Ah, the shoulder – the unsung hero of our daily activities, until it decides to throw a tantrum and make its presence known. If only shoulders had a mute button, right? But alas, shoulder pain insists on being the drama queen of discomfort.
Shoulder pain can be described as any type of pain, tightness, or discomfort emanating from any area around the shoulder joint. There are many different types of symptoms, ranging from mild to incredibly severe.
I know how intrusive this can be, which is why I’ve put together the ultimate guide to pacify those rebellious shoulders. We'll dive into some basic anatomy, get an understanding of how the shoulder works, look at what not to do if you have shoulder pain, look at shoulder friendly exercises you can do if you have shoulder pain, and of course, I'll show you how to assess and relieve a variety of shoulder issues. Knowledge is power so my goal is to share info in an easy digestible way so you can take control.
HOW DOES THE SHOULDER WORK?
The shoulder joint is classified as a ball and socket joint and is made up of three bones: upper arm bone (humerus), shoulder blade (scapula), and your collarbone (clavicle).
The humerus head (the ball) fits into a rounded socket in the scapula, which is called the glenoid. From here, muscles and tendons attach the shoulder blade to your collarbone to complete the shoulder joint. The humerus moves freely in the glenoid and receives support from the shoulder blade and clavicle to create stability.
DIFFERENT MOVEMENTS OF THE SHOULDER
There are 6 movements that the shoulder can produce, however most of these movements do not happen in isolation, but rather together, producing an almost unlimited amount of possibilities.
The 6 movements of the shoulders are as follows:
Internal Rotation - The humerus rotates in toward the midline of the body
External Rotation - The humerus rotates away from the midline of the body
Flexion - The humerus raises up in front of the body
Extension - The humerus raises up behind the body
Abduction - The humerus moves away from the body
Adduction - The humerus moves toward the body
WHAT OTHER AREAS OF THE BODY WORK WITH THE SHOULDER?
Nothing in the body works in isolation, especially the shoulder. When performing any type of movement that involves the shoulder, these other parts of the body can have some sort of influence:
Scapula - As I mentioned before, the humeral head inserts into the scapula at the glenoid. When the shoulder moves in any direction the scapula must move with it. For instance, as you raise your arm up in front of you (shoulder flexion) the scapula must upwardly rotate (think the top of it rotates backward and down, while the bottom comes forward and up).
Thoracic Spine - The thoracic spine is made up of 12 vertebrae (T1-T12) and make up the upper part of the torso, starting at the base of the neck and ending at the bottom of the ribs. It’s ability to flex, extend, and even rotate is what allows the shoulder to move through it’s greatest range of motion. For example, to reach maximal shoulder flexion, the thoracic spine must be able to extend as well.
Cervical Spine - The cervical spine is made up of 7 vertebrae (C1-C7) and more commonly is referred to as the neck. This area doesn’t necessarily move when shoulder actions occur, however, if it’s flexed too far forward (think of the posture associated with staring down at your phone) shoulder movements will be compromised.
Elbows and Wrists - The elbows and wrists are usually never considered when it comes to shoulder movement, however, as everyone loves to say, “it’s all connected”. If there is a lack of movement in the elbow rotators and/or wrist extensors, shoulder movement will be compromised. For example, during a palms facing pull-up, if the elbow can’t supinate (rotating the palm toward your face), movement of the shoulder will be compromised. For wrist extensors, if range of motion is compromised in this action during a push-up, shoulder extension will be reduced.
THE DIFFERENT TYPES OF SHOULDER PAIN
Shoulder pain can manifest in a variety of ways. Here are some common examples of what I hear clients describe:
Dull ache - In the tissue surrounding the shoulder
Sharp pain or pinching - Emanating from the front of the joint and even from the inside
Shooting “nervey” pain - This can manifest anywhere, starting from the base of the neck and running all the way down the arm
"Warm" pain - that can be described as warm or even hot
MOVEMENTS THAT CAUSE SHOULDER PAIN
For most people, shoulder pain tends to show up when doing certain motions, rather than hurting while doing nothing. The most common actions that produce aches and pain are:
Reaching or pressing overhead - By far the most common. Think military press, or simply reaching for something in a cabinet
Horizontal pressing - Think pushups, bench press, and chest press
Reaching behind you - Like reaching for something in the back of your car, or putting on a jacket
Flexing the arm up in front of you - Lifting a cup of coffee off the table
Lifting the arm - When you lift it up to the side
Sleeping -Unfortunately it’s very difficult to pick a certain position while sleeping, and most shoulder pain sufferers will experience some sort of pain/discomfort when trying to sleep
THE DIFFERENT TYPES OF SHOULDER PAIN CONDITIONS
Shoulder pain can be diagnosed in a number of ways. Here are the most common ones:
Tendon inflammation (bursitis or tendinitis) - Bursitis is defined as inflammation of the small filled sacs (bursae) that help reduce friction between the muscles and bones. Tendinitis is when tendons (the tissues that connect muscles to bones) are inflamed, which is brought on by excessive movement or degeneration of the tissues.
Tendon Tears - When too much load or stress is placed upon the tendons, tears ranging from full rupture to micro tears can occur.
Impingement - If the shoulder blade puts too much pressure on the area that lies underneath it when the arm is lifted away from the body (to front, side, or combination of the two), the shoulder can “impinge" this area leading to irritation of the rotator cuff tissues.
Rotator Cuff Issues - One of the most common types of shoulder pain is rotator cuff strains or tears. This pain and discomfort usually shows itself on the top outside part of the shoulder and can hurt when doing almost anything with the shoulder.
Instability - If you’ve ever experienced a shoulder dislocation (humeral head pops out of the shoulder socket) then you’ve definitely felt instability. The surrounding tendons, ligaments, and muscles can become loose or torn thus no longer providing the support that they’re supposed to provide.
Frozen shoulder - If the inside of the shoulder joint suffers too much abuse, the shoulder joint may start to suffer a neurological response, known as frozen shoulder, where range of motion will be significantly reduced without any warning. The debate is still out on what actually causes this condition.
Arthritis - When the shoulder joint starts to experience “wear and tear” due to age, overuse, underuse, or lack of strength, pain will definitely start to set in. There are different theories on what actually causes arthritis, however, everyone can agree that it can be quite painful.
Fracture - If you break your humerus, scapula, or clavicle then you’ve suffered a fracture (broken bone).
The most common conditions I work with clients on are tendon inflammation, shoulder impingement, rotator cuff issues, frozen shoulder, and arthritis, and I've experienced shoulder issues over the years so I know how intrusive it can be.
These issues tend to improve with a combination of tissue remodeling (increasing strength in the tissue), developing more range of motion in the shoulder (specifically internal and external rotation), and slowly reintroducing compound strength movements (horizontal pressing, incline pressing, throwing, etc.).
See also: Simple Exercises for Rotator Cuff Issues
HOW TO KNOW IF SHOULDER PAIN IS FROM A MUSCLE OR A JOINT
Determining if your shoulder pain is a muscular or joint problem should be done by a licensed practitioner. However, it’s a safe bet that if the problem comes and goes, and usually tends to lessen after you’ve got the area moving, then most likely it’s a muscle problem.
On the other hand, if you’re experiencing sharp pains, and/or it never seems to calm down, then most likely its a joint problem.
COMMON CAUSES OF SHOULDER PAIN
Shoulder pain comes from a variety of reasons as listed below:
Poor internal or external rotation range of motion (the most common in my opinion)
Lack of mobility in the scapula and/or thoracic spine
Inability for the wrists and/or elbows to flex, extend or rotate
Overuse of the shoulder
Poor lifting technique
Lack of use
Direct trauma (car accident, collision sports, etc.)
COMMON COMPENSATIONS WHEN YOU HAVE SHOULDER PAIN
When your shoulder lacks one of the main functions we discussed earlier, other parts of the body will begin to chip in when doing motions that primarily involve the shoulder.
For example, if you lack flexion (putting your arm overhead), your lower back will extend (think sticking your butt and chest out), to allow you to get into this particular range of motion. This then places an obscene amount of stress on the lower back. You’re essentially using your lower back to move something overhead. This is a terrible idea!
Here are some other common compensations that happen:
Neck and scapula when pressing overhead
Elbows when doing rows and/or pull-ups
Pectoral (chest muscles) when benching or other horizontal pressing movements
Wrist when doing push-ups or other horizontal pressing movements
WHAT NOT TO DO IF YOU HAVE SHOULDER PAIN
If you’re currently dealing with shoulder pain, here are a couple of things that may seem beneficial, but I would definitely suggest NOT doing as none of them will actually fix the problem.
Rest - Prolonged rest after an injury may sound like a great idea, but when you stop using tissues, they atrophy (shrink and become weaker). So your symptoms may have calmed down, but the moment you start to use the shoulder again, bam… pain returns.
Icing - This may have the ability to temporarily calm down the current symptoms if done immediately after experiencing the pain, otherwise it is useless.
Stretching - When tissues are injured or damaged, the act of stretching is only going to make things worse. Think of damaged tissue like a rubber band with a bunch of cuts in it. If you repeatedly stretch the rubber band, it will eventually snap.
Myofascial release or massage guns - Foam rolling, lacrosse ball smashing, and massage guns are all just another form of stretching. They essentially numb the pain temporarily, which gives you this illusion that the tissues are healthy. Then when you go and use them, the tissues get even more injured.
Banded rotator cuff exercises - Even though you’re strengthening the tissues of the shoulder with these exercises, you’re not increasing the range of motion.
CAN SHOULDER PAIN GO AWAY BY ITSELF?
In 99.9% of shoulder pain cases, shoulder pain will not go away by itself. In order to see relief for pain, discomfort, or whatever symptoms you may be experiencing, you must build stronger tissues and increase range of motion within the shoulder. Failure to do both of these will result in your shoulders permanently hurting and most likely getting much much worse.
HOW TO KEEP TRAINING IF YOU HAVE SHOULDER PAIN
I know one of the things that popped into your mind when you felt that first twinge of shoulder pain was, “Oh no! Am I going to have to stop lifting?” so I'm here to tell you that you can definitely keep training when experiencing shoulder pain, but there are certain things you must take into consideration.
First up, you can’t do anything that makes it worse. Movement alternatives for some of your go-to exercises are a great way to continue to train without exacerbating the problem. They change the angles, grips, and/or ranges of motion of your favorite exercises. For example, if you feel like you must bench, or do something similar, I would suggest using a close grip neutral grip push-ups instead.
See also: Shoulder Friendly Push-Up Alternative
Secondly, you must continue to work on your shoulder range of motion and tissue quality. Movement alternatives are a great way to keep training but the big caveat is that these alternatives are a short-term solution while you work on the root of your shoulder problem. If all you do is adjust the exercise, your shoulders will only get worse, forcing you to constantly keep modifying more exercises, until eventually you run out of options.
See also: Kinstretch Class for Shoulders and Neck
The combination of these two concepts will allow you to slowly build a better shoulder while maintaining your strength and muscle that you’ve worked so hard for. Plus, when your shoulder is ready to go back to the more common exercises like barbell bench press, you’ll be more than ready!
HOW TO ASSESS YOUR SHOULDERS
Seeing where shoulder issues are stemming from starts with assessing your shoulders and how they move. Although I always suggest seeing a professional, there are some simple steps you can take on your own to assess your shoulders to see how much range of motion you have, and which motion needs work.
Step #1: Assess Internal Rotation
Place your arm straight out to the side and flex elbow to 90 degrees
Engage your scapula so it doesn’t move at all
Keeping your head, thoracic spine, and wrist completely still, rotate your forearm down towards the floor without your elbow dropping
See how far your fist comes down without forcing it
Repeat for the other side
Step #2: Assess External Rotation
Place your arm straight out to the side, flex elbow to 90 degrees, and move elbow forward so it's slightly in front of your shoulder
Engage your scapula so it doesn’t move at all
Keeping your head, thoracic spine, and wrist completely still, rotate your forearm backwards without your elbow dropping
See how far your fist moves behind the elbow without forcing it
Repeat for the other side
HOW TO RELIEVE SHOULDER PAIN
Relieving shoulder pain starts with a simple formula of creating more space in the shoulder joint, building better tissue quality and developing better shoulder mechanics.
Here are the necessary steps in order to relieve shoulder pain in more detail:
Create more space within the shoulder joint by developing more internal and/or external range of motion. Determine which needs more by performing the assessment detailed above.
Build better integrity in the tissues of the shoulder joint.
Develop better shoulder joint mechanics (get the shoulder moving more cleanly and with more efficiency).
Slowly implement strength training movements that put an appropriate amount of stress on the shoulder so you can continue to progress.
See also: Relieve Shoulder Pain With This Sequence
See also: The Best Shoulder Exercise for Golfers
YOUR STICKY SHOULDER SOLUTION
Join me for the Healthy Shoulders 10 Day Challenge and get the simple - but incredibly powerful - set of exercises that will stretch and strengthen the tissue inside your shoulder capsule, which creates more space and relieves those issues.
We’ve been getting a ton of requests for a program like this so I’m excited to be bringing it to you!
ABOUT COACH MATT PIPPIN
Matt is a Strength and Mobility Coach with over 15 years experience in his field and has coached over a thousand professional, collegiate and everyday athletes with the goal to help them move, feel and perform at their highest level. He's incredibly passionate about bringing simple and effective online mobility training programs to everyone who wants to take control of their self care and make lasting change. CLICK HERE to learn more.
Certifications:
NSCA Certified Strength and Conditioning Specialist
Level 3: Fascial Stretch Specialist
Level 1: Institute of Motion Health Coach
Certified FRC Mobility Specialist (FRCms)
Level 1 Kinstretch Instructor
Weck Method Qualified