Shoulder pain can be very debilitating. Tasks that were once small and simple can now seem tedious and painful. And if you enjoy being active, shoulder pain and impingement can prevent you from doing many of the things that you love!!
So Where Do I Start?
First, we have to differentiate between two broad types of shoulder pain - there are MANY shoulder conditions out there but we're going to keep it simple and keep it broad.
What was the mechanism of injury?
Suffering a Fall or Direct Blow to the Shoulder
If you first started noticing your pain after suffering a fall or a direct blow to your shoulder then this post may not be for you. I recommend at least undergoing an x-ray to make sure that you haven't fractured any bones. You don't necessarily need an MRI and it doesn't matter if you tore your RC (minor tear vs major tear - major tears require surgery but most minor tears do not). However, you MUST find out if you did any damage to the bone before exercising - otherwise, you may delay healing to the bone and this can lead to surgery later on down the road.. so please seek care from a healthcare professional if you fit in this category.
Gradual Onset Of Pain That Progressively Worsens Over Time
On the other hand, if you are unsure when you injured your shoulder but the pain appeared to start gradually and is getting worse and worse every day then this article is for YOU! The longer you wait, the more at risk you are for developing compensatory movement patterns which will lead to more and more pain.
Anatomy & Physiology Of The Shoulder
Okay.. Let's back it up a bit and start with the anatomy. The picture shown below can be a bit intimidating but hopefully after this post you'll have a better understanding of the topic.
There's no better way than taking charge of your own health rather than relying on medical professionals to diagnose and treat you.. unfortunately, the way our health care system works today if you rely on someone else then you may be poorly advised. Especially if you're only with that person for 5-10 minutes at the most! So take the time now to educate yourself and get to know YOUR body :)
Your shoulder is a ball-in-socket joint - picture it like a golfball on a tee. The golfball (humeral head) is bigger than the tee (glenoid fossa of the scapula). Because of this, your shoulder has LOTS of motion and mobility - more than any other joint of the body. But because of this, the shoulder can easily become unstable which can then lead to dislocations, rotator cuff/labral tears and impingement.
Back to the ball-in-socket model:
The rotator cuff consists of 4 muscles (subscapularis, supraspinatus, infraspintus & teres minor) that, when working properly, assist with centering the ball on the socket. This prevents the bad stuff from happening as discussed in the previous paragraph.
When the rotator cuff isn't working properly (this can be due to a number of reasons) then it will have difficulty centering the ball in the socket which can then lead to pain - typically by upward migration of the ball (humeral head) that hits the acromion process which causes pinching (impingement) of the muscles. When these muscles are pinched, they tend to get inflamed and are inhibited. That leads to muscles imbalances and even more pain.
See why this cycle is so nasty??
Now that you know a little more about the anatomy of the shoulder, let's move on to treatment!
A great exercise for opening up the mid-back is laying vertically on a foam roller. Make sure your tailbone and head are resting on the roller. Then bring your arms by your side to get an added stretch on the pectorals.
Perform this stretch for 5-10 minutes after work and/or before your workouts.
If this is too much of a stretch, start with a towel roll. Get a regular sided towel from home and roll it up vertically then perform this same technique.
# 3 Shoulder Mobility
It's very important that you address thoracic mobility BEFORE shoulder mobility. You can do as many shoulder mobility and flexibility exercises as you like but if you have poor posture and your thoracic spine is restricted it will be impossible to have full shoulder mobility - unless you compensate elsewhere, such as the low back or if you're have significant ligamentous laxity.
Since you've addressed your thoracic spine already (follow @missphysiofit for more thoracic spine mobility exercises), now let's move to shoulder mobility.
My favorite exercise is repeated shoulder extensions. We typically spend a lot of time in a neutral shoulder position or shoulder flexion (such as reaching forward or overhead) but we rarely spend time in shoulder extension (as pictured).
One way to restore shoulder mobility is by working in the opposite direction that you typically stay or work in.
Take a golf club, broom or yard stick and perform the exercise as pictured. Perform 20 reps with 5 sec hold. Make sure you're standing up tall. Don't allow yourself to lean forward to performing this exercise.
# 4 Shoulder Flexibility
However, in the therapy world Mobility refers to motion within the joint. If a joint is hypomobile then it's stiff and restricted. If a joint is hypermobile then it's loosy goosy. Flexibility refers to the length of the muscles surrounding the joint. For example, tight hamstrings is a flexibility issue, restricted hip capsule is a mobility issue.
Flexibility = extra-articular restriction (muscle restriction outside the joint)
But since you've already address your thoracic and shoulder mobility.. let's move on to shoulder flexibility exercises. The #1 culprit(s) I see primarily involved in restricted overhead motion is the Latissimus Dorsi (AKA the Lats) and Teres Major.
When there is pain at the shoulder, both muscle groups tighten up as a protective mechanism. However, if the issue at the shoulder isn't addressed quickly, then they can cause further problems.
The Lat is a powerful and broad muscle group that span from the shoulder to the pelvis. It's a powerful extender of the shoulder as well as adducts and internally rotates (IR) the arm (adducts = brings it in toward the body, IR = rotating the arm inward). The teres major is a small muscle that attaches to the blade and the "ball" part of the shoulder, it also adducts and IR the shoulder.
My favorite exercise to restore flexibility of the lats and teres is to foam roll them (see above video). Now this doesn't restore flexibility permanently, nor does it "break up scar tissue". However, it can temporarily restore some muscle length so that you can do the strength and stability exercises in the next section. Once strength/stability is restored to the shoulder joint then the flexibility issues are usually no longer a problem. As stated previously, the muscles get tight and restricted to compensate for the lack of stability.. restore the stability issues and the muscles will naturally elongate over time.
Foam roll for no longer than 5 minutes. I usually foam roll each segment 20-30 second 1-2 times each before performing the strength/stability exercises.
# 5 Rotator Cuff/Scapular Stability
I see trainers do this all too often.. they start with the strength & stability aspect and then end with flexibility/mobility. However, they're missing out on key aspects into recovery which can cause further pain, injury and aberrant movement patterns.
If you attempt to strengthen a muscle crossing a joint that lacks mobility and/or flexibility or even an adjacent joint (such as the thoracic spine) then this WILL lead to further compensations due to the restrictions.
So please don't skip over the previous sections because they're boring or don't seem as effective. They are the bread and butter in restoring full shoulder motion and abolishing pain.
As far as strength & stability goes, you want to focus on the posterior rotator cuff (the muscles on the back of the shoulder) as well as the scapular stabilizers (the muscles that connect to the shoulder blades).
Please watch the video below for some of my favorite rotator cuff and scapular stabilization exercises.
I hope you've found this helpful! Do NOT perform these exercises if they cause you pain. Please seek further help from a local physical therapist or physician of your choosing.
I also offer Money-Back Guaranteed after 2-4 sessions if you're not completely satisfied with the results. I 100% believe in what I do. I have seen people's lives transformed by making minor modifications to their daily routine. You will be surprised what the body can overcome if you are able to address the real reason behind the pain.
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Dr. Katie Spruell, PT, DPT, CSCS
KS Fitness + Co, LLC
Dr. Katie Spruell, PT, DPT, CSCS
I am a licensed Physical Therapist and Certified Strength & Conditioning Specialist practicing in Nashville, TN. I started a small private practice - KS Fitness + Co, LLC - in April 2018.
My plan is to take Nashville by storm and challenge the current healthcare system! I believe Physical Therapists should be the first line of treatment because who better to treat you than a Musculoskeletal & Movement Specialist?! :)
I want to bridge the gap between Physical Therapy and Personal Training to achieve better outcomes, increase quality of life, and help others achieve their fitness goals!
I love God, food, beer and the fam bam (not in that order!).