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While many people suffer from stiff shoulders, a significant number suffer from the opposite problem Shoulder Instability. The joint feels “loose,” clunky, or unreliable. You might feel like your arm is going to pop out when you reach for something, or you might suffer from a “dead arm” sensation after throwing or lifting.
Often accompanying this is Scapular Winging—where the shoulder blade sticks out like a wing instead of sitting flat against the ribcage. This creates deep, burning pain between the shoulder blades and makes the arm feel weak and heavy.
At Breakthrough Pain & Performance, we treat instability not just by strengthening muscles, but by upgrading the neurological control system. The shoulder is the most mobile joint in the body, sacrificing stability for range of motion. It relies almost entirely on the brain’s ability to coordinate muscle firing to stay in place. If that coordination fails, the joint becomes unstable.
Scapular winging is the hallmark of a dysfunctional Serratus Anterior muscle. This muscle wraps around your ribs and acts as the “glue” that holds the shoulder blade flat against the chest wall.
When the Serratus is working, it provides a solid foundation for the arm. When it is weak or inhibited, the blade peels away from the ribs. This destroys the mechanics of the shoulder. The rotator cuff has nothing to pull against, so the arm becomes weak. The muscles of the neck (Upper Traps/Levator Scapulae) try to compensate by holding the shoulder up, leading to chronic neck pain and tension headaches.
Why does the Serratus switch off? It is supplied by the Long Thoracic Nerve. This nerve is easily compressed or irritated by tight neck muscles (Scalenes) or poor posture. We trace the nerve back to the neck. We ensure the signal is getting through. Then, we use specific cortical activation drills to reconnect the brain to the muscle. Standard push-ups won’t work if the brain can’t find the muscle; we teach you how to feel it and fire it again.
If you have ever dislocated your shoulder or subluxed (partially dislocated) it, your brain remembers. It creates a powerful Apprehension Reflex.
Whenever you move your arm into a position that mimics the injury (usually out to the side and rotated back), the brain panics. It fires the Pectorals and Lats to pull the arm down and in. While this stops the dislocation, it also stops you from moving normally. You develop a restricted, guarded movement pattern.
We treat the fear. We use Graded Exposure and Proprioceptive Training. We place the arm in positions of stability and slowly work towards the range of apprehension. We prove to the brain that the joint is held securely by the muscles. By rebuilding the brain’s trust in the joint, we can switch off the apprehension reflex and restore full function.
We see many clients with Hypermobility Spectrum Disorders (HSD) or EDS. For these individuals, the ligaments are naturally loose (lax). Ligaments are the passive restraints of the joint. If they are loose, the muscles (active restraints) have to work overtime to hold the joint together.
This leads to chronic muscle fatigue and trigger points. The muscles never get a rest.
Our approach for hypermobility is Proprioceptive Stabilisation. We don’t stretch hypermobile patients (they are already too flexible). We teach them how to find “mid-range.” We teach the brain to control the joint using deep co-contraction of the stabilising muscles rather than hanging on the ligaments. We teach you how to be strong, not just floppy.
Instability often involves damage to the Labrum (the cartilage ring that deepens the socket). A SLAP tear or Bankart lesion can create a clicking sensation and a sudden loss of power (“Dead Arm”) when throwing or lifting.
While severe tears may need surgery, many can be managed conservatively. The key is to turn the Rotator Cuff into a “dynamic labrum.” If the cuff muscles are strong and reactive enough, they can compress the ball into the socket, compensating for the torn cartilage.
We focus on Reactive Stability. We use drills where you have to stabilise the arm against unpredictable forces (like someone pushing your arm while you hold it still). This trains the reflex loops to fire faster than the instability can occur.
Shoulder blade pain (Medial Scapular Pain) is often blamed on a “knot” in the Rhomboids. Patients dig a tennis ball into it for years with no relief.
Usually, this pain is Referred Pain from the lower neck (C5-C7 discs or joints). The nerve that supplies the deep neck muscles also supplies the area between the blades. If your neck is stiff or irritated (“Tech Neck”), the brain refers pain to the scapula.
Alternatively, it is the Dorsal Scapular Nerve being entrapped by the scalene muscles in the neck. We treat the neck to fix the shoulder blade. By mobilizing the cervical spine and flossing the nerve, the “knot” in the back often melts away instantly.
1. The Neural Audit: We check the Long Thoracic Nerve and the Spinal Accessory Nerve. We ensure the hardware is working.
2. The Reset: We release the overactive compensatory muscles (Upper Traps/Pecs).
3. The Anchor: We reactivate the Serratus Anterior and Lower Traps to glue the blade to the ribs.
4. The Reflex: We train the shoulder to remain centred during fast, dynamic movements.
This clinic is for you if:
We build the stability you need to trust your body again.
