Dr. John Rusin Shoulder Pain


-Shoulder pain is climbing the ranks as one of the most common orthopedic conditions diagnosed and treated in today’s medical community.

-A combination of bad posture and the rise of hand held technologies can be to blame for this epidemic of shoulder, neck and upper back pain.

-The shoulder screw home mechanism (also known as shoulder packing) can position the shoulder in optimal position for functional exercise, even if your posture is less than stellar.

-The same setup position using shoulder packing can be used in every movement involving the upper body.


Shoulder and upper back pain is one of the most common chief complaints I see on a daily basis from my patients as a performance physical therapist and soft tissue specialist. Regional shoulder pain is present in a majority of the population, no matter if you are throwing a baseball for a living, or working a 9-5 in your cubicle. In a current day society that is so highly dependent on handheld technology, our posture has become a serious risk factor to our orthopedic health.


The screw home mechanism, also known as “packing the shoulder,” is the most centered position of the head of the humerus (upper arm bone) in the glenoid fossa (portion of the shoulder blade, think the socket). The ability for an individual to achieve true shoulder centration is made more difficult with the presence of a postural stress syndrome (PSS).

PSS is a form of chronic malalignment that causes soft tissues such as muscles and fascia to get fibrotic and shortened, ultimately weakening movements and limiting functional range of motion. With the inability for the shoulder and neck complex to move with efficiency through a useful range of motion, that region of the body will assume a “new neutral” position that negatively effects function.

This is where it gets tricky. Our new neutral position is not functional, and it actually increases our risk for injury if not negated before any movement integrating the upper quadrant (shoulder, upper back and neck complex). Our first option is obviously to correct the PSS with focused exercise and soft tissue work. That being said, people are going to train, even if they do sit at a desk 11 hours a day. The screw home mechanism activated stabilizers of the shoulder, and positions the shoulder in a neutral position before any pressing or loading movements.

Shoulder joint centration is a combination of external rotation of the glenohumeral (true shoulder) joint and depression, downward rotation and retraction of the scapulae (shoulder blade). Check out this video where I demonstrate a bad position (hike the shoulder upward) then center the shoulder with the screw home mechanism:


The same screw home mechanism can be used at the shoulder joint to protect your shoulders, and align the joint for maximal force output and functionality no matter what upper body exercise you are completing. The screw home can be used in closed chain and open chain positions of the upper extremities (push up or press for example), and isolated holds or dynamic activities. Different angles and body setup applies, but the centration of the shoulder joint stays the same. Here’s some examples of ways to incorporate the shoulder screw home into your training:

RKC Plank Iso-Hold (Closed Chain/ Iso-Hold)

The plank…AH! I cannot tell you how many times I see this amazing activation and pillar stability exercise get absolutely butchered! The planks function is to train your postural stabilizers against gravity. The plank needs to be functional to translate into better compound lifts, and I can say without a doubt that the 3 minute plank you are doing in yoga isn’t translating very well! Focus on quality of movement instead of the quantity of time that you are holding. Max out your tension by squeezing every single muscle in your chain. If you are doing this exercise at the correct intensity, 8-15 seconds should have your gasping for air, and burning in places you didn’t know existed.

Key Coaching Cues: Use a slightly posterior pelvic tilt on your setup. It will get the anterior core more involved, and position your glutes for maximal tension! See my ass up in the air slightly? That’s where you need to be.

Push Up Iso-Hold (Closed Chain / Iso-Hold)

Same rules apply as the RKC Plank Iso-Hold. You are going to get those shoulders packed while de-weighted, activate your core, and squeeze with everything you got. This is a slightly more advanced variation of the RKC Plank due to having to control both your elbow and wrist joints in a static neutral position.

Key Coaching Cues: Drop the ass down just a little from the RKC Plank position. Maintain a neutral position at the spine and pelvis, creating a straight line ankles through the spine.

Push Up (Closed Chain / Dynamic )

Let’s take this one step further. Setup is going to be the same as the Push Up Iso-Hold, but we are going to add a dynamic pressing component into the movement. While maintaining the strong core and pelvic position, control the eccentric portion of the push up down to the ground with neutral shoulder alignment. Use a pause at the bottom of the motion to recruit shoulder stabilizers and minimize momentum. Once again, press up and get your elbows straightened out. While in the push up hold position, build tension once again for 1-2 seconds before completing your next rep.

Key Coaching Cues: The Push Up is all about core activation. We aren’t trying to half ass our way through 65 unbroken presses, we are activating stabilizers, and pressing for functionality and translation into more advanced loaded pressing movements. And for anyone out there who can complete 65 unbroken push-ups in a correct movement pattern, I’d like to see it.

Single Arm Kettlebell Shoulder Pack (Open Chain / Iso-Hold)

While in a standing position, our core must always be activated to maintain a spinal and pelvic neutral position. From this stable base, we are able to use our upper quadrant more effectively, and with more efficiency in movement. During the shoulder pack, swing the KB up to shoulder height. Maintain this static position with the core and shoulder girdle musculature firing at maximal tension.

Key Coaching Cues: Once the bell is up at shoulder level, make sure to cue a neutral rib down position. I like doing this with my opposite hand. Adds some tactile cues and keeps you honest when holding for max time and effort. Also, emphasize external rotation of the shoulder to set screw home. I OVER-emphasize this in the video to make the action clear.

Single Arm Kettlebell Overhead Iso-Hold (Open Chain / Iso-Hold)

The next step up from the Shoulder Pack Iso-Hold is getting the elbow and wrist involved. The more joints you are put in charge of from a stability and motor control aspect, the more difficult the movement becomes. From the shoulder packed position, press the bell overhead. Initiate the screw home mechanism in the overhead position. Hold for prescribed time with the biceps approximating the side of your head.

Key Coaching Cues: The hand position is the easiest way to make sure you are loading the shoulder correctly and centrating the joint. In a correct position, your palm will be facing away from you. With multiple joints involved, cue from proximal to distal to make sure you cover all your bases.

Single Arm Dumbbell Bench Press (Open Chain / Dynamic)

We made it back to the bench! Even though meatheads may disagree, all the same setup rules for shoulder packing still apply. Using a pronated grip, press the dumbbell vertically while maintaining a shoulder packed position.

Key Coaching Points: Shoulder stability on the bench is all about rhythm. For most clients, I cue a exp-1-2 rhythm. Accelerate the weight up vertically in a controlled manor, build maximal tension at the apex of the movement, and eccentrically control the weight down for 2 seconds. This will increase your TUT (time under tension) and deliver a greater training effect.

Single Arm Neutral Grip Dumbbell Bench Press (Open Chain / Dynamic)

Same Setup as the pronated grip press. We are using a neutral grip position in this pressing variation to help centrate the shoulder joint from start to finish. The neutral grip forces us to externally rotate the shoulders throughout the movement. If you are struggling with the traditional dumbbell bench press, a neutral grip may be a great variation for you. Also, any shoulder issues or past injuries, learning how to correctly position and press from this variation is a great option.

Key Coaching Cues: Maintain a constant angle between your upper arm and body. AKA don’t flare the elbows. Just because your hands are still in neutral doesn’t mean your upper extremity maintains the same position.

Seated Single Arm Neutral Dumbbell Overhead Press (Open Chain / Dynamic)

The seated position challenges the core in a very direct manor. Compensations from the pelvis are no longer able to be achieved due to being flexed at the hips, throwing all the core stability forces through the abdominal cavity and back. Make sure to maintain a rib down position and co-contraction of the anterior and posterior core. Squeeze for maximal force and tension through the core, and move weight vertically with stable shoulder position.

Key Coaching Cues: Posteriorly rotate your pelvis in a seated position to lock in your lower spine and activate your core. This position will keep you from overarching your lower back, and losing stability farther up in the kinetic chain.


Combat your daily posture by taking action in self myo-fascial release and corrective exercises. While your working on loosening up those muscles, make sure you are still training, and training hard! Protect your shoulders by improving your alignment and setup with the shoulder screw home mechanism. Get ‘em packed before movement occurs, and maintain that optimal position throughout the movement.


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