Do you suffer from shoulder pain?
Does something as simple as lifting the kettle make you cry out in pain?
Do you feel scared of lifting your arms?
Do you feel like your shoulders and neck are always tight?
This blog post aims to explain to you why you might be getting your shoulder pain and how we can relieve your pain NOW, but also keep it away for good! Shoulder pain is extremely common… In fact, as much as 20% of the population can be suffering from shoulder pain (Pribicevic, 2012). That’s 1 in 5 people!
Now the prevalence and especially severity of shoulder pain can have profound economic impacts for the individual and their families (Pribicevic, 2012). This is influenced by a host of factors, including:
- History of shoulder pain
- Your occupation / work
- Psychological factors
Diagnosis of shoulder pain
Unfortunately, a rigorous diagnosis cannot be made from the comfort of our own home. However, the good news is that many of these issues have one thing in common – that is they don’t actually matter a whole lot. In fact, the research shows us that many asymptomatic (no pain) individuals have these diagnoses on perfectly healthy and non-painful shoulders.
A quick google search of shoulder pain may lead you to finding the following terms:
- Tendinitis / tendinopathy
- Rotator cuff tears
- Shoulder impingement syndrome
The pathological terms such as bursitis or shoulder impingement syndrome have been contested by a plethora of research. The majority of which is written by Jeremy Lewis, a renowned shoulder specialist in physiotherapy management of shoulder pain. Essentially, shoulder pain should not be necessitated by complicated terms and biomechanical principles. Instead, should focus on simpler subject matters like load tolerance, daily activity and strength of the muscles in the shoulder.
But my doctor told me I needed an injection…
More relevant perhaps, is the increasingly common shoulder procedures recommended by “shoulder specialists” and doctors. These include subacromial decompressions, rotator cuff repairs and corticosteroid injections to resolve shoulder bursitis. Let’s do a quick 13 reasons why compressed into 3 reasons as to why it’s not relevant:
- Subacromial decompression: The relevance of the acromion (You may have heard of acromion types) to rotator cuff pathology of pain is not well supported by research.
- Rotator cuff repairs: Over 50% of people over the age of 60 without shoulder symptoms had a partial or full thickness rotator cuff tear
- Bursitis: 96% of men who did not have shoulder symptoms, had abnormalities including subacromial bursal thickening, supraspinatus tendinosis and tears and glenoid labral abnormalities.
Data from Lewis (2016)
So now that we know that the diagnosis is not necessarily important for the shoulder when considering shoulder pain, what should we do then?
Outlining the six-step process
1. Short term: Immediate pain relief
Some of the following immediate pain relief strategies seem very basic, and common sense. These short term pain relief strategies include:
- Over the counter (OTC) pain relief (*DISCLAIMER: I am not a doctor, and am in no way recommending you to go get pain relief. Instead, a consultation with your doctor should be made prior to buying any pain relief, especially if you are taking any other medication).
- Heat therapy, such as: a heat pack, a hot shower or hot bath
- Cold therapy, such as: a ice bath, cold pack or cold shower
- Avoiding provocative movements / finding comfortable resting positions
The reason why I don’t have any specific recommendations between ice and heat, is because the effects of both are usually due to preference of the individual. Some do not tolerate ice packs and some do not enjoy the feeling of heat on their shoulders. However, the general precaution is heat should not be applied in the first 72 hours post injury. This is even more important if there is obvious swelling or inflammation around the area, in which case the heat could make the swelling worse.
The other precaution is: avoiding provocative movements. The first and most important rule is do not avoid all movement. This may seem counter intuitive to some, but is especially important for recovery of all injury. That is because avoidance of movements can have profound effects on your recovery, and also your mental and psychological health. This does not just pertain to the shoulder joint, but to all joints and pain. When considering pain, we must consider the impact of a host of other factors, including psychological and social factors. This is called the “Biopsychosocial Model”, which I have mentioned in a separate post.
2. Short term: Self-Massage
Trigger point or self-massage is fantastic for short term pain relief and increasing function in the short term. Usually with any pain, there’s an associated tightness of muscle in and around the affected joint or area. A release of this muscle can provide temporary relief that lasts anywhere from a few minutes, up to a few days. The easiest way to massage is to find a tennis ball, baseball or anything that can help massage your shoulder and then push it into the back of your shoulder blade area:
Massage can be administered for 3 – 5 minutes, or until tolerated. Be aware that massaging for too long or too hard may lead to bruising or increased soreness around the area.
Self-massage or trigger points of these muscles can make your joint feel much ‘looser’ and provide good pain relief. However, massage does not inherently make your shoulder stronger, more flexible, increase durability or provide any long-term benefits; many times the shoulder pain will return after a short time. Therefore, we recommend self-massage in conjunction with the next few steps described.
3. Medium term: Stretching
Stretching of tight muscles around the area may help with additional pain relief. However, similar to the self-massage, stretching only provides moderate short term relief and benefits, and usually your shoulder pain may return once the stretching has ceased or you return to activity.
Shoulder stretches include:
- Posterior capsule stretch
- Pec stretch
- Overhead stretch
Each stretch should be held for 15 – 30 seconds and should not be pushed into painful areas. Repeat throughout the day as needed or tolerated.
4. Medium term: Movement modification
Shoulder position while sitting is… important, but at the same time it isn’t. Think of standing in cue for a long period of time – some of us can stand completely still without moving, but most of us need to shift our weight, move side to side, slouch to one side and then the other. That’s a completely normal process of our body, that allows us to have freedom of movement and essentially allows us to keep our joints moving.
The same concept applies to your shoulder joints – there is no perfect position at a desk or workplace to “set” your shoulders. Anyone who tells you to sit in one position for hours at a time likely doesn’t listen to their own advice. Instead, posture and sitting position is a RANGE. Movement within that range is important, as it allows for your joints, muscles, ligaments and bones to move. As long as you provide some constant movement, you will find that your shoulder pain will ease quite quickly. That being said, there are some modifications that may feel beneficial to your shoulders while they are sore and painful.
4a) Desk position
The ideal posture… Forearms on desk, feet firmly planted on the ground, shoulders upright. This seems to be the quote-on-quote, best posture for many individuals.
However, these postures are also absolutely fine and will not cause your shoulders to suddenly break down.
Understandably, when you’re deep in the middle of a project and you’re not paying attention to body position it becomes easy to forget. Fret not! Just keep moving again and using your shoulder joints and you will feel your shoulder start to relax and relieve itself.
4b) Normal shoulder movement
The common issue that many individuals have – whether it’s natural or learned – is depressing their shoulder blade down when lifting the arms up.
Understandably, many were taught at a young age that good posture meant chest out, shoulders down even when reaching up and out rather than shrugging shoulders. However, this is not exactly a natural movement pattern and isn’t something that our bodies are designed for.
Our scapula’s don’t actually have a anatomical attachment to the back of your ribcage. This allows for a large degree of freedom of movement and is what our shoulders are designed for. So instead of keeping our scapula depressed, we should actively engage in their elevation and movement upward as we also move our arms upwards.
5. Long term: Strengthening your shoulder
Strengthening of your shoulder can also occur in two parts. Namely:
- Isolated strengthening of the rotator cuff
- General upper body strengthening
The rotator cuff is as the name suggests, muscles that help rotate the shoulder. The primary ones that we focus on are your external rotators, called the supraspinatus, infraspinatus and teres minor. These muscles can be trained through isolated exercises such as:
Rotator cuff specific exercises:
- Sidelying external rotation exercise
- Sitting external rotation exercise
Please, please, please do not do external rotations in a standing position. Gravity works downwards, and if you do rotations in a standing position, you do nothing to work your rotators as they have no resistance to push again. This is why the exercises are so specific, in order to correctly target the rotators in a movement plane that is challenging.
If you want to do these in a standing position, a cable external rotation is a suitable alternative.
General upper body exercises
These exercises are as they suggest. Performing your normal gym or exercise routine that involves upper body strengthening. As all exercises that involve pushing, pulling involve the rotator cuff to some extent, these exercises are all beneficial in improving the strength and functionality of your shoulder.
If you are still having ongoing pain during certain exercises like the shoulder press or bench press, you can try decreased ranges or pauses at different points. For example:
- Shoulder press
- Single arm variations using dumbbells
- Slow controlled reps
- Bench press
- Top half with pause
- Bottom half off the rack
- Decreased weight
Long story short, there is no “Best Exercise” for strengthening the rotator cuff, as any upper body strengthening is beneficial in providing stimulus to the muscles.
However, the topics of load management, form and posture will need to be left to another blog post… Otherwise this one will become an essay!
6. Long term: Have no fear!
Pain relief is fantastic, as it will allow you to feel psychologically and mentally better as well as allow you to do more things physically. Unfortunately, if we only focus on getting rid of our pain every time and not trying to create a long-term solution… This is where you start to get frustrated and angry because it just won’t go away.
Many times, we may be able to get temporary relief from massage, dry needling or any other fancy types of pain modulation. However, if we don’t fix the underlying problem, or the cause that may be exacerbating or worsening your shoulder pain, then it is likely to just return time and time again.
Luckily for you, shoulder pain can be fixed, we just need to make sure we are on the right direction and pathway to create a situation that will allow it to fix. However, in order to do this, we must consider the solution from multiple directions and not just pain relief.
Fundamentally, shoulder pain is generally not a concern unless you have the following symptoms:
- Severe pins and needles down the arms and into the fingers
- Heaviness, throbbing, “feels cold”
- Significant loss of strength and ability to grasp or lift objects
- If you have had a traumatic event prior to the pain starting
If any of these signs and symptoms describe your situation, a urgent consultation with your local health practitioner is recommended to identify if you need further referral to the Emergency Department or investigations.
Shoulder pain can be fixed. All it takes is proper management, understanding the right steps and creating a plan to address it. Hopefully through this blog post you’ve learned the six steps to creating pain free shoulders:
- Pain relief
- Movement Modification
- Have no fear! (Education)
You’ve also learnt that many of the diagnosis such as bursitis, impingement and rotator cuff tears are not relevant to your outcomes! This has been one of our most comprehensive guides to date for any joint, so I hope you’ve enjoyed the read!
Leave us a comment or share this post with some of your family or friends!
- Lewis, J. (2016). Rotator cuff related shoulder pain: Assessment, management and uncertainties. Manual Therapy, 23, 57 – 68.
- Pribicevic, M. (2012). The epidemiology of shoulder pain: A narrative review of the literature. In Pain in perspective. IntechOpen.