So in part 1 and part 2 we looked at the structure and function of the shoulder, and then the way in which it moves, using pull and counter-pull of different muscles around the girdle. In this part, I’ll look at a couple of general reasons why people get shoulder pain (there just isn’t time or space to get too in-depth ) and how to avoid trouble.
So why do I have shoulder pain?
Quite commonly I will see clients who have a pain in their shoulder. The pain that they feel is generally not the place in which the shoulder has actually “gone wrong”. There will have been a number of issues, quite small in nature, which have progressed without getting better, and the shoulder has adapted itself as best it can to the new situation. Slowly, the problem has got worse, and muscles which aren’t meant to be doing a job are recruited because the correct muscles aren’t working, they all get tired, and start to hurt. After that, even more muscles begin to hurt, and all of a sudden you have a shoulder which, although it still moves, is painful in a number of places and positions, and is unable to be stretched out because so many of the muscles throughout its structure are being affected.
Interestingly, Shirley Sahrmann believes that “most patients with shoulder pain develop their condition as a result of movement impairments of the scapula – which then disrupts the relationship between the humerus and deltoid“. So it may not be that the point in the shoulder that hurts you is the origin of the pain. It is just as likely that the origin is somewhere in the shoulder-blade muscular complex, which then unbalances the shoulder and contributes to dysfunction, and, ultimately, pain.
It is fairly common to find a shoulder that hurts in a specific place because it is being squashed by another structure. That pain is often the secondary issue, and is masking the actual reason why the shoulder is being inefficient at that time. If there is pain underneath the shoulder where the humerus hits the underside of the clavicle, that might hurt, but the reason for it doing that is highly likely to be that one or more of the muscles attaching the shoulder-blade to the arm, either a rotator cuff muscle, or an accessory muscle is out of whack, and causing the imbalance, which then causes the pain.
When looking at shoulder problems, the whole thing needs to be looked at, not just the small area that is hurting most. That is the area least likely to be the cause of the pain.
How can I stop the pain?
The easiest way to stop the pain is not to be in the position of having pain in the first place – prehab. However, if you are reading this, it’s probably too late for that.
You may know a few exercises with a theraband, pulling in and out, that kind of thing. If you do these, try putting a towel in your armpit and squeezing that as you do the exercises. This will inhibit the deltoid (the major muscle of these actions) and will encourage the rotator cuff – the muscles that you really want to exercise – to strengthen and co-ordinate against the pull of the deltoid.
Wall slides and Prone slides are also good, make sure that you are actively engaging your muscles under the arms pulling downward and pushing back toward the wall as you move, encouraging them to work harder. Don’t be surprised if you feel knackered after only a few sets of 5 of these. Start slow, work up. It’s all about balance. If you tire these muscles out with too many sets, the net result will be that the shoulder ends up being too tired to work properly – and you end up with more imbalances. This is NOT the point of the exercise.
Little and often.
Note – this blog is not an exhaustive list of what could be wrong with your shoulders, it’s a brief look at generic rotator cuff issues. If in doubt, go and get a diagnosis or hypothesis from a sports doctor/physio /osteo/massage therapist.