Shoulder pain is a very common issue. Most folks with shoulder pain do not recall any injury. They are also surprised because “they didn’t do anything” to injure it. Well… they also didn’t do anything to prevent these common issues from arising either :-).
A pain-free shoulder requires a strong rotator cuff, good posture, and a healthy metabolism. Whether you are being proactive and want to decrease your risk of developing shoulder pain, or you recently recovered from a bout of shoulder pain and don’t want it to come back— this post is for you.
The onset of shoulder pain is often multifactorial. Shoulder pain and dysfunction are very common in the adult population. Your age, lifestyle, overall health, activity level, diet, occupation, and, of course, genetics all play varying roles in your joint health – especially your shoulders. Our metabolic health matters, too… did you know that shoulder pain and rotator cuff tears occur more frequently in people with diabetes, high cholesterol or gout? I talk about the most common reasons for severe shoulder pain in this article…. “Why Does My Shoulder Hurt?”
Is shoulder pain preventable?
Well… to some extent, yes, it is. I have written extensively about the importance of muscle mass and strength training and its effect on our longevity. Humans lose 1% of their muscle mass annually after 30, and that pace quickens in our 50s. This is a process known as sarcopenia. The loss of muscle mass and strength affects our shoulders, too. The rotator cuff and the other muscles that coordinate proper shoulder function respond poorly to deconditioning and weakness.
Many folks who present to the office with complaints of shoulder pain do so at predictable times throughout the year. Let’s say you have taken the winter off. You didn’t exercise, no heavy chores… your shoulder deconditioned for months. Spring has arrived, and there’s a lot of work to do. 50-pound bags of mulch need to be scattered around, grass must be seeded and fertilized, and all that stuff in the basement must be thrown away.
Your rotator cuff isn’t going to enjoy that very much. The muscles were not used to performing heavy or repetitive activities, so they are easily strained now.
How Common is Shoulder Pain?
A study in 2011 found a 1-year incidence of shoulder pain in primary care clinics to be about 15 in every 1000 patients, with a lifetime prevalence of up to 70%. This study also mentions the high likelihood of shoulder pain lingering without relief if proper rehabilitation and care do not occur. In fact, upwards of 40-50% of participants in the study were found to have recurring or lingering shoulder pain in a 12-month follow-up.
Whether or not your pain will linger depends on many factors. some rotator cuffs are simply strained by an increase in activity. That inflammation will often subside within a few weeks. There are other times when the rotator cuff undergoes structural changes and tendinosis or tendinopathy occurs. Cases of tendinopathy, which is also the cause of tennis elbow, achilles pain, and hamstring pain—can easily take up to a year to resolve.
The most common diagnoses for shoulder pain include:
- Atraumatic:
- Rotator cuff Tendonitis, tendinosis, and degenerative tears
- Bicep Tendonitis
- AC joint arthritis
- Frozen Shoulder
- Calcific Tendonitis
- Bursitis
- Traumatic:
- Rotator Cuff Tears (from impact or fall)
- AC joint separation
- Frozen Shoulder (sometimes)
- Bicep Tear (from impact, fall, or weightlifting accident)
- Other muscle strain or tear (i.e. deltoid)
- Labrum Tears (from impact or fall)
- Dislocation or subluxation
For this article, we will focus on atraumatic shoulder injuries and how to keep your shoulders healthy to try and prevent these types of ailments. There tends to be the same underlying dysfunction that predisposes almost everyone to shoulder injuries. Is it poor posture? Is it muscle weakness? Is it tightness? Is it a rounded upper back? You will have to keep reading to find out.
How Does the Shoulder Joint Work? A Review of the Anatomy
The shoulder is a ball and socket joint, somewhat similar to the hip. You can access a complete review of shoulder anatomy here. The ball of the humerus (arm bone) and the concave glenoid of the scapula work in conjunction to move the arm in many planes of motion. You may have heard the “golf ball on a tee” analogy; however, I’d argue that this analogy does not give justice to the exact mechanics and function of the entire shoulder complex. Yes, the arm moves because the ball of the humerus rotates on the glenoid, but most (if not all) functional movements incorporate more than just this ball-and-socket relationship. And without considering the entire complex, you predispose yourself to the entire list of atraumatic shoulder injuries listed above. So – what part of the complex are we forgetting?
The scapula. Consider the scapula as a steering wheel, driving the car that is your arm. Each wheel on a car has its own independent motion – spinning forward, backward, and rotationally to change direction as you drive. However, you need a steering wheel to make sure the movement of all the wheels occurs simultaneously so the entire car turns in the same direction. This is the job of your scapula. As it rotates upward and downward, it drives the direction of your humerus and clavicle so you can raise your entire arm overhead without hitting the structures sitting within the joint (i.e. tendons, boney prominences, etc.). Therefore, the key to maintaining healthy shoulders and preventing atraumatic injuries is to improve the strength, stability, and motion of your scapula.
How Does Posture Affect My Shoulder Pain?
Before we discuss exercises for your scapula and shoulder girdle, we should first have a quick conversation about posture. Yes, most of us could use a refresher course on what “good posture” means and how bad posture affects our shoulder joint.
If the word “posture” is mildly triggering and creates frustration, then let’s consider this as your alignment instead. The way you stack your joints on top of one another matters when we talk about absorbing forces and loads – even while sitting. If we stack all of our joints on top of one another, then we have created a solid, strong structure that can hold up our entire body against gravity without increasing fatigue or stress on any one joint or body part. Build a tower of blocks, and I bet you align them perfectly – making sure one block does not stick out too far as to create instability and cause the tower to fall. Our joints are the same, and specifically our neck/shoulders. Poor posture/alignment causes our shoulders to roll forward – meaning it has extra weight to hold up against gravity and thus become less stable. Referring to our “golf ball on the tee” analogy, forward shoulders also cause the golf ball to sit more on one side of the golf tee. You’d imagine that the golf ball would not stay on the tee for very long before falling off and rolling away. Now your humerus won’t actually “roll away” (although you could argue dislocations/subluxations to do just that); however, it is likely the tendons and ligaments holding that golf ball for dear life will take the brunt of it – causing tears and inflammation.
In addition, a forward shoulder also causes the scapular muscles (i.e., rhomboids, trapezius, and posterior rotator cuff) to be lengthened. Any muscle that rests in a lengthened position will be inherently weak – the same goes for a shortened muscle. This is because of the contractile units in our muscle tissue – they need to be aligned (or stacked) just right to produce a contractile force. If lengthened, these units are not aligned with one another, thus making force production much more difficult.
Weak scapular and rotator cuff muscles + a forward shoulder (or poor posture) = reduced scapular mobility and strength → SHOULDER PAIN.
How Do I Improve My Posture and Strengthen My Shoulders?
The first and most important aspect of obtaining good posture is truly awareness.
What is “good posture?”
How does “good posture” feel?
What muscles should I be using to have “good posture?”
“Good posture” is how you align your body in a way that stacks all of its joints on top of each other. So, as you sit or stand throughout your day, ensure you find a neutral spine, and the rest of your body will follow suit. A neutral spine typically means:
- Tilting your pelvis slightly underneath you without rounding your lower back
- Squeezing your shoulder blades (aka scapula) together slightly to bring your chest forward and shoulders in line with your hips.
- Tucking your shin backward (aka creating a double chin) to place your ears in line with your shoulders and in line with your hips
Now, focus specifically on your shoulders. To pull your shoulders back, pretend as if you are trying to tuck your shoulder blades down into your back pockets. Feel the muscles along the inner parts of your shoulder blades and spine engage. These are your rhomboids and middle/lower trapezius muscles. You should feel strong here, but relaxed in the tops of your shoulders (upper trapezius). This is good posture!
You may find that holding this position very tiring and even creates soreness in your middle and lower back after just five minutes. That’s okay! This soreness or discomfort is similar to how your quads might feel after 2 minutes of a wall sit. Well, maybe not as intense, but you get the idea. Having good posture takes time, practice, and of course – strengthening! By performing these simple upper back and shoulder exercises, you will find having good posture is much easier, and your shoulder pain might subside.
Exercises for Shoulder Pain and Posture:
The following exercises strengthen your scapular and rotator cuff muscles to improve your posture and reduce shoulder pain/injury. Ensure that with any upper body exercise, you are first engaging your core for spinal stability and moving your shoulder blades. Remember, your shoulder blades drive the bus, and they must be engaged first if you want your entire shoulder complex to move together as a unit.
Perform each exercise for 2-3 sets of 10-15 repetitions, taking at least 30 seconds of rest between sets to allow for recovery and reduce unnecessary fatigue. The first exercise listed is a stretch to help reduce tightness in the chest that could be pulling your shoulders too far forward. Perform the stretch for at least 3 sets of 30-60 second holds at least 1-3 times daily. If you need extra instruction and guidance, click on the exercise for a video.
