For an acquired unstable sternoclavicular joint, what type of strengthening (if any) can be done to aid in stabilizing this difficult condition?

I generally look at sternoclavicular (SC) joint issues as a “fallout” similar to acromioclavicular (AC) joint issues or acquired thoracic outlet syndrome.  A single inefficiency can lead to a number of different pathologies; it’s no different than seeing someone with limited hip mobility presenting with back pain, knee pain, or a strain of one of the muscles crossing the hip.

Anecdotally, at the other end of the collarbone, most of the insidious onset AC joint problems I’ve encountered have been individuals with glaring scapular instability (often accompanied by an excessive glenohumeral internal rotation deficit).  With lower trapezius and serratus anterior weakness in combination with shortness of pec minor, the scapula anteriorly tilts and abducts (wings out) – and you’ll see that this leads to a more inferior (lower) resting posture.  Certainly, it contributes to the low shoulder position that the Good Doctor Reinold just described.

In the process, the interaction between the acromion (part of the scapula) and clavicle can go a little haywire.  The acromion and clavicle can get pulled apart slightly, or the entire complex can get pulled downward a bit.  In this latter situation, you can also see thoracic outlet syndrome (several important nerves track under the clavicle) and sternoclavicular joint issues in addition to the AC joint problems that you’d obviously expect.  It’s really just a matter of where folks break down.

So, just like you often look at a hip or an ankle first in many cases of folks with knee pain, I often look at the scapulothoracic and glenohumeral joint first in the SC joint folks.  Obviously, this would be different in someone who had direct trauma to the area, and you’d want to rule out congenital factors that may be present.

Another thing you can’t overlook with pain in this area is the possible presence of a costochondritis.  We had a kid in about a month ago who presented with some annoying SC joint pain with swinging.  After prying a bit further, I found out that he’d had really bad mononucleosis the previous summer and had struggled to get over it.  This kind of inflammation can be present even far down the road.  We sent him to a doctor and he recommended two weeks of Motrin – and our guy was good to go.  It can happen with everything from strenuous exercise, to chicken pox, to infection – or be referred pain from elsewhere.  Complex stuff, for sure.

You can read a bit more about the AC joint stuff in these two old newsletters of mine:

http://ericcressey.com/newsletter168html
http://ericcressey.com/newsletter169html

Good luck!

Eric Cressey is the president of Cressey Performance, based just west of Boston, MA.  Eric is a highly sought-after coach for healthy and injured athletes alike from youth sports to the professional and Olympic ranks.

You can find Eric online at EricCressey.com.