IT’S NOT ALL CONNECTED.
Your feet and your neck are as connected as LA is to New York. Do connections exist? Sure. But a stiff ankle causes neck pain about as reliably as a fender-bender on the 405 backs up the BQE. How would that work, exactly?
When someone says “It’s all connected,” I hear something else: “I don’t know how these things are connected, so I’ll gesture at everything.”
But the how, the actual relationship between things, is the essential (essential!) knowledge. And those connections can be fucking hard to find.
For example, I once solved an athlete’s knee pain by paying more attention to her calf. We’d exhausted our options at the knee, so I had to look elsewhere—but I didn’t cast about all willy-nilly. I looked at the nearest neighbor. The calf and the quad both control the forward and backward motion of the knee when the foot is on the ground. That’s their connection, the relationship, the how.
For reasons unimportant to this post, we had recently removed some of her heavy calf raises. Restoring them made her knee pain go away. Why? Her quad no longer had to overwork to control the knee. It had the help it needed.
Calf and quads go together like Taylor and Travis. But the relationship between a pelvis and a shoulder is as “connected” as I am to becoming Taylor Swift’s coach. Do I see a through line? Yes. Would I like it to happen? Also yes. By my count, I have only two degrees of separation. But the likelihood of closing that gap is as probable as a pelvis causing shoulder pain. Could it happen? Maybe? Is it likely? No.
The human movement system has too much play and too many movement options for butterfly-effect bullshit like “this tilts that, and that cocks up your flactoid valve, and that’s why your shoulder hurts.” There’s too much slack in the human movement system for such a chain of events. A pelvic tilt gets absorbed long before it affects the shoulder in any specific way. You can shimmy your shoulders all day, and yeah, your cheeks jiggle in your chair, but your pelvis doesn’t tilt, rotate, or suddenly start hurting because you’re “out of alignment.”
The reality is more uncomfortable than most coaches want to admit. There’s something local to the pain, something right under our noses, and we don’t know it, don’t see it, and don’t even know how to find it. So instead of staying with the problem, we go looking for the next one, something we can spot during a rushed day and a too-short session. We grab whatever we can identify, blame it to preserve our sense of value in the client’s eyes, then do what humans do best: build a story. “Those weak and dastardly buttcheeks ruin everything!” And just like that, we get to keep our respect and our payment as the expert who knows what to do—even when we don’t.
So where do you look, if not far away? You stay. Stay with the shoulder. Stay there longer than you think; longer than is comfortable. Dig. Keep excavating after every instinct tells you there’s nothing left to find …because that’s usually exactly when something shows up.
***
We have established that local problems have local solutions, and that staying with a problem longer than feels comfortable is how you actually solve it. But what happens when you’ve genuinely exhausted the local options?
You look at the nearest neighbors.
“Nearest” means directly connected, one degree of separation away—and relevant to the specific movement problem. An extensor digitorum brevis (toe extensor) sits near a painful Achilles, but it’s irrelevant because it has no meaningful way to act on it. Proximity without influence isn’t a connection.
Let’s say it’s anterior shoulder pain. You stayed local and tested interventions at the deltoid, rotator cuff, pec, and bicep. None showed promise. Your client was strong in every position and permutation, enduring too. They had no funky movement patterns. But they never once said, “It feels better,” or “That’s a good kind of pain, you know?”
So, what are the nearest neighbors? The spine? The scapular retractors? That serratus thing everyone keeps yammering about?
Let’s look. One degree of separation means structures one segment away—in this case, whatever else attaches to the scapula or collarbone. Let’s leave the clavicle for now and focus on the scap and the muscles attached to it: all three parts of the trap, the two rhomboids, levator scapulae, and serratus anterior. Seven suspects.
To narrow your search of those seven, look for clues in movement. Watch your client use his arm in flexion, extension, load bearing, pulling, and pushing. Don’t forget open and closed chain. Which actions look off, asymmetrical, weird, or weak? Is it protraction (serratus)? Upward rotation (trap)? What about downward rotation (rhomboids and levator scapulae)? Movement gives you clues.
Let me set the scene:
You’re looking at this client with fresh eyes, wondering, What else could be the problem? Let’s call him John. You walk around him and notice his collarbone looks flat. Very flat. His AC joint might be lower than his SC joint. Your eyes move to his upper trap, and it looks like a steep slope, like the side of a mountain instead of a gentle, rolling hill in the Shire.
You ask John, “What kind of shoulder work did you try before me, if any?”
He lists twelve different forms of isolated rotator cuff work and scapular retraction. It’s all generic shoulder work, the stuff handed to anyone with any shoulder complaint. So you follow up: “What cues did you use? What were you telling yourself to do it well?”
He demonstrates a lot of back-and-down scap motion.
Of our seven suspects, can you identify which movement he has omitted from his training?
[gratuitous space for you to think]
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[gratuitous space for you to think]
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[come on, stop scrolling for a second and try.]
It’s scapular elevation, specifically the upper trap and levator scapulae. Both elevate the scap, but they rotate it in opposite directions, so they’re not interchangeable. To figure out which one is the bigger problem, less capable of handling forces, you need to watch him move.
You pull up the videos on your phone and see that his upper trap looks soft and squishy when he raises his arm overhead. In fact, his whole trap looks… weirdly off. Like there’s no muscle definition in the middle and lower trap. But the upper trap looks worst because the shoulder is so low, and it’s one degree of separation from the problem. It doesn’t move the glenohumeral joint directly, but it moves the scapula. And the scapula is the socket. You work the socket, you affect the joint.
You ask for shrugs because that targets the upper trap — scapular elevation during the painful movement, shoulder flexion. He can barely get his arm up. Interesting. And there’s no pain. Eureka?
Here’s video of what that looks like.
Notice how easy it is on the right side, and that he leans while raising his left arm and is straight while raising his right? The lean shortens his lever, making it easier. See how sporadic his scapular elevation actually is? It flutters up, flirts with his ear, then drops away again like it’s playing hard to get.
You can’t call the upper trap hypothesis a success or failure until you’ve actually restored function to it. If you bring it back online and the problem disappears, you have your answer. If it remains, you’ve eliminated a suspect and your list just got shorter. Three cheers for elimination and the scientific method. (It’s rude you didn’t clap.)
Zoom out for a second. Do you see how we built rock-solid logic here, rather than some hand-wavy “it’s all connected” nonsense? You also found your next best choices in the process: levator scap, middle trap, lower trap.
And FYI, if you want to drill this kind of thinking until it becomes instinct — building hypotheses, testing them, failing well, and finding the answer hiding in plain sight—well, that’s exactly what we do in the Evolved Coach course.
What we just did is a nearest neighbor search, and it helps solve almost all problems. Seriously, most problems are solved locally or with one degree of separation. How or why it’s causing pain can remain a mystery. Explaining pain isn’t your job. Your job is to solve problems. You must eliminate the suspects with the highest probability of causing problems before blaming distant structures. This is a more honest approach to solving movement problems. It’s logical, reasonable, and most of all, it fucking works. It solves problems with greater results in less time.
But, there are exceptions. And as for what they are? That’s the next post. For now, you need to see how much more sensible it is to do these local searches than make up improbable stories about how a pelvis causes shoulder pain.
[Feature Photo by D koi on Unsplash.]