Videos%20and%20transcripts/Functional_Anatomy_of_the_Upper_Extremity_Transcripts.pdf


Kim, T., An, D., Lee, H., Jeong, H., Kim, D., & Sung, Y. (2016). Effects of elastic band exercise on subjects with rounded shoulder posture and forward head posture. The Journal of Physics Therapy Science, 28, 1733-1737.


Moore, K. L., Dalley, A. F., & Agur, A. M. (2014). Clinically Oriented Anatomy, (7th ed.). Baltimore, MD: Lippincott, Williams & Wilkins.


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