Shoulder Pain? Thoracic, Humeral Flexion screens & STM

Shoulder discomfort can be maddening because it often shows up during perfectly normal training. We take a different route: we start with quick safety screens to rule out red flags, then we hunt for the real limiter that keeps stealing motion from the shoulder. A surprising amount of “shoulder pain” is a thoracic spine problem in disguise, and once you see it, your assessments and your programming get a lot clearer.

We walk through a clean, repeatable thoracic rotation screen and the biggest mistake that creates a false pass: letting the low back and pelvis do the work. You’ll hear exactly how we lock out the lumbar spine, what “good” thoracic rotation looks like, and why a simple standard matters for everyone who presses, pulls, or throws. We also share a practical control test we love: if you can’t breathe and talk while holding a position, you don’t own that movement, and your body will compensate the moment load shows up.

Then we move from assessment to action with corrective exercises you can use right away: smarter thoracic foam rolling with neck support, banded thoracic rotation that stops pelvis cheating, and PNF-style drills that help you earn new range of motion under control. Once thoracic rotation is no longer the bottleneck, we screen humeral flexion for overhead work, show how rib flare and arching sneak in, and lay out a simple way to load new overhead range using a foam roller setup and a kettlebell. If you want better overhead mechanics, fewer flare-ups, and a clearer plan for shoulder mobility and stability, this is your playbook. Subscribe, share this with a training partner, and leave a review with the screen that revealed your biggest limiter.

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Transcript

Shoulder Intake And Red Flags

SPEAKER_00 0:00

So when a client comes in, they have shoulder discomfort. We want to go through the four screens to make sure we don't have any red flags to refer out to our team physical therapist. Sarah's been experiencing some shoulder discomfort. And so after we sit down and talk for a good 10 minutes, she signs the waiver and consent for soft tissue.

Thoracic Rotation Screen Done Right

SPEAKER_00 0:16

One of the first things I'm going to look at when it comes to the shoulder is thoracic mobility. There's 12 bones in the thoracic region, and we should have roughly 45 degrees of rotation up to about 60. And if we do not, then that's going to steal range of motion from the anterior side. Remember, with pain, you can be experiencing discomfort on the anterior side, and it could be because your thoracic mobility sucks. If you don't have optimal range of motion, it could start stealing range of motion from your neck, it could start stealing from the lumbar. You could have low back pain because you don't have optimal range of motion in the thoracic region. So this is just one of our go-to low-hanging fruit drills that we can screen to see if we have that optimal range of motion. And if we do not, then we can do some soft tissue work. So Sarah's gonna lay on her side. I call this the cuddle position. Now open up as much as you can. As far as you go, go, go, go, go, go, go. Now you can see this is what we call a false positive because she's barring from the low back. So what I want to do, come back over here, is I want to lock out that lumbar region. And it's probably the biggest mistake I see with this test, is we just have them open up

Foam Rolling That Actually Helps

SPEAKER_00 1:15

and we do not lock out the lumbar region. So I'm gonna put my hand right where her belt would be, and I want her to open up. So now when I lock out her lumbar region, you're gonna see that she's extremely restricted here. So what I would like to see, hop up, Sarah, is the ability to talk through this. So if I reach over here, you're gonna reach across with your top hand and you should be able to go straight on the ground. And you notice how I'm my voice has changed. My thoracic rotation could improve, but it's significantly better than what Sarah had. If your client cannot talk in this position, they cannot own movement. So if we try any type of rotation exercise, it's gonna be restricted and we're only as strong as our weakest link. For a lot of your clients that do foam rolling in the mid back, very similar to your calves, they're just gonna give themselves a big hug and go back and forth. So give yourself a big hug and go back and forth on the thoracic region. Good. It's not that impactful. If you have your client stressed in this position, it can cause some neck discomfort. So, Sarah, I want you to put this behind your head, and that's just gonna support their neck. Then I'm gonna get over your client and you're gonna go back and forth a little more aggressively. Don't get too excited with this view right here. But we're gonna go back and forth. And this is just a lot more aggressive. And we're gonna open up that mid part of the back for a good 30 to 45 seconds. As I make a joke at the seminars, number one rule: don't have eye contact. It makes it creepy if you're looking at your client. So we'll go back and forth for a good 30 seconds. Now, Sarah, what I'd like you to do is put your arms straight up, protract. Now see if we can get our elbows to touch the ground. Come back. I like to see five to eight reps with this. Protraction, coming back, retraction, neck is nice and supported.

unknown 3:04

Good.

Banded Drills And PNF To Gain Range

SPEAKER_00 3:05

All right. So this is one of the drills I like to do for thoracic rotation with a band. With adduction in the inner thigh, you're gonna lock out the low back. If you don't have this, people will just tend to rotate through their pelvis, and we don't want that to happen. So Sarah's gonna move this hand towards me, trying to keep this one locked, and we're just trying to open up and get that new range of motion under load. Keep this one nice and taut. Really open up, two more reps. One and two, nice on switch sides. Within the workbook at the seminars, as well in the slides with this course, you will see that we need to check both sides to make sure that total arc is there. Keeping this one anchored down, open, open, open, really come through that mid, one more, and good. So we do the soft tissue, and then you choose one or two drills. Usually for the first time I meet someone, one is enough, and then you're gonna want to load it up and get into the CCA. As you're working with someone, and if you're noticing that we're not getting the range of motion that we would like, you could throw in a second one. One of my favorite ones to do is get into a deep squat and then work with a PNF variation, proprioceptive neuromuscular facilitation. So your client is gonna open up, and I want Sarah to do is drive her elbow into me, drive your hand into me. Three, two, one, and then we're gonna get a little more range of motion by opening up, drive into me. Three, two, one, open up, come back down, three, two, one, open up. And now try the other side, give that full range, and then you're gonna drive in three, two, one, open up, drive, three, two, one, open up. And each time I'm putting the pressure for that isometric contraction at a different spot. Three, two, one, open up. And good. The first time I do this test on my client, I will do those drills, and then I want to see if we get a new range of motion. Hold on one second. And so, if you do, you found the recipe. You do not need to test and retest every single time your client comes in. So if this was the first time meeting Sarah, I would test and retest. If there's a discrepancy and then the drills increase that range of motion, the next time that they come in, you would start with the soft tissue, and then you would get into the correctives improving mobility and stability. So let's lock out that lumbar region and see if we get an improvement with her range of motion. Go. Definitely feel like she's at a lower position here, whereas before she was a little bit up here. So I feel like this would be a pretty good idea that she has limitations within her thoracic. So next time she comes in, we foam roll, we get into a stability and mobility drill, then we get out there and lift some heavy weight. One other thoracic drill that I really like to do that you can do by yourself is you get into this quadruple position right here, and we're gonna sit down. So by sitting down, you're gonna lock out that low back. You'll see people just you know wrench through it and they're actually rotating through their lumbar region. We have a little bit, like five to 15 degrees, but I want to eliminate this if the issue is the thoracic. So then I'll have her take her left elbow, put it on the left knee, and then we're going to cup the ear and open up. And this is gonna be just a true thoracic exercise. Come back down. If you wanted to band this up, it's gonna get a little more mobility and stability in there. You could also incorporate that PF variation, but a lot of times just doing five to eight reps is gonna grease that area up so we can now have that new range of motion. So then we go out there and train and own our overhead mechanics.

Overhead Flexion Screen And Loaded Fixes

SPEAKER_00 6:43

Now that we've eliminated thoracic rotation as a limiting factor, if we pass that on both sides, then I want to screen how the humerus is working. We should be able to get to 160 degrees of humoral flexion, very similar to the test that we did earlier, but I'm not worried about optimal range of motion for the test. I just want to see if they can pass that by getting their hands overhead. So this is a little more advanced. You should keep your arms nice and straight. I don't want to be bending at the elbows because then we're creating that range of motion through elbow flexion. So you can do this on the wall if you'd like, or if you have a mat or a massage table, that's fine. I don't want to see an anterior tilt and a thoracic arch. If I can get my hand back here, as you can see with her, that's not optimal. If she did have that rib flare, I would have your hands come up. I would compress this down and then have your client come nice and slow until you notice that increase, and then that's where you'd stop. So that's where the point would be. She has great humoral flexion, as you can see. The thumb distance to the wall is at 160 degrees. As long as we aren't arching, which she's not, they would pass this screen. But let's pretend like your client starts getting a little bit of limitation right around there, like at 140 degrees. This would be a gold mine because what do we do for overhead pressing? Military press, a lot of other exercises that are gonna get us into almost close to 180. And if you can't own that, you're gonna arch, you're gonna get a rib flare, anterior tilt, and then we blame the exercise like it's bad. It's not bad, you just can't own that range of motion. So here's what I want to do for Megan. I'll have her sit up. Very similar to what we did earlier, is I'm gonna put the foam roller in that thoracic region. Okay, we're gonna bridge up, put your arm straight up, bridge, and then I'm gonna give her a kettlebell, and we're gonna load this new range of motion. And you're just gonna communicate with you when she says that, oh, that's that's it right there, and we don't notice any competition. You're gonna wanna hold there for a good five seconds, and then I want to cue her to pretend like she's gonna throw the kettlebell through the TV. So put force into the bell. Three, two, one, relax, and then we're gonna get a new range of motion. This is another PNF variation, and then engage hard, hard, hard, relax, and then engage hard, hard, hard, and relax. Make sure the neck is neutral. If there's any discomfort, we can regress this. A lot of variations that you can play around with the PVC pipe, you can have a band and pull it back, and those would all be great drills if we notice we cannot get our hands overhead.