A progression to lifting your arms overhead pain free

Posted on September 5, 2013

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The most common complaint of those with shoulder pain is a limited ability to lift their arm(s) up. One of the ways I disagree with many in approaching this ailment is I don’t avoid lifting the arm overhead; I embrace it.

You won’t get your arms over your head by only working them under your head. 

Rather than do a ton of pulling / rowing exercises and jerking off with rotator cuff bands, I like to work on what’s painful. Instead of rolling around like a dead fish on a foam roller in the hopes you’ll be able to magically lift your arm up, I like to start by…working on lifting your arm.

 You don’t get your arms vertical by only moving them in the horizontal. 

Overhead pressing / overhead movement is not bad. It’s how you move your arms overhead. It’s how you progress your body into this motion. Before we can go over a sample progression, we need to review some concepts.

Math can be helpful

Anybody past the age of 10 can relate to this scenario: You’re in a math class, 90% of the students hate what they’re learning, it’s hard, it’s abstract, eventually someone raises their hand and the teacher acknowledges them:

“When am I ever going to use this?”

As someone who took every math class my high school offered, majored, then minored in math, I can tell you it took until I was 20 years old -in Calculus 3 (!)- for a teacher to consistently go, “Here’s where this is used in real life.” It was a crazy experience. Finally, all the math I learned for 15 damn years came together, and I could consistently see how I could use it. Learning algebra, derivatives, and integrals can really suck. But when you learn you can use those three things to find the shortest path between two cities for a plane flight (it’s not a straight line; it’s a curved line), well, that’s pretty cool.

The only exception to the above was physics. Physics, while not technically a “math” class (it’s not a requirement for a math major), is something you see the applicability in immediately. Because physics deals with the motion of objects, the majority of problems deal with everyday things. It’s common for teachers to use objects in front of them to go over a problem. It’s much less abstract than nearly every other conventional math oriented class.

This is my long way of saying give me some time to go through this. It might take a minute, but you’ll be able to see the application to human movement pretty easily if you’re patient. I’ll keep things as reader friendly as I can.

I know I have a good amount of engineers, programmers, etc. who read this site. It’s been a while since I’ve done some of this stuff, so, for the technically inclined, I’m sure this won’t be as astute as it could be. Feel free to help me out if you think it’s warranted.

Finally, this will give me a chance to show my parents I did  learn something in school, despite my rants against formal education.

Some brief anatomy

We need to first, anatomically, understand why someone has trouble lifting their arms overhead. Understand the following is not applicable to everyone with issues lifting their arms. But, this will apply to a great majority.

In short, an imbalance often happens between the muscles which pull the arm down and which pull the arm up. The muscles pulling down become dominant over the muscles pulling up. This happens around the scapula and humerus.

Right scapula back view.

Right scapula back view.

Humerus bone anatomy

When the arm goes up, the humerus flexes and the scapula upwardly rotates. When the arm comes down, the humerus extends; the scapula downwardly rotates.

Shoulder scapular motions

Shoulder flexion and extension

Humeral flexion and extension.

The scapular upward rotators and humeral flexors often become weak / don’t work properly; the downward rotators and extensors often become stiff / work too much.

We want to work the upward rotators and flexors, and concurrently limit the work on the downward rotators and extensors. However, we need to methodically do this. If a person has weak legs you don’t immediately throw them in a squat rack with 500 pounds. Not unless you want to cause them a hell of a lot of pain. Same thing for lifting your arms. People can become so poor at lifting their arms where their own bodyweight is analogous to the 500 pound squat. (Their own bodyweight can cause them pain.) Gravity becomes their barbell.

Poignant physic / biomechanic concepts

Gravity points down (seriously)

It might sound silly, but I’m telling you people forget about gravity, and the fact it points downward, all – the – time. 

Fg Force of Gravity

Fg = mass * the acceleration due to gravity

The acceleration due to gravity is a constant. Everything falls at the same rate. So, the only way we can manipulate the force of gravity is by changing the mass. Greater mass? Greater force. Less mass? Less force.

Quick tangent: Gravity is a load. For the purpose of this post, unloaded will mean in the absence of gravity. I’ve seen many fitness people say things like, “This movement is ok because we’re not loaded. We’re only fighting gravity.” Uh, no. If you want to say unloaded means there’s no added resistance, that’s fine…as long as you say that. But you can’t say a movement is ok because there’s no load, because gravity doesn’t count. It absolutely counts. If it didn’t count people wouldn’t get pain lifting their own body weight.

Said another way: If gravity doesn’t count, why does someone get pain in their shoulder when reaching into the top cabinet? But, they’re fine if someone else lifts their arm for them? (Active raise versus passive raise.) Because in the former situation their arm is doing work; in the latter someone else is doing work for them. The work –against gravity- is causing them pain.

Work

Work = Force x Distance

Our shoulder does more work when 1) The force is increased and or 2) The distance the shoulder moves increases. Greater force (such as resistance) or distance = greater work. Less force or distance = less work.

It’s important to note this equation for work is when something is going in a straight line. During an arm raise we’re not only moving up, we’re also moving back.

Shoulder flexion and extension with arrows

We’re rotating, and our axis of rotation is the shoulder joint. We need to know the rotational work our arm has to do.

Rotational work

Rotational Work Formula (Credit: WolframAlpha)

Rotational work is directly related to the amount of degrees the arm moves and the torque of the movement. The greater the torque, the greater the work. The greater the distance, the greater the work.

Torque

Torque Formula

Torque Formula (Credit: WolframAlpha)

Don’t get caught up in the math. The principles of the formula are what we’re concerned with.

Let’s discuss the distance aspect. In torque, the distance is regarding the length of the moment arm. Not the distance the arm travels.

“The distance from the pivot point to the point where the force acts is called the moment arm, and is denoted by ‘r‘.”

For a nice discussion of torque and moment arms see here.

Torque formula with schematic

Credit: WolframAlpha

Our shoulder would be the pivot point, and the force acting on our arm -whether gravity or a resistance- is acting at some distance from the shoulder, which is called the moment arm.

The most important takeaway here is: A greater moment arm requires greater torque, and thus work, from our shoulder.

Think of it this way, if you were to hold your arm straight out in front of you,

Straight arm arm raise mid point

And someone applied a resistance at your hand,

This is harder...

This is harder…

And then a resistance closer to your shoulder,

...than this.

…than this.

What would be harder? The resistance at the hand of course. See, you understand moment arms better than you thought.

Summing up so far

  • People with issues lifting their arms often have an imbalance between the muscles which lift the arm and those which pull the arm down.
  • We need to wake up the muscles which lift the arm and calm down the muscles which pull the arm down.
  • Gravity points down.
  • People with shoulder pain often have trouble resisting gravity due to the workload.
  • The work on the shoulder musculature during an arm raise is directly proportional to the torque.
  • Torque is directly proportional to the length between the resistance and the shoulder, i.e. the moment arm.

An obvious application

Say a person has pain lifting their arm up:

Straight Arm Arm Raise bottom

Straight arm arm raise mid point
Arm Raise top position

We could reduce the workload on the shoulder by simply bending the arm:

Standing arm raise from flexion bottom portion

Standing arm raise from flexion

Arm Raise top position

We lessen the workload (and torque) on the arm by reducing the moment arm.

Straight arm arm raise mid point with moment arm line

Standing arm raise from flexion with moment arm line

Straight arm moment arm close up Bent arm moment arm close up

Say you need you reach to a top shelf:

Notice how she wanted to naturally bend her arm on the way down? The body already knows how to lessen the workload on itself. 

This quick, immediate adjustment, can give pain relief. But let’s take it further. After all, why fight gravity if we don’t need to?

Making gravity our friend

By laying a person supine (on their back) and raising the arms overhead -not to the ceiling, but overhead to the floor- we can lessen the workload on the arms even more. Looking at a straight arm, arm raise again:

Supine Arm Raise from extension

Supine Arm raise straight arm mid point

Supine Arm Raise Fully overhead

Instead of gravity fighting the arm raise the entire time, it’s only doing it for half. Gravity is still of course present the entire arm raise, but, now it’s only resisting arm flexion until the mid-point. After the mid-point, gravity is actually helping our arm flexion goal.

Supine Arm Raise from extension with gravity line COM

Supine Arm raise straight arm mid point with gravity line

Supine Arm Raise Fully overhead with gravity line COM

We could make this even better by not performing the full motion. Rather than start from extension, we could start at the mid-point.

Supine Arm raise straight arm mid point

This way our humeral flexors don’t have to do any active work to get our arms overhead. Gravity does all the work for us.

Free fall is ill advised when it comes to your joints

This is where some practical experience comes into play. The only way our muscles aren’t fighting gravity in a supine arm raise is if we let the arms completely free fall. Doing this isn’t a good idea.

1) The hands hit the ground rather hard, but yeah, you could soften the blow with padding.

2) Even though gravity is providing a passive stretch, pain can still be present if the person is really stiff. The muscles work passively too. Some people aren’t going to be able to get to the ground yet. “So, just don’t let them go to the ground then. They can hold themselves up.”

You mean, rather than let the person do this:

Supine Arm Raise Fully overhead

Have them do this?

Supine Arm Raise Right before full range of motion

Bringing us to

3) Unless the arms are in free fall then the humeral extensors are working eccentrically to prevent free fall.

Gravity helps the humeral flexors by providing passive flexion. Meaning gravity is doing the work for the humeral flexors. However, unless you’re letting the arms completely relax and fall, then the humeral extensors do turn on.

Shoulder flexion and extension supine with arrows

Think of a push-up. If you take your time going down you’ll feel your chest and shoulders working quite a bit. They’re helping you go slower / preventing free fall as they lengthen.

Push up eccentric mid way

Your arms are pushing into the ground to control how fast you descend. The muscles are eccentrically working. As they are being lengthened, they are contracting.

As I went over in the anatomy section, we want to minimize turning on the humeral extensors as much as possible. While we have a pretty friendly way to get the arms up by generating passive movement into humeral flexion, we can still improve things by turning off the humeral extensors.

Slide it up

Start with the elbows bent; keep the hands on the ground (palms facing one another):

Supine Arm Raise slide starting position

Slide them along the ground:

Supine Arm Raise slide half way up

Supine Arm Raise Slide Top

Slide them back to the starting position:

Supine Arm Raise slide starting position

This enables us to

1) Eliminate the force of gravity against the humeral flexors. (Because we’re supine.)

2) Use the force of gravity to help the humeral flexors. As the elbows extend, gravity pushes the arm down. The forces of the elbow extensors and gravity cause our humeral flexion to come along for the ride.

Supine Arm Raise slide half way up with gravity line

3) By having the knuckles on the ground there is no eccentric work on the humeral extensors. The hands are already touching the ground; the humeral extensors don’t need to be turned on to prevent this; it’s already happened.

4) By sliding the knuckles back in a direction which is down and into the ground, we generate most of the humeral extension through elbow flexion. The humeral extension comes along for the ride.

Supine arm raise slide elbow flexion

Supine Arm Raise slide starting position

Regressing even further

Not only can we put someone supine to change the affect of gravity, we can put them quadruped.

Backward Rocking Start Position

Then, we can work on our overhead range of motion by rocking backwards:

Backward Rocking Almost End Position

The difference between this and the supine slide above is, now instead of gravity only pushing the arm down, gravity is helping our overhead range of motion by pushing the entire back down.

Supine Arm Raise slide half way up with gravity line

Backward Rocking Almost End Position with line

The back has greater mass than the arms. Our force of gravity is greater here than in the supine slide, making it easier to get our arms overhead. Gravity has gone from being a friendly coworker to a BFF.

Bringing this all together and attaining a progression

In something like the Quadruped Hip Rocking and Supine Arm Raise w/Slide, our muscles which move the arm overhead are doing very little, if any work. Keep in mind though, we still have to overcome the stiffness of the opposing muscles. For instance, many people will, to their surprise, get quite a bit of burning and work out of the slide exercise. Especially when done correctly. (Video of form later.) Because gravity is doing more to help us in the hip rocking than the supine slide, and the hips help pull the body back, the rocking tends to be easier on our arms than the slide.

Once we can lift our arms overhead without having to overcome the force of gravity, we can then bring gravity into play. We can ease our way into things by starting with the arms bent and performing half the range of motion.

Standing arm raise from flexion

Next, we can straighten our arms. Increasing the work by increasing the length of the moment arm.

Straight arm arm raise mid point

Then, we can increase our range of motion. By increasing the distance our arm moves we increase the work.

Straight Arm Arm Raise bottom

Ranking (least work on shoulders to most)

1) Quadruped Backward Rocking

2) Supine Arm Raise w/Slide

3) Standing Arm Raise @ 90 w/Arms Bent

4) Standing Arm Raise @90 w/Arms Straight

5) Standing Arm Raise @180 w/Arms Straight

Videos of our progressions

Note: I tend to have the person keep their back against something so they make sure they’re not compensating with their lower back.

Closing words

There are a ton of ways you can progress between these variations as well. You could manipulate the moment arms further (rather than fully extend the arm, only go half way), you can manipulate reps, sets, add resistance, etc.

Of course, all the ways you can vary adhere to the laws of physics and the math behind it.

Shout out to my brother, Chris, who’s studying physics, for help with this. 

Looking for more help with getting the arms up? Try one of these.

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Posted in: Pain, Shoulder Pain