Wednesday, July 9, 2008

Shoulder Pain Relief - Miscellaneous Hints

Chances are your shoulder pain, like practically every other kind of pain, is something that you have spent many years working to create. This may seem hard to accept, and it is not meant as an insult (rather, a blunt truth, which is generally true for everyone, I've found) but once you are open to this way of thinking, you can get amazing results - such as are never possible if you continually think that "something is wrong with the shoulder, how can I get it fixed? Who will I go see?" 

How can such a generalization be true for most all types of shoulder pain?  There are many different reasons  for shoulder pain: bursitis, injury, disease, torn muscles, muscle spasm, arthritis, etc. Most somatic practitioners, I'd guess, would agree that there is some mysterious aspect to this: in so many cases, once somatic work is well underway, shoulder pain will diminish, or disappear - no matter what is the original cause. I would not have believed it myself, had I not experienced it both in my own body, and while working with many clients. How can gentle movement and re-education help, say, chronic shoulder bursitis? Well, it does! That has been my experience. It seems that whatever shoulder trouble a person is destined to get, the foundation or preparation - or you could call it an invitation - for that kind of trouble, has been taking place for many years, by how a person has been using their shoulders and their whole body. Whatever injury happens or whenever chronic pain emerges, it will exist in a body-mind-emotional-movement matrix that has been long in preparation. If we change the matrix, we change the shoulder pain - or get rid of it entirely. It is really quite an adventure to experience such a thing, working from the back-end so to speak, and  I hope you will take the time to read this long post, to get a sense of some of the details behind this funny way of thinking. 

All that is not to say that you cannot benefit by manipulative or surgical intervention, or other modalities. It may  be the best thing, it may be absolutely necessary.  You'd be foolish not to do so, in many cases. That is certainly true if you have a torn rotator cuff or a painful bone spur - surgery is often a good choice. For sure, medical diagnosis is a good thing in any case.  If you have a true case of adhesive capsulitis - not just a mild form of frozen shoulder - you will need strong and skillful intervention. Gentle mobilization won't be enough, and finding an experienced Physical Therapist for this would be a great choice. In my case, I discovered a Feldenkrais Trainer - Jeff Haller - who was the first person to actually help my situation, reduce my pain. He is a strong man, and he used very forceful (but slow and skillful) manipulation (just one session, 35 minutes!) to partially open the joint, and I was literally in tears from pain - but afterwards, my pain was much less, and from then on, I could handle the situation on my own, with mobilization exercises (walking fingers up the wall and doing ATM lessons for the shoulders). Before that, I could not - the pain was too excruciating. Jeff told me "Feldenkrais is about doing what is needed, and that's not always gentle and comfortable as many think". 

Granted, Jeff knew what to do (plus, he is a Trainer), but I don't think many other somatic practitioners have truly had much experience with such extreme pain and such tremendous, forceful muscle grabbing as is found in adhesive capsulitis. It's more of an extreme medical condition for which people go to physical therapy.  If you can find an experienced somatic oriented person, use them, of course. In my case, after seeing Jeff, I found a Chinese/Vietnamese acupressure master (A Dr. Tran in Anaheim, California near the end of his long career) who knew how to continue opening the shoulder joint, using (again) strong, slow mobilization - while at the same time using finger acupressure to manage the pain and facilitate the process. He was really good. So, I myself will shop around and find what I think is best. But whatever else you do or don't do,  if you also explore the somatic, the self-education and "take responsibility for what I have created" point of view, you get better, more lasting results.

You may be told that a particular muscle is causing your trouble. You strengthen or stretch or massage it, and your pain goes away. It becomes pretty easy to think the muscle was the entire cause of the problem. Well, another question  you could have asked is "Why did that particular muscle become a problem in the first place, or how can I stop it from happening again?" Then you enter the somatic realm of self-care, education and movement exploration. You'll find such ideas in  the list below. Granted, they are all artificial, compared to doing an ATM class or taking a Feldenkrais Training program for four years. Actually, that is where the list came from - first taking a training, then noticing what happened that there is no more pain or trouble anywhere in the body. The shoulders just naturally embody all those ideas, and there is no trouble. What's artificial is creating a list from what was seamlessly integrated into global movement patterns.  So, involvement in the Feldenkrais Method is the best way, where you learn and assimilate at your own pace, many things related to your whole body, to movement and self-image, not only your shoulders. Results are real, lasting, entirely beneficial. 

Much better than using such a list, also, would be to see a qualified somatic professional, who had the experience and common sense to be able to know which (if any) of these were pertinent for you at that time. He or she could guide you though a process of very quick progress, where relief would happen fairly quickly (provided you cooperated with certain other common sense recommendations that may be made, such as modifying your gym routine, or eating more greens and  less inflammatory foods (usually grain based and starchy, or junk food) to minimize inflammation.

This list, as good as it may be, is like a band-aid approach to a systemic problem. Really, we need to learn to organize our bodies - especially including our pelvis and ribs - in such a way, moment-by-moment that strain on the shoulders is minimized, and all arm or shoulder maneuvers become effortless, easy and elegant. That requires long mentoring in the Feldenkrais Method or the martial arts, or some other type of somatic work. You'd need to learn to sit dynamically, not statically with rigid spine, ribs and pelvis all day long. While doing Feldenkrais Awareness Through Movement (ATM) you are often challenged to move in new, strange or difficult ways, and slowly you wake up forgotten abilities to stay present, to be adaptable to what the moment may bring, to organize and attend more intelligently to your body as you go about life. It carries over to life, unlike regular exercise. Then, shoulder pain, or hip pain or back pain simply does not become an issue (baring serious injury or disease).  

So, if  you are willing to think in a new direction, I will share some of the ideas that I have garnered from my years of practice. My clients taught me some of these items, and others I learned in workshops or from personal trainers, PT's or from extensive reading. However, most came from my experiences during - and after, but as a result of -  my four year Feldenkrais Professional Training Program. Only a few of them, or perhaps none of them, will apply in your particular situation. You need to try them out and see. Choose whatever calls to you, whatever seems to make most sense, that you might need. 
  • If you are a musician, do you ever slap your hand on your leg in time to the music, or clap your hands? That's OK, but watch how you do it. It can be done with softer wrists, more gently, so that you don't completely stiffen your shoulder(s) to do that. 
  • Similarly, as you type at a keyboard, what are you doing with your shoulders and ribs? If you are freezing down your shoulders, instead of staying loose, every key hit will "rebound" back into the hand, and this is a prime cause of carpal tunnel syndrome. Learn to type with a softer chest, with mobile, loose shoulders. 
  • Notice what you do as you hold your computer mouse. Is your shoulder lifting? Can you imagine having a heavy elbow as you use your computer mouse? Can you sense your whole body, how you are sitting or standing, and intuit what little changes you can make in your posture or sitting arrangement to make it easier to use the mouse?
  • A prime cause of shoulder and neck pain is not keeping the chin in as you work or talk or walk.  The back of the neck needs to learn to be more relaxed and lengthened, and we need to learn how to relax our chin down, not force it down, especially as we sit to work or meditate for long periods without a break. When the chin is too high, the back of the neck is too tense, the weight of the head is compressing down the spine in a most damaging fashion. It is SO important to keep the chin in, in a natural way. At the same time, one needs to learn how to not protrude the head forward too much.  It sounds simple, but it is not easy. You might take 3  years or more of intensive study of the Alexander Technique to accomplish this - people do that and get miraculous results. If you try to do this artificially, by using will power unintelligently, you will look as if you "swallowed a spoon" as Moshe Feldenkrais said. You need a teacher, absolutely, to learn this. The Alexander Technique is wonderful, you should try it, and please don't think it is only about keeping the chin in! It is a very sophisticated form of somatic education, and that alone would probably give your shoulder(s) great and permanent relief. 
  • Never hold a phone to your ear by hiking up one shoulder. That would be practicing the very thing that will cause you the most trouble, long term. Never do it. Never!
  • On the other hand, it is wonderfully effective to hike up one or both shoulders to the ears, holding it there momentarily and strongly, and then slowly let it sink down, down, down. When it reaches bottom, imagine it is still going down. You'll get a sense of restfully grounding the shoulder. The reason hiking up your shoulder to hold the phone is so bad, is that you are staying fixed like that, for a prolonged period, and also you are not consciously, slowly relaxing your shoulder back down to normal, after the phone call. Instead, your shoulder hangs on to at least some of what you just "taught it to do", which was to stay hiked up towards the ear.
  • Look at your desk, your computer keyboard height, your chair height, and decide whether your arms and shoulders - while you write, type, mouse or draw or whatever - are being elevated too high. This may feel good, since the neck muscles that pull up the shoulders are being relieved of work, but nonetheless, you are perpetuating a bad habit. Gradually change the geometry of your work area (lower desk, lower keyboard, higher chair, etc) to create a little feeling of stretch between the neck and shoulders. That will keep you moving in the right direction.  
  • Think of heavy elbows as you walk or run. The shoulders are not so easily voluntarily controlled, as are the hands or even the elbow. We don't turn doorknobs with our shoulders. Mostly, the shoulders respond to what the hands and the rest of the body is doing - they are reflexive, in other words. So, logically, the best approach will be indirect. Because the elbow is halfway from the hand to the shoulder, it is a good "handle" with which to direct the shoulders. If  you directly tell your shoulders to relax and drop, they will quickly forget that instruction; they are not wired to remember such things! Just holding to the idea of "heavy elbows"  - letting yourself dwell on that concept for a minute or two now and then - means grounded, not lifted, shoulders. Lifted shoulders are a prime cause for shoulder trouble of all kinds.
  • Understand that somatic re-education means slowing down, getting a teacher or attending classes and doing something  very different than you do in exercise, or even in everyday life. Most folks have shoulder blades and clavicles that are glued to the body far too tightly, so the arms for the most part move independently of the shoulder. The gleno-humoral joint, where the upper arm meets the scapula, is therefore grossly overworked in most people. For years, for a lifetime, too much movement has happened right there, and far too little in the scapula and collarbone and ribs and pelvis - in response or in preparation or participation to arm movements. A lifetime of moving like that is a strong habit! How many millions of movements have you made with your hands and arms? It is almost certain that if you try to change this alone, at home with some exercises or ATM tapes, or by doing a few corrective exercises - you won't be as  successful as if you had the guidance of a teacher and the support of a classroom of like-minded students. Alone, you might well learn new and better ways to use your arms and shoulders. But the first moment you have stress, or need to over-exert yourself, or be athletic, or  have a stressful job to do, or try to concentrate too hard, or have a social interaction  - you will lose what you thought you had gained.  The learning is lost. Why? Because such learning is extremely context specific. You'd need to practice your new learning in  all  kinds of situations. Either that, or you'd need to learn to create from within an awareness and readiness and body intelligence that will serve you well, in every situation, in every moment of life. That is what good somatic education will do for you.  
  • Your scapulae, the shoulder blades on your back, are meant to slide and glide as the arms move. Most of us hold them  rigidly fixed to the ribs. While walking, for example, let your arms swing a little, and think/imagine/visualize/sense the shoulder blades sliding and gliding in response to the arms swinging. Almost nobody can do this, except Feldenkrais students. I would be absolutely shocked if, while taking a walk,  I were to observe someone having normally-moving shoulders like that. Everybody is frozen down as they walk, their arms are swinging grotesquely from frozen shoulders and tight ribs. Allowing movement of the swinging arms to flow gracefully through the shoulders into the ribs and spine and pelvis is a wonderful way to release, relax and rejuvenate the shoulders. The counter-rotation of the pelvis and ribs will create just the right amount of arm swing. Even people who think they have good shoulder movement, who think that their shoulders are relaxed, are freezing them down as they walk, if not completely, then at least partially. And when, eventually, they get shoulder pain, and muscles start to grab painfully, they will blame the shoulder!
  • Accept the toll that aging has done to your body. It is not just about tissues becoming decrepit or less-than-vibrantly-youthful. Probably you have a collection of over-tight muscles, many with painful tender points. You have many postural distortions, some major and some minor. Your balance and breathing and movement patterns all need refreshment and updating. Every joint is probably over-compressed. You no longer "move into length" as you did as a happy young child - now you "move into compression". Every injury, every fall, every trauma, every surgery, every pregnancy, every divorce, every episode of back pain, every stress, every prolonged wrong sleeping position, every too-hard pillow, every athletic event where you overextended - has left it's mark on your body. So now, your shoulder(s) hurt! Well, most likely you need to attend to your whole body in a systematic fashion. You need  to find a way to release all those tender points, rehabilitate and reintegrate (not just stretch!) all those over-tight muscles and fascia, and get a new take on life. That is pretty much what would happen in a four year Feldenkrais Training program. Or, you can visit massage therapists, chiropractors,  PTs, osteopaths and personal trainers, and do what they say, get treatments, and much progress and improvement can be had in this fashion. That would probably cost you as much as a Feldenkrais Training Program! For sure, you'd need to give up thinking you want them to focus only on your shoulder pain. Let them do what they see needs to be done, to create lasting results. They are smart, educated, dedicated people, and they want to help.  You need to ask them for corrective or helpful exercises. Most of them won't offer such advice, because so very few people want to do such things, or even if they do, they actually never really do them. They know everyone is too busy.  Such professionals appreciate clients like that. They can really help you if you listen to their advice, and do what they say. You'll astonish them. So many of their clients only want their symptoms to be fixed.
  • Avoid using arm rests on chairs - especially soft sofas - if the arm rest is too high. The test is: as you sit there, with your arms on the arm rests, are your shoulders being elevated? That is not a good thing - certainly not for prolonged periods! It is NOT something you want to teach yourself:  "I'll sit down and relax, be comfortable, while keeping my shoulders elevated off the first rib, so it is ungrounded, disconnected. I'll teach myself how to relax while being disconnected. I'll teach myself to passively be shrugging my shoulders as in "I give up" while I passively watch TV", I'll teach myself how to breath and try to relax while keeping the shoulders lifted. Whenever I want to relax or breathe easily, from then on, my body will think it has to have elevated, not restfully grounded, shoulders."  All this is horrible, yet so many people do this for many hours every day, while watching TV! The paradox is that it feels so good, to have the armrests on the chair take over the weight of your lifted shoulders, instead of the neck muscles doing all that work. That gives the neck relief and you feel very comfortable, relaxed.  Nonetheless, you are still encouraging the habit of lifted shoulders, and while relaxing!  You want to learn something more intelligent than that: such as learning to let the shoulders restfully stay grounded on the upper rib cage, as it should be, as Nature would have it - while you are relaxing. You want to learn to lengthen all those muscles that are attached to the neck, that continually are hiking up the shoulders. When they are chronically tight, they are chronically pulling up the shoulders and the first and second ribs. Making a correction on this one point, alone, can make a huge improvement in your shoulder pain. In my case, I simply got rid of all chairs with arm rests. I consider them an abomination. While that seems a bit spartan, I have very comfortable shoulders, 24/7,  without even twinges of pain, and I am over 60, and I do lots of heavy lifting - helping friends move, etc. I sit at my computer many hours a day. I have suffered too much pain (adhesive capsulitis both shoulders - unbelievable pain for many months) and I know too much to be so foolish as to use arm rests on chairs.
  • On the other hand, it is wonderfully refreshing and helpful to use armrests that are too high, if you understand what  you are doing. After sitting like that for say ten minutes, giving  your neck  and all the those pull-up-the-shoulder-muscles a chance to passively shorten and relax (by taking over their work you allow them to later willingly passively lengthen), remove your arms and slowly, consciously, deliberately enjoy letting the shoulders come to a restfully grounded position on top of your rib cage. You'll be naturally, easily lengthening and gently stretching all those muscles, as well. That is wonderful. You'll love the sensation, even more than sitting with arms on the armrests.  You'll even feel empowered. And then, sit comfortably like that for ten minutes or longer - that is the true learning you want to savor, to enjoy and prolong. You could repeat that process as many times as you wish.  What is harmful is to continually sit with elevated arms and shoulders, not understanding what you are doing, and without consciously releasing them downwards after doing that. You'll get up and walk around with shoulders more lifted than when you sat down. A lifetime of that cannot be good!
  •  Understand that an elevated first and/or second rib can be a prime cause for chronic or acute shoulder pain. It usually happens on the side of the dominant hand and is probably related to lifting the shoulder as you work. Lifting a shoulder eventually pulls up the ribs. Then you truly have a chronic problem, until you get it fixed. No amount of shoulder stretching or strengthening or massage is going to help that.  It is easy to see this, as you stand in front of a mirror. One shoulder will be noticeably higher than the other (but of course this could also be due to scoliosis or other issues). The problem is the ribs, not the shoulder, but the pain is felt in the shoulder and lower neck. There are protocols - even self-care methods too complicated to describe here - that will quickly and painlessly correct elevated first and second ribs, but these are not widely known. Other professionals do occasionally miss this, and keep treating just the shoulder; when I see such clients, they express to me their frustration about never getting improvement on their pain, after so many visits. If you follow the advice on this list, particularly about keeping shoulders grounded in various ways, you will slowly correct this condition. For a quicker fix you'd need to see an osteopath, chiropractor, Ortho-Bionomy practitioner or somatic or massage professional who knows how to recognize and correct elevated first and second ribs. Hopefully, they'd also give you some guidance about how to stop creating such a situation.   
  • Redefine the word shoulder to include all the bones (and the soft tissue that is attached) that move with the shoulders. That includes the humorous bone of the upper arm, the scapula,  and especially the clavicle or collarbone which most people forget is part of the shoulder. Spend a minute a day massaging around your collarbones, and move your arms, and feel how the collar bones move as the arms and shoulders move. Most people - especially those with shoulder trouble - think that good posture means lifting the chest, holding the chest and clavicle rigidly lifted. Because they include the collarbones in their idea of good posture/lifted chest, their shoulders have a real problem: how can the arms move and the shoulders be functional when the collar bones are never moveable? Answer: it is impossible, everything will be distorted, muscles will be grabbing and pain and trouble are inevitable, eventually.  Do you know how the body creates an immobile collarbone - in response to your constant command to stay lifted, stay pulled back, stay immobile, that is what good posture is? It does it by continually tensing the rhomboid muscles, which are between the shoulder blades and the spine. For almost everyone, those muscles are excruciatingly painful to touch, and I have delicate, difficult job on most new clients when it becomes a priority to release that tension, and allow a little movement of the shoulder blades on the spine. After some weeks most clients stop holding on like that. They breathe easier and look younger. 
  • Understand that grounded shoulders means the collarbones are resting on top of the first ribs. In other words, the  shoulders have a skeletal resting place. Their weight is supported by the skeleton.  That is why, here, I am making such an issue about grounded shoulders. Otherwise, muscles (that attach to the neck!) are holding up the entire weight of the shoulders. How can the shoulder function normally? How do you think your neck will feel after, say, 70 years of supporting the entire weight of the shoulder girdle? Do you think there might be some neck vertebrae compression, for starters? It is really worth the effort to learn about how to acquire restfully, effortlessly, grounded shoulders, and explore and work until you achieve that.
  • Shoulder that are continually too tense - why is that? It is because, if the spine, pelvis, ribs,  scapulae and collarbones are not moving in harmony with arm movements then all of the movement happens right at the shoulder joint. That becomes a mechanical catch-point - and for many years! - and the muscles that surround and stabilize the shoulder joint are going to be guarded and tight. They are continually being ambushed by arm movements, with no help from moveable or soft ribs or spine, which instead are rigidly holding stiff. Of course they are going to be guarded, they will tend to be over-tense, no matter how much you try to stretch or relax them. They need to be continually tense to allow you to keep moving your arms as you have been, all these years. But, eventually things will break down, or a muscle will tear ("torn rotator cuff"). Will you then blame the muscles? Plus, if you are too successful at relaxing or stretching those muscles, you'll find yourself susceptible to injury, due to an unstable shoulder joint. The missing piece, the intelligent approach,  is getting pelvis, spine, ribs and collarbones involved with the arms. That means somatic work: slowing down, feeling new connections that cannot be felt while moving "normally", and using heightened awareness, for a short time, to give yourself new movement options, that will actually be available during the press of everyday living.   
  • Take a look at any exercises you are doing, especially those you do on a daily basis. Are you keeping your shoulders grounded? Are you keeping your "elbows heavy".  As you raise your arms up to the sides, or in front, are you also hiking the shoulders up? Even 1/4 inch of shoulder-up-hiking will disconnect your collarbones from your first ribs, and that is as bad as 4 inches. You don't need to do it, at least not very much. Are you using minimal tension in the hands? Remember, hands that continually grip, that never fully relax (due perhaps to too many years of gripping steering wheels, forks, TV remotes, pens and pencils,  computer mouse, etc) means the shoulders that belong to those hands will also be continually gripping and out-of-sorts. Hands, elbows and shoulders come as a complete package. Neurologically, for sure, they are not separate things. In  order to release excess chronic tension in the hands and fingers, I've found, private work is needed. The tense hands are so much a part of who the person thinks they are - competent, ready to work hard, etc - that outside intervention is crucial. 
  • Many times a day say to yourself (do this for one week see if it helps) Soft hands, quiet hands. 
  • Remember that lifted shoulders, or shrugged up shoulders, are body language for "I give up"  or "I cannot deal with this" or "I cannot take responsibility for this". It is certainly not the body language we want to communicate to ourselves, at least not 24/7 as so many people do. You may think your shoulders are grounded, but probably they are lifted, perhaps just a fraction of an inch. So few persons really have restfully, fully grounded shoulders! When you meet such a person you relax immediately. When their shoulder are lifted, you don't, you feel a little uptight yourself. All this is totally unconscious for most of us. No matter how little they are lifted, the entire weight of the shoulder girdle is no longer supported by the skeleton, but instead by muscles that attach to the neck. When you see people with truly grounded shoulders, you take a deep, relaxed and pleasant breath. The eyes relax. It is rather unusual to see it, truly. Most of us are so uptight! One place to observe grounded shoulders: a Jackie Chan martial arts movie (or any martial arts movie).  As they punch or swing they keep their shoulders fully relaxed-grounded (they've spent years learning how to do this), so that their ribs and pelvis can powerfully participate in the arm movement. A punch with lifted shoulders would have no power. Yet, many of us move our arms all day like that, for our entire lives. And then we wonder why the shoulder is acting up!  Actually, restfully grounded shoulders is normal, healthy human posture that is our birthright; most of us have lost it due to stress and being just a little bit - or a lot -  uptight.  
  • Understand that resolving unconsciously, chronically lifted shoulders takes time, understanding and skill. It is multi-causational and it is not simple. Postural modifications need to happen. Self image has to change. Ways of moving need to be clarified and modified. A multi-pronged approach is needed. Plan on being patient and trying many things - including stress relief techniques such as meditation -  or taking ATM classes. Getting  involved in the Feldenkrais Method will eventually cover all bases.
  • Think soft hands, quiet hands several times a day. 
  • Suspend your body weight between two chairs, like a gymnast on parallel bars - keeping the shoulders firmly DOWN using stiff and straight arms. This takes a little athletic ability, so don't do it if you feel you are not up to it. But you could do a modified version, not suspending the entire torso weight. Little kids intuitively love to do this, especially as they start to go to school and their shoulders start to lift. Their little bodies know that this exercise will restore relaxed, grounded shoulders. I remember being hungry for that exercise during my early school years. At every opportunity, I did it. And yes, I was taking gymnastics classes, as well.  Keep your shoulders firmly down as you start to suspend your torso between the two chairs. You can even do this on a chair, by suspending your torso as you press your hands - stiff  armed - into the sides of the chair. In fact, I do this practically every time I sit, unobtrusively. This is SUCH a wonderful little exercise. I do it several times every day. The shoulders are being forced towards your ears by your body weight, so you need to activate and strengthen the muscles that keep the shoulders grounded down. If you do nothing else, at least begin to attempt this one thing. Even if you cannot fully suspend your entire body weight, do whatever you can. I do two or three seconds of this at least once a day. My body demands it. It feels sooo good.  
  • Think heavy elbows many times a day, as you reach, lift, walk, run, type, write or converse.
  • Learn to reach forward - to hold a mouse, to grab a steering wheel, to hold a pen - with heavy elbows, and relaxed hands, and soft shoulders. As you reach, so will you continue to use your shoulders, even when the reaching is done. Reach  consciously, with quiet relaxed hands and soft shoulders. Once your hands arrive at location, then and only then tense them (minimally) to do what is needed. Don't anticipate by tensing even 1/2 second too soon. 
  • Learn how to bring your head more over your center, and not be so protruded to the front. I have already written about this extensively. Head forward posture guarantees that your shoulders will lift, no matter how many hours a day you command your shoulders to stay grounded, no matter what sort of corrective exercises you do. The reason for that: many of the the muscles that hold and stabilize the weight of the forward-protruded head attach to the shoulder blades. The forward-protruded head literally pulls the shoulder blades up, no matter what else you do or do not do. If you have spent many years, unsuccessfully, trying to "ground" your shoulders, this is probably the reason - almost certainly. You cannot correct head forward posture without knowing the right strategies, or alternately getting involved in the Feldenkrais Method. It will never work to simply try to force the head to go backwards several times a day. Neck joints don't work like that! 
  • Find a good personal trainer, and follow the advice. The good ones know all about grounded shoulders and how to correct head forward posture. They can help you more than perhaps anyone else - but the danger is your shoulders might become too fixed, even in the grounded position. Many weight lifters (probably the ones without good coaching) are like that. Feldenkrais can be a good antidote. 
  • Remember that lifted shoulders are part of a whole-body-mind-emotional syndrome of being uptight, ungrounded, disconnected.   So, as you attempt to relax your shoulders down, also attend to relaxing your uptight belly, letting your jaw hang loosely, feeling your feet soften and widen as you sense them, relaxing the floor of your pelvis which is certainly drawn up also with the shoulders, and softening your stiff chest. Mentally let  go of your worries, and any sense of inadequacy, at least for a moment. All of these must cooperate if you want the shoulders to remain naturally grounded.  
  • Deliberately do your daily exercises with shoulders grounded, for most of the exercises (for which grounded shoulders are appropriate - for chin ups or lat pull-downs etc, it is not.) 
  • Begin to learn how to breathe without lifting your shoulders. How to do that: take a deep breath, hold the breath, and then relax downwards your shoulders. Did they drop? That means that every time you inhale, you are lifting your shoulders. It is not necessary, it interferes with breathing. Why should breathing involve lifting the entire weight of the shoulder girdle with every inhale? No wonder you are tired at the end of the day! Slowly inhale again, this time not allowing the shoulders to lift as you inhale. The test is, as you hold your breath after the inhale, can they drop down as you relax them? If  the answer is yes, you need to keep practicing inhaling, without lifting the shoulders. If you practice this one minute, five times a day, for two weeks, you'll be amazed at the changes in your body, in your personality and in your energy level. 
  • Many times a day do my favorite little quick trick for grounding shoulders: think heavy elbows and grounded shoulders (you can even make some physical effort in this direction) while lifting your upper chest. Do both of these at the same time. This is wonderful - it grounds the shoulders, lifts the chest, brings the head back over the center, and more. It is not something you want forcefully do all day long, for sure, but now and then, a second or two several times a day will work wonders. It will remind you to no let the shoulders keep drifting up towards the ears. 
  • Practice lifting the shoulders slowly about one inch or less, and even more slowly, letting the shoulders release downwards, ever-so-gently with gravity. And when the shoulder reaches "bottom" in your imagination, let it keep going down. 
  • Most people need to stretch their biceps and triceps. Please do a little research on the internet and find some stretches that appeal to you. Remember, just straightening the arm, does not mean the bicep muscle is stretched. You need to take the arm behind you for that. You'll understand better if you do a little research. Personally, I do a bicep stretch every chance I get. 
  • As you sleep on your back or side, keep the arms fully lengthened. Bent, contracted arms means trouble, eventually, for your shoulders. 
  • Stay involved in Feldenkrais, take classes, see a practitioner a few times a year, to keep you on the right track. It is too easy to get off into ideas of holding, manipulation, stretching, adjustments or strengthening as the complete solution to shoulder issues. Certainly these may help, and are often a complete and quick solution to pain. But will it last? Feldenkrais offers ideas (this list gives you some hints) to sort of fill in the missing pieces that are not there with those modalities. This present list is by no means complete, and a qualified somatic professional most likely will discover helpful ideas for you, that are perhaps nowhere else to be found. The Feldenkrais Work is creative in that way. It looks at what you are doing, not only with your body and movement, but with your awareness, and devises strategies to maximize learning in the direction that will bring about positive changes most quickly. For each person, that is a unique process, and practitioners are sensitive to that. 
  • What kind of work do you do? If you are using your arms in a particular way, especially repetitively, go to a personal trainer or physical therapist, and get advice about how to stretch the muscles that you have been tightening, and strengthen the muscles that you have not been using in your particular activity. This may be a complete cure,  it will balance your shoulder girdle,  when nothing else has worked. Yet, it is so basic. And really, PT's and personal trainers are highly qualified to help you on this score. They live in a world of muscles and corrective exercise and stretching - that is their training and experience.
  • What kind of exercise or sports do you do? If you don't have good coaching, at least research articles about appropriate stretching  and strengthening exercises to balance out from the particular things you do repetitively in your sport.
  • Avoid pulling your shoulders back. This creates head forward posture and immobilizes the collarbones, and much more (see my article on this topic). It will take mindfulness and persistence to fully divest yourself of the habit of pulling your shoulders back, if you have done this for a lifetime, as part of your idea of "good posture". You might need to see a somatic practitioner, like a Feldenkrais Practitioner. What I've observed is that even if you think you are not pulling your shoulders back, you are, every time you stiffen to sit up straight. You need someone to observe what you are doing; habits like that can be too close to the bone for us to even be aware of them. 
  • When you raise your arm overhead, to reach to a high shelf, or pull a light cord, or to raise your arm overhead in a classroom, keep  your elbow and hand centerline, until your hand is over your head. In a martial arts class they will teach you this, as part of how to punch directly overhead.   Then, and only then, can you allow your hand to drift off to the side. If you lift your arm directly up to the side, you can strain the deltoid muscles, and doing that while lifting a weight is a prime cause of torn rotator cuff injuries. Train yourself to do it the right way.
  • Be sensible about weight lifting and exercise. It is so easy to get imbalance, or injured.  At least occasionally use a personal trainer or coach. For instance, if you only do push-ups for the upper body, you are ignoring the muscles that you'd use to do the rowing movements, pulling the arms into the body. You need to strengthen those muscles equally to the muscles you use doing a push-up, otherwise in time you will end up with muscle strength and flexibility imbalances that can precipitate shoulder trouble. In fact, because we all reach forward so much, we need to strengthen our ability to do the opposite. I recommend the rowing movements to everyone. Incorporating them in your daily routine can definitely heal (in my experience) many cases of chronic shoulder pain  and trouble. It has been true for me, certainly.  
  • If you have a leg length difference, or if you otherwise know your body is out of alignment (scoliosis, etc), learn corrective exercises to stay in alignment. One good web site, that can sell you DVD's teaching you how to do this is found by googling The Malalignment Syndrome. Many (but not all!) somatic professionals, or personal trainers or PTs or chiropractors or osteopaths, also can show you self-care exercises to correct your imbalances. When your body is out of alignment, that alone can cause lots of shoulder trouble. It will show up on one shoulder more than the other.  The real question is, once you are in alignment (whether by chiropractic, osteopathic, PT,  Feldenkrais or personal trainer), how do you stay that way? That takes more work, lots of Feldenkrais work, in my opinion. Most people who are out of alignment, I've found, are perpetuating that trouble by how they sit, stand, walk and move. Simply mechanically correcting the malalignment is the easiest thing; the real work lies in learning how to stop creating malalignment, and instead create ease, balance, and functional symmetry in the body. But everyone has a different take on this, and you should explore your options. Personally, I do not recommend or use foot or arch supports, since I feel they can perpetuate the problem. It superficially corrects only  one  of the symptoms - leg length difference. With some clients, they can never hold good alignment. Others, after one session, they are "in", apparently forever. Others take some weeks or months to stabilize or partially stabilize. Personally (and I've found it true for many clients), my experience has been that white sugar, in excess, is the main trigger for going out of alignment, and staying that way.  In January every year (after the holiday season, eating too many sweets) I can always count on an increased client load - people I have not seen for many months come, with all kinds of complaints. Once the diet is modified to have less starch and sugar, alignment stabilizes more easily. You might try this.     


:: bogna :: said...

This would make a great little book!

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