At Cohen Health and Performance, we specialize in physical therapy in Bethesda and physical therapy in McLean for active adults and athletes who want to get back to the activities they love. One of the most common mistakes we see in traditional care—yes, even among other physical therapists—is a failure to appreciate how complex the shoulder really is.
The shoulder is the most mobile joint in the entire body. That’s what makes it so essential: reaching, throwing, lifting, pushing, and pulling all require freedom of motion. But that same mobility also opens the door to a ton of possible compensations and dysfunctions when something isn’t moving well.
Your Shoulder Isn’t Just a “Ball-and-Socket”
Think of your shoulder like a golf ball sitting on a tee. The ball is your humeral head (upper arm bone), and the tee is the glenoid (part of your shoulder blade or scapula). But that “tee” isn’t grounded into the earth—it’s actually floating on your rib cage. That means your shoulder’s stability is influenced by your rib cage shape, position, and even how you breathe.
Most providers stop at the shoulder joint itself. But for us at Cohen Health and Performance, whether it’s physical therapy in McLean or physical therapy in Bethesda, we know that treating shoulder pain means looking beyond the joint.
If the shoulder blade doesn’t sit securely on the rib cage, the muscles around it—like the upper traps or rhomboids—often work overtime to stabilize things, leading to tightness, knots, and nagging pain in the upper back or neck.
The Rib Cage is the Unsung Hero
One of the foundational drills we use to retrain shoulder mechanics involves placing your forearms on the wall. Here’s the key:
- Straight line from wrist to elbow
- Externally rotate through the shoulders
- Use your rib cage—not your arms—to press back into the shoulder blades. Perform 5 breaths in this position.
A cue we love: Imagine a hot poker hovering in front of your sternum. Your job? Pull away from it without slumping forward. This activates a crucial muscle called the serratus anterior, which helps anchor your scapula and sets the stage for clean, pain-free movement.
Getting the Shoulder Blade Moving Again
Once you’ve created a supportive rib cage, the shoulder blade (scapula) can do its job again—mainly rotating upward as your arm reaches overhead.
A simple but effective exercise to improve this scapular movement is Downward Dog:
- Start in a push-up (or all 4’s) position
- Press away from the floor with your hands
- Drive your chest toward your knees
- Focus on feeling the shoulder blades rotate upward and outward
This kind of targeted movement work is exactly what we emphasize in our programs for physical therapy in Bethesda and physical therapy in McLean. Without proper scapular motion, your rotator cuff is forced to overwork—and that’s when breakdowns happen.
What About the Rotator Cuff?
Only after we’ve addressed rib cage position and scapular movement do we move to the rotator cuff. By this point, rotator cuff exercises are finally in the right environment to be effective—rather than just throwing rubber band exercises at a deeper problem that hasn’t been solved yet.
Final Thoughts: There’s Hope for Your Shoulder
If you’ve had shoulder treatment in the past and it didn’t work—or if you’ve been dealing with shoulder pain for months or even years—don’t lose hope.
The truth is, shoulder pain is multifactorial. It can stem from poor rib cage positioning, scapular movement limitations, limited mobility, or underdeveloped rotator cuff function. And many healthcare providers simply don’t take the time to look at all of these layers.
That’s where we come in.
If you’re looking for expert-level physical therapy in Bethesda or physical therapy in McLean that goes beyond surface-level care, contact us today. Our team of Doctors of Physical Therapy will work with you to get to the root of your shoulder pain and get you back to doing what you love—stronger and smarter than ever.
