Ever have pain in your shoulder when lifting overhead? Shoulder pain with sleeping? Shoulder pain limiting your workouts? Not sure if your shoulder pain is actually a problem or something that is just going to go away on its own?
Shoulder pain generally starts out as pain that comes and goes. It may start with pain with lifting overhead but not every time. Then the pain increases either in intensity or in frequency. So maybe it hurts everyday now instead of every other day. Or maybe you can’t reach completely overhead anymore and you have use your other arm to reach high overhead. This increase in intensity or frequency can occur over a few months, weeks or years.
Then people go to the doctor and a lot of shoulder pain doesn’t show up on X-ray or MRI. Most people will be told arthritis or some inflammation, given some medication or an injection and sent on their way.
The rotator cuff is often involved in causing some shoulder pain and what most people focus on when they think of shoulder pain. The rotator cuff which is four muscles that are in your shoulder and some are more likely to tear. And unfortunately this is the first thing that people think of when they have shoulder pain. So they will often avoid getting help because they think rotator cuff tear = surgery instead of thinking that by treating their shoulder when they first start feeling pain will actually allow them to avoid a rotator cuff tear and avoid surgery.
Most shoulder pain is not a rotator cuff tear. And most cuff tears if they are caught early enough are fixable without surgery. Most doctors won’t operate on small tears and physical therapy has been proven to restore the normal function of the shoulder without pain even with a small tear.
Or it could be a rotator cuff issue without being a tear. It could be a rotator cuff tendinitis, which is an inflammation of the rotator cuff. But if the inflammation is left untreated it could lead to a rotator cuff tear.
But how? How does inflammation and ignoring the pain eventually cause the rotator cuff tear?
One of the big things that we see with shoulder pain is compensation. Inflammation, rotator cuff tears, bursitis, tendinitis – they all go hand with compensation.
What is compensation?
It is when you move your shoulder differently, shrug your shoulders, change how you use your shoulder in some way that creates knots in the muscle. These knots cause pain and then pain gets worse over time.
The worst part about compensation is that you don’t even know you are doing it. Your body is designed to protect itself. You will learn different ways to move your shoulder so it won’t hurt. This different movement is small but does create knots and pain in the muscles.
This is why the pain comes and goes. The knots are worse somedays and the pain is greater and sometimes they are relaxed and the shoulder hurts less. Eventually they get to a point where they do not relax and the pain becomes constant.
But how does it get inflamed in the first place?
While there are many factors that feed into inflammation one of the biggest causes of inflammation is posture.
Most of the time people are slumped in front of their keyboard or smart phones. When you are slumped over you wind up closing off your shoulders and actually pinching one of your rotator cuff muscles. You can watch the video below to get a better understanding of what that looks like and where that occurs.
When you roll your shoulders up back and drop them down there’s a nice space in between the top of your shoulder and your humerus (arm bone). This will open up the space for the muscle to move and not be pinched in between the 2 bones.
When you pinch this muscle, you can cause inflammation or impingement. So when you lift overhead you close the space and cause the muscle to be pinched. Eventually the muscle becomes so inflamed that it fills the entire space so it doesn’t matter if you are sitting in correct posture or not and you get the pain not only when you are moving it but also when you are not using it.
How do you know if you are closing the space besides watching your posture?
One of the things you can do right now is just roll your shoulders up back and drop them down or just try and push your shoulders down.
If you find your shoulders drop down, you are in a compensatory pattern. You’re in a pattern you probably didn’t even realize. You most likely didn’t realize you shoulders were up elevated into your ears. This compensation pattern is going to cause you shoulder pain.
Why don’t injections work?
Many people with shoulder pain get injections to help with the pain. While the injection will stop the pain sometimes, it won’t cure the problem. That is why people always need another injection eventually.
After awhile the injections won’t work, they won’t even help with the pain and by that then the amount of time and money you will need to invest to fix that problem has gone up exponentialy.
So what can you do if your shoulder hurts to solve the problem and not just put a band aid on it? Watch the video below to see the top 3 shoulder exercises.
If you want a doctor of physical therapy to provide you with a free consultation and you live in Bucks or Montgomery County Pennsylvania, then click here and someone will be in touch with you to determine the exact cause of your shoulder pain.