Shoulder pain is one of those presentations that can stop you from enjoying your day. Rolling in bed becomes difficult; carrying shopping or even sitting there and doing nothing can be frustrating. At Melbourne Massage and Treatment, I got to see many clients who complained of shoulder pain for a variety of reasons. Although one thing that is common with those different types of pain is the imbalance in the mobility stability joint chain, especially in people who do physical labour, repetitive overhead work, or intense gym training. Therefore, while many people expect me to focus only on the sore spot in the shoulder, my myotherapy approach is always broader and more thorough. Yes, I treat the shoulder as the primary concern, but effective, long-term relief comes from understanding why your shoulder is overloaded in the first place. That means looking beyond the glenohumeral joint and assessing thoracic mobility, scapular control, and thoraco-scapular stability, which are key components that are often overlooked but critical for shoulder health and to help you fix the shoulder pain. Why Shoulder Pain Often Persists The Shoulder is a joint characterised by a great amount of mobility and not much stability, which puts it at high risk of injury and so pain. When your shoulder hurts, it’s rarely because the shoulder itself is “weak” or “damaged” in isolation. Indeed, to arrive to the pain response, either you had a severe trauma, like a fall on the shoulder or more commonly, the shoulder is compensating for: Poor thoracic spine mobility Weak or poorly coordinated scapular stabilisers Faulty movement patterns under load Repetitive strain from work or training And let’s be clear, we are all different, so two individuals who do the exact same job or sport may end up having different pain and presentation due to basic anatomical differences in the shoulder. That said, here are some common presentations that can lead to shoulder pain: If the thoracic spine doesn’t move well, the shoulder is forced to work harder. If the scapula doesn’t stabilise properly, the ac joint gets overloaded Genetically, the space between bonds (Humerus and Acromioclavicle joint) is narrower than the norm My Clinical Assessment Process For Shoulder Pain When you come to my Myotherapy Clinic in Fitzroy North for shoulder pain, I don’t just ask where it hurts, but I would assess: Thoracic spine mobility (especially rotation and extension) Cervical movement in active and passive motion Scapular positioning and control Shoulder range of motion under load Training or work-related movement demands Previous injuries or recurring pain patterns This is particularly important if you: Work in trades or manual labour Train heavily in the gym or sport Perform repetitive overhead movements Have had recurring or long-term shoulder pain A tailored assessment, such as the above one, allows me to not only pinpoint why the shoulder is in pain and what further investigation may be needed to confirm the findings but also address these factors, allowing us to understand the underlying drivers of your pain. The Role of Thoracic Mobility in Shoulder Pain The thoracic spine (mid-back) plays a massive role in how your shoulder functions. This is because the thoracic section of the spine is the mobile portion that anticipates the stable scapula-thoracic joint in the mobility, stability chain. Limited thoracic mobility can lead to: Reduced the overhead range Increased strain on the rotator cuff Poor scapular mechanics Neck and shoulder tension As part of the myotherapy treatment protocol for shoulder pain, I often combine manual therapy, joint mobilisation, and movement-based rehab to restore thoracic movement.When the thoracic spine moves better, the shoulder doesn’t have to overwork, pain reduces, and then we can increase the strength by increasing the load. A classic example of the thoracic shoulder relation is a cricket player. The thoracic rotation along the throwing action is essential to optimise the force imprinted during the throwing action. In fact, imagine the thrower in a cricket game, using only the shoulder, and not rotating that thoracic joint chain. The shoulder load would be excessive, and in a short time, it would cause overload injury and so shoulder pain. Scapular Stability: The Missing Link Your scapula (shoulder blade) is the foundation for shoulder movement. Indeed, the scapula-thoracic joint is the stable joint between the thoracic and the glenohumeral mobile joints. But not only that, indeed, the scapula is the origin point of the rotator cuff muscles, a group of muscles that control the positioning of your humeral head in the glenoid fossa. If it lacks stability or control: The shoulder joint becomes vulnerable Tendons are placed under excessive stress Pain persists despite “strengthening” exercises As a Clinical Myotherapist, I focus on improving thoraco-scapular stability, ensuring the shoulder blade moves smoothly and supports the arm during load, lifting, and rotation. This is especially crucial for people involved in: Weightlifting Cross-training Construction or trade work Sports requiring throwing or overhead movement To strengthen the stability of the scapula, we then have to work on the rhomboid muscles and the trapezius (upper, mid, and lower), but even the levator scapulae. So yes, it is not a quick fix to restore shoulder functionality and remove shoulder pain, but there is a step-by-step journey that can be taken, and it is your choice to start walking along this path. I am here only to help you understand what the right path is for your presentation and ensure we take the right route. Hypermobility and Shoulder Pain One often overlooked factor in shoulder pain is hypermobility. Hypermobility means your joints move more than the norms which isn’t always a bad thing, but it significantly increases injury risk when stability is lacking, particularly in the shoulder. For hypermobile individuals: Ligaments provide less passive support Muscles must work harder to stabilise joints Poor scapular stability leads to shoulder overload When hypermobility exists alongside poor thoraco-scapular stability, shoulder pain becomes far more likely. In these cases, treatment isn’t about increasing flexibility; instead would be the opposite: Improving neuromuscular control Enhancing scapular […]
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Here in Fitzroy North, at my Myotherapy Clinic and 1:1 fitness class studio, I get to work with a wide range of clients, and what I notice is that there is a lack of knowledge and awareness on how to deliver a Glutes Strengthening. And why I believe that a squat is important is simply because squatting is an action that we do so often throughout the day that we all should be good at it, and it is the best functional movement that allows you to reinforce the full body structure. Therefore, when I come across those presentations, I ensure to educate my patients about the basic mechanics of a squat, including mobility, stability, and glutes strengthing. Are You Looking Into Glutes Strengthening? Let’s Check Your Joint Mobility and Stability First In order to deliver effective training for your glutes, including delivering an efficient squat, you will look at: Adequate ankle mobility A well-coordinated hip hinge Stability in fee tarsals and knee joints Those are regular things I would look at during a myotherapy treatment and 1:1 fitness class in Fitzroy North, to improve glute activation, movement efficiency, and injury resilience. Ankle Mobility Exercise to Improve Squat Depth and Lower Limb Mechanics As discussed in greater depth in the mobility and stability blog, before we start looking at strength and start working on functional movement, like the squat, we want to ensure that the mobile joints are mobile enough to deliver the right mechanics. In fact, limited ankle mobility often results in compensatory strategies such as: Excessive forward trunk lean during squats Early heel lift Increased stress on the knees or lumbar spine Clinical Importance of Ankle Mobility Adequate ankle dorsiflexion allows improved tibial progression during squatting movements, enabling more effective hip and glute loading. Exercise: Knee-to-Wall Ankle Dorsiflexion Drill Position the foot flat on the ground, facing a wall Aim for a 10 cm distance between the big toes and the wall Maintain heel contact with the floor Drive the knee forward toward the wall under control Perform slow, controlled repetitions Your aim is to teach the wall with the kneem, with a big toe-wall distance of min. 10 to 12 cm Clinical application:This exercise is commonly prescribed in myotherapy sessions to improve squat mechanics, reduce compensatory loading, and support long-term joint health. Hip Hinge Drill for Posterior Chain Activation and Spinal Control The hip hinge is a fundamental movement pattern required for safe and effective loading of the gluteal muscles, but not only that, indeed, poor hip hinge mechanics often present as excessive lumbar flexion or extension during deadlift-based movements. Why Hip Hinge Mechanics Matter Efficient hip hinging can help with: Increases glute and hamstring activation Reduces lumbar spine strain Improves RDL and deadlift performance Exercise: Wall-Assisted Hip Hinge Drill Stand approximately 20–30 cm from a wall Push the hips posteriorly to make contact with the wall Maintain a neutral spine and rib position Return to standing using glute contraction (squeeze those glutes) Clinical focus:This drill is a key component of both rehabilitation and performance-based programming at Melbourne Massage and Treatment. It is also a fundamental movement pattern taught in my glute-focused fitness classes, ensuring clients build strength safely and efficiently. Stability Starts From Your Feet Foot stability is a crucial part of delivering a good squat, especially during a low-bar squat, when feet are flat on the ground. Imagine your feet unable to give a stable direction to whatever is above, like the ankle, knee and hip. This would lead to knee shaking during squatting, and once the squat load increases, the risk of injury rises. So for foot stability, we look at: Even weight distribution of your load along the plantar of the feet, not only on your toes or on the heel. All toes, grabbing the floor, throughout the squat performance Lower-bar squat, feet flat on the floor (be barefoot or use gambaletto type of shoes) and feet wider than hip, stand in slight external rotation High-bar squat, feet open wide as hip stand (so a narrow stand) and heel well elevated. In both my clinical work and my strength-based fitness classes, foot stability is always assessed first. On the other hand, more about the high and low bar squat is available from this blog. Squats for Functional Glutes Strengthening In my glute-strengthening fitness class sessions, the squat is one of the primary movements we refine. Keep in mind that when we talk about squat for glut strength, we always refer to the lower-bar squat. Therefore, when performed with appropriate technique, this exercise is the most effective exercise for developing functional glutes strenghtening and improving lower-limb coordination. Below, you will find the most common Clinical Faults in Squatting Limited ankle mobility restricting depth Poor hip control resulting in lumbar compensation Reduced gluteus contribution due to motor control deficits So this is what you need to focus on to for a Optimal Glute Engagement while squatting: Maintain even foot pressure throughout the movement Maintain spinal alignment and controlled descent Drive upward through the heels and mid-foot Clinical note:Squat depth should be dictated by movement quality rather than arbitrary range targets. Romanian Deadlifts (RDLs) Another Glutes strengthening Exercise The Romanian deadlift, in comparison to the conventional deadlift, is a partial movement, where the load never touch the ground throughout the exercise (once it gets picked off the ground). This type of lift is ideal for exercising the posterior chain, particularly in the gluteal and hamstring musculature. Benefits of RDLs in Myotherapy and Strength Training Enhances glute and hamstring load tolerance Improves hip-dominant movement capacity Reduces injury risk through controlled eccentric loading RDL Execution Guidelines Maintain close bar or weight proximity to the body Initiate movement via hip hinge, not knee flexion Maintain spinal neutrality throughout the range Terminate the movement when pelvic control is lost Clinical relevance:RDLs are regularly integrated into rehabilitation and strength programs for clients with lower back pain or who are returning to lifting after injury. But are also ideal to build […]