By Dr. Jessica Warnecke PT, DPT, OCS
The shoulder is the most mobile joint in the body. It is the region that connects your entire arm to the rest of your trunk and is comprised of a combination of bones, muscle tendons, and ligaments that allow you to move freely when putting on a shirt, driving your car, placing dishes in the cupboards, and playing sports.
Most people think rotator cuff when referring to the shoulder. This, in fact, is just a small make-up of four muscles that assists in movement. The biceps muscle of the arm, the pec major and minor of the chest, the deltoid, the trapezius muscle group, teres major, rhomboids, levator scapulae, serratus anterior, and latissimus dorsi also all contribute to stability and mobility. Because it is such an intricate network of structures, each of them must constantly work in sync to allow us pain free movement throughout the day.
The muscles that surround the shoulder create a series of force coupling actions as we move. The upper and lower trapezius and serratus anterior muscles work together to control movement of the shoulder upwards as we lift our arm. When we lower our arm, the levator scapulae, pec minor, latissimus dorsi and rhomboid muscles help control the movement. If we develop weakness in certain muscle groups, then other muscle groups have to kick in to pick up the slack.
Over time, this throws off the mechanics of the shoulder and can lead to many issues down the road. For instance, in many shoulder injuries, the lower trapezius and serratus anterior muscles are weak and underworking. The upper trapezius is very strong and takes over the movement of lifting the arm upward. This throws the coupling force out of whack and leads to overcompensation patterns that put unnecessary strain on other structures such as the rotator cuff muscles.
One very common cause of shoulder pain is referred to as a tendinopathy. Tendinopathy is a pathology of the muscle tendons, which attach the muscles to bones. An acute injury is called tendonitis and occurs due to inflammation of the tendon. This can occur after playing a long tennis match, lifting weights overhead, or tweaking your shoulder when picking up a heavy grocery bag. If not severe, rest and ice can help this acute inflammation subside and you regain your normal function.
If this inflammation doesn’t subside because you keep using the arm, working through pain, or injuring other nearby structures, tendinosis can occur, which is a chronic degeneration of the muscle tendon tissues involved. Tendinosis can also occur if there have been muscles in the shoulder not working properly over a long period of time (think 3 months or more). Most people that haven’t encountered a specific injury, but have had pain in their shoulder over a number of months or years, often fall into this second category.
Whether an acute rotator cuff strain (also known as a tear) occurs or there has been a gradual worsening of symptoms, pain can present as aching at rest or when lying on the injured side-- to sharp with lifting the arm up, reaching outward or trying to lift an object such as a purse or grocery bag. Depending on the size of the muscle strain, an increased amount of weakness and disability may also be present.
Another common cause of shoulder pain is known as an impingement. There are multiple types of shoulder impingement and numerous factors are looked at in order to properly diagnose what is the specific cause of the impingement. The most common type of impingement is subacromial impingement.
Subacromial impingement can occur with any structure that goes through the tiny space underneath your acromion. Bursa inflammation, tendonitis, and muscle strength deficits can all lead to issues in this small space. Often, the primary cause occurs when a muscle group involved in the coupled movement of the shoulder isn’t working up to par, as discussed above. Over time, the other muscles that are over working (commonly the pec and upper trapezius muscles) get too tight and start to pull down on the acromion process, which decreases the already limited space. Then, any time you raise your arm, the biceps and/or supraspinatus muscle tendons that run through this space get compressed causing sharp and aching pain. This can make sleeping on the affected side, reaching across your body to put on your seatbelt, or raising your arm to put dishes away very painful.
What to do?
Stretching and Strengthening are two obvious answers. However, your specific issue dictates the most efficient course of stretching or strengthening that needs to be done. Without examining you, I could give a decent list of things to do, but that doesn’t necessarily mean they’d be the most effective.
I will provide ONE single stretch and ONE single strengthening activity that I give literally every patient with shoulder pain do.
For your stretch- keep your chest muscles mobile. Clasp your hands behind your back and extend your arms away from your body until you feel a stretch in your chest. Hold for 30 seconds, rest, and repeat this 3 times. Perform this 3-4 times a day if you’re having consistent pain, and it will help reduce the tension of your muscles in the front of your shoulder.
For your strength- activate the muscles of your mid back between your shoulder blades. Pretend you have a pencil at the middle of your back. Pull your shoulders backwards and squeeze the pencil between your shoulder blades. Hold for a count of 5, relax and repeat 10 times. Do this 3-5 times throughout the day to help keep your back muscles working.
This is just a quick explanation of a few of the more common reasons we may get shoulder pain. To get more information on additional causes of shoulder pain, plus learn tips on how to reduce your pain and improve your function, request a copy of my FREE eBook, “Common Causes Of Shoulder Pain (Plus Tips To Help Relieve It).”
If you feel like you may be suffering from any of these injuries described, you will benefit from seeing a good orthopedic physical therapist. We are trained in examining the shoulder complex as a whole and diagnosing the root cause of pain and impairment. Don’t ignore your pain…it won’t go away on its own.
Meet Your Therapist
Jessica has been in Austin, TX for the past four years. She grew up in Idaho and attended PT school at Idaho State University. She completed an Orthopaedic Residency and became a Board Certified Orthopaedic Clinical Specialist in 2016.