Shoulder pain is one of the most common reasons for visiting your physio or GP and can be caused by a number of reasons. Some are caused by trauma or injury and others are a gradual build of symptoms over time. This post is written by Andrew Alexander, physiotherapist at Physio Connex Tuggerah (Central Coast), and is directed to those looking to prevent shoulder pain or the shoulder that isn’t getting better.
To understand the ways to improve shoulder pain, you have to know a little bit about what our shoulder is:
The shoulder is a ball and socket joint – but the thing to note is the size of the socket – IT’S SMALL. It isn’t held well together with bone and cartilage, instead relying on tendons to hold the ball in the socket. These four tendons are called the ROTATOR CUFF, and they play a huge role in how painful our shoulder can be.
The amount of force through these tendons is dictated by the ability of your shoulder blade to hold firmly onto the ribcage and move smoothly when the arm is raised. If the scapular muscles aren’t strong or ‘switching on’ at the right time, the rotator cuff can be forced to work harder and hence produce reasons for pain and dysfunction.
The control and ability of our muscles to work proficiently can also be influenced by our neck and thoracic spine plus the nerves that extend from those areas.
So how do we improve shoulder pain???
Improve spinal mobility
Using foam rollers, trigger point balls and stretch bands are great ways to improve your spinal mobility. The 2 key movements we need are upper back rotation and extension. Laying over a foam roller so the spine is extended is a great way to start, moving to more specific pressure on the muscles between the shoulder blades using a ball. Jobs that have repetitive movements, overhead shoulder tasks or office-type roles will naturally make you more stiff and tight through these areas. Having a stretching and mobility routine may be the key to improving shoulder function. We always prefer prescribing an individualised mobility program so do not hesitate to give us a call to make sure you are on the right track.
Build strength around the shoulder blades
The muscles that we need to work are the ones that hold the scapula down on the ribcage and assist its movement when lifting the arm up. The 2 best muscles to look out for are the lower trapezius and serratus anterior. They are the most common inhibited muscles with shoulder pain and can be tricky to turn on if you’ve had pain for a while. It is important to train these muscles in isolation but also relearn how to use them in more functional and complex movements in any push or pull motion. A very common pattern is overactivation of upper trapezius and latissimus dorsi. Our lats are generally big movers of the shoulder, they do not so much play a role in stability. A movement screening assessment is very helpful to identify these compensatory habits.
Strengthen your rotator cuff
Like any muscle and tendon, the stronger it gets, the better it can deal with load and the harder it is to injure. The problem most people have, is that they don’t add rotator cuff strengthening into their normal workouts. My advice: start easy, start light. Using light elastics or pulley resistance can be a great starting point. Going too hard, too early will only overload the muscles and pre-fatigue them before other shoulder exercises in your program. Once you have strengthened these muscles in isolation, they will become more helpful to you in bigger, more complex movements like overhead tasks.
As you can see, shoulder pain can be due to combination of issues – not just the shoulder joint itself. By paying attention to one, two or three of the above areas we typically see quick improvement. If there has been trauma or an accident associated with your pain, your treatment and exercises may be a little more complex. We recommend seeking advice from a physio to provide individual assessment and appropriate treatment.
Written by Andrew Alexander