Have you ever glanced in a mirror and thought to yourself, “Wow, my shoulders don’t quite look like they are even? One looks like it is much higher or lower than the other. Is something wrong with me?!”. If this has happened to you, you are not alone. 

A large percentage of people report having shoulders that are not the same height, or that appear uneven. There are many reasons your shoulders may seem this way and in most cases, it does not mean there’s anything wrong with you. It can, however, give you some insight into the way your body moves and how it is responding to your current lifestyle or even events that have occurred in the past. 

The remainder of this blog post will focus on the various reasons your shoulders could appear uneven and what to do if this is the case for you!

What Causes Uneven Shoulders?

There are two main categories of causes for uneven shoulders: structural causes and non-structural causes. Structural causes refer to the anatomy of your body and, for that reason, are unlikely to change. Non-structural causes, on the other hand, have more to do with how your body has developed and adapted over time due to things like repetitive movement patterns or motions and therefore have a greater capacity to change. Let’s further investigate both categories.

Non-structural Causes of Uneven Shoulders

Arm Dominance

Perhaps the most common reason for the appearance of uneven shoulders is much simpler than we might think and that is hand dominance – whether you’re a “righty” or a “lefty.”

Surprised? Don’t be.

Whether it’s hours of writing, constantly carrying objects, playing sports, repetitive work, etc., if the dominant hand is constantly in use, certain muscles surrounding the shoulder will start to adapt. This can oftentimes result in the appearance of the dominant shoulder being lower or more forwardly rotated than the non-dominant shoulder. A clear example of this truth was demonstrated in a 2022 study that looked at the difference between dominant and nondominant shoulder positions in tennis players. It found on average, the dominant shoulder of over 300 elite tennis players was positioned 7-8 mm anteriorly compared to the other side. This is caused by certain muscles on the front of the shoulder becoming overdeveloped due to prolonged time in sport over many years (1). 

 

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Previous Injury/Muscle Imbalance

Up next, let’s discuss the impacts of injury on shoulder height and position. Injury to the upper extremity (which includes the arm, shoulder, and elbow) can lead to various changes in how muscles are positioned and how they function. Whether a muscle is strained, bone is bruised or broken, etc., all these injuries can impact our anatomy and potentially lead to the appearance of uneven shoulders.

READ: WHAT TO KNOW ABOUT TISSUE HEALING TIMELINES

Let’s stick to the muscles for a minute and examine those that can impact the positioning of the shoulder. The following list is not comprehensive but should serve as a good outline of where these muscles are generally located and the common impacts on shoulder position.

 

 

• Trapezius: This muscle extends from the neck to the middle of the back and helps perform the “shrugging” motion. If one side is tighter than the other, you may see an elevated shoulder.

 

• Levator Scapulae: This muscle runs from the upper neck to the shoulder blade and helps raise the shoulder blade. Tightness or overdevelopment from constant use (think about hand dominance again) can cause one side to appear higher.

 

• Rhomboids: These muscles connect from your shoulder blade to your spine. If one side is tighter than the other, it will pull your shoulder closer to your spine and can lead to uneven shoulders. For more on rhomboid pain (and if it TRULY is rhomboid pain, check out the video below!)

 

 

• Pectoralis Major and Minor: These muscles are positioned in the front of your chest. If tight or overdeveloped, they will pull the shoulder forward and down, leading to an uneven appearance.

 

• Serratus Anterior: This muscle helps hold the shoulder blade against the rib cage. If one side is weaker than the other, the shoulder blade may “stick out” and lead to an uneven appearance

 

• Rotator Cuff Muscles: These muscles surround the shoulder joint and help with stabilization. If one or more muscles are injured, others will compensate, once again, you guessed it, leading to an uneven appearance.

 

As you can probably see by now, the anatomy of the shoulder is quite complex. The bottom line is that if you injure or overuse one muscle or group of muscles, compensations will begin to show up, oftentimes in the form of uneven shoulders.

Learn more about some of the key muscles of the shoulder on our rotator cuff podcast here:

LISTEN: ROTATOR CUFF DISCUSSION WITH [P]REHAB PART 1 

 

Structural Causes of Uneven Shoulders

Leg Length Contributions

The first structural cause of uneven shoulders is differences in leg length. You may hear your medical provider call this leg length discrepancy.This just means that one leg is longer than the other. Leg length discrepancies do exist and if your PT or healthcare provider is suspecting a difference side to side, they may take some measurements for comparison. A common method of measurement is placing one end of a tape measure on the ASIS (the bony part of the front of your hip) and the other end on your medial malleolus (the ankle bone on the same side as your big toe. If the difference side to side is greater than 1.5-2.0 cm, your provider will likely begin having the discrepancy further evaluated. When this discrepancy exists, it affects the rest of the body and can create the tendency to shift weight to one side. If one hip is lower than the other, the shoulder on that side will be lower as well (4).

 

 

Scoliosis

The other most common structural cause of uneven shoulders is scoliosis, which you may be familiar with as a curvature of the spine. When this curvature is present, there is oftentimes a rotational component involved that will lead to one shoulder being lower than the other. Outside of uneven shoulders, individuals with scoliosis will also oftentimes have one shoulder blade that is more prominent than the other, one hip that is higher than the other, and one side of the rib cage that is higher than the other when bending forward. Depending on the severity of the curve, your provider may recommend conservative measures like exercise and bracing, or in more progressive cases, surgery. Check out this article on causes, treatments, and exercises for scoliosis.

READ: SCOLIOSIS: CAUSES, TREATMENT, AND EXERCISE IMPLICATIONS

Is this Something you Need to Fix?

In most cases, uneven shoulders are fairly normal and something that is not an immediate risk to your health. If you are starting to experience additional discomfort in your shoulders, you can reach out to a trusted health professional (or take a peek at our Shoulder Rehab and Shoulder Prehab programs through the app). 

A few very common postural exercises that you may receive from a physical therapist depending on your individual situation are as follows and you can also find without our programing through the app:

Scapular Retractions

This exercise is aimed at helping bring the shoulders backward, into a more neutral position. Many of the muscle imbalances we may see today are caused, in part, due to prolonged postures, such as sitting at a desk. There is “good” to “excellent” evidence that using scapular retractions can be a helpful first step in addressing shoulder imbalances and resultant pain (3).

Prone Y Lift-Off

This next exercise focuses on strengthening the lower trap, which has the job of pulling your shoulder blade down and backward. If this muscle is weak, the shoulder tends to rise. The Prone Y Lift-Off has been shown to help improve postural alignment shoulder to shoulder and ensure the lower trapezius is working effectively (2).

 

Conclusion

It can be pretty alarming to suddenly notice your body is not symmetrical in ways you might have previously imagined. However, it’s important to note that based on the activities you participate in daily, the hobbies you have, your job responsibilities, and others, your body is constantly adapting. Some muscles will get used more than others, and as those areas of your body get stronger, the visual appearance can and will oftentimes change as well. For instance, that is why cyclists look different than football players; both sports carry significantly different demands. Add in an injury or structural change and it makes perfect sense that as your body adapts, there will be noticeable changes. Unless it is leading to severe pain or discomfort, it is not necessarily something that needs to be addressed. Our bodies are unique and adaptive and resulting visual differences are part of the natural process of adaptation to our lifestyles and activities. Embracing these differences can help us appreciate the incredible capacity of our bodies to adjust and thrive in various environments.

 

LEARN MORE ABOUT OUR SHOULDER REHAB PROGRAM

 

Resources:

1. Ellenbecker T, Roetert EP, Petracek K, Kovacs M, Barajas N, Bailie D. Bilateral Comparison of Anterior Shoulder Position in Elite Tennis Players. Int J Sports Phys Ther. 2022 Aug 1;17(5):863-869. doi: 10.26603/001c.36629. PMID: 35949371; PMCID: PMC9340837.
2. Park SH, Lee MM. Effects of Lower Trapezius Strengthening Exercises on Pain, Dysfunction, Posture Alignment, Muscle Thickness and Contraction Rate in Patients with Neck Pain; Randomized Controlled Trial. Med Sci Monit. 2020 Mar 23;26:e920208. doi: 10.12659/MSM.920208. PMID: 32202262; PMCID: PMC7115121.
3. Titcomb DA, Melton BF, Miyashita T, Bland HW. Evidence-Based Corrective Exercise Intervention for Forward Head Posture in Adolescents and Young Adults Without Musculoskeletal Pathology: A Critically Appraised Topic. J Sport Rehabil. 2022 Feb 16;31(5):640-644. doi: 10.1123/jsr.2021-0381. PMID: 35172275.
4. Vogt B, Gosheger G, Wirth T, Horn J, Rödl R. Leg Length Discrepancy- Treatment Indications and Strategies. Dtsch Arztebl Int. 2020 Jun 12;117(24):405-411. doi: 10.3238/arztebl.2020.0405. PMID: 32865491; PMCID: PMC7477698.

About the Author

John Schaefer

PT, DPT, CSCS

[P]rehab Writer & Content Creator

John is a native of Rochester, MN and a double graduate of Saint Louis University, where he studied marketing and exercise science before earning his DPT.

Always up for an adventure, John traveled to Boston following graduation to intern at Champion PT and Performance. There he was able to work with high-level high school, college, and professional athletes. Following this experience, he headed south to pursue orthopedic residency training in Houston, TX at Harris Health System, working with a largely underserved and non-English speaking population.

John’s treatment philosophy hinges on empowering movement through extensive education and easy-to-replicate exercises, as well as meeting patients where they are. This perspective is shaped by his personal experiences, including five broken bones and two surgeries, during a multi-sport childhood filled with lots of activity and adventure.

Outside of work, you can find John cycling, attending concerts/festivals, hiking, and traveling!

Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.