There are many factors that contribute to an individual’s shoulder pain; some of which include age, activity, comorbidities, preexisting shoulder conditions or injury.
One of the most common causes and the most modifiable risk is postural overload. This is typically seen on desk workers or those with manual intensive occupations. A combination of muscle imbalances between the front and back of our postural girdle can lead to reduced range of motion and compression of certain structures, leading to our experience of shoulder pain.
Another cause can be due to the breakdown of cartilage within our shoulder joint, otherwise known as osteoarthritis. This is usually seen within the older population as it is a degenerative disease marked by aging cartilage.
Similarly, rheumatoid arthritis can also affect joints like the shoulder but instead is primarily an autoimmune condition. This is where the body attacks itself, interpreting the lining around our joints as a threat and eventually wearing it down. Consequently, this causes pain, fluid build up, stiffness and inflammation.
A less common cause is compression of a cervical spine nerve root which is a nerve in the neck. This is typically experienced as numbness or pins and needles past the bony tip of the shoulder known as the acromion and can travel all the way down to the fingers. Adjunctly, the general tight musculature following a nerve root impingement can also add to the experience of shoulder pain.
Lastly, frozen shoulder or adhesive capsulitis is due to inflammation and scarring of the capsule that surrounds the normal shoulder joint. Any damage may result in a frozen shoulder due to the accumulation of scar tissue in the shoulder capsule. It is marked by a significant reduction in joint range of motion.
Of the aforementioned causes of shoulder pain, all of which can benefit from regular physiotherapy to manage acute symptoms and prolong functional use of the upper limb with long term results.
Why Does My Shoulder Hurt When I Lift My Arm?
Overhead lifting and repetitive overhead tasks are common functional limitations experienced by those living with shoulder pain. Understanding the anatomy of the shoulder is crucial in understanding the underlying cause of these provocative movements.
As we can see above, the shoulder joint is made up of various structures. The bony structures include the arm bone (humerus) and shoulder blade (scapula). On the shoulder blade you can notice a bony prominence known as the acromion.
Beneath the acromion lies important structures, like the supraspinatus muscle tendon and the subacromial bursa (sack of fluid).
These structures can get pinched while we raise or lower our arms due to a number of risk factors;
- Postural overload
- Muscle weakness
- Shoulder instability
- Degenerative tendinopathy
This is known as subacromial impingement, denoting pinching of structures below the bony prominence at the tip of our shoulder known as the acromion.
What Does Shoulder Bursitis Feel Like?
To appreciate the painful response bursitis elicits, it is important to unpack the name and understand the anatomy.
A bursa is a small sac of fluid that acts as a cushion between the surfaces of a bone and soft tissue, reducing friction. Itis is a suffix that denotes a certain area or structure being inflamed. Thus, bursitis is simply inflammation of the bursa.
This can be caused by subacromial impingement, infection of trauma.
Shoulder bursitis varies between individuals due to the severity of the inflammation and length of time with the condition. It typically manifests as an excessive diffuse warmth around the shoulder joint. There is usually significant pain around the front and side of the shoulder with restricted joint range of motion especially with overhead movements. Lastly, the inflammation commonly causes night pain.
How Do I Get My Shoulder To Stop Hurting?
There are a number ways to help the shoulder pain from hurting, one of them simply is improving your overall posture and avoiding movements that aggravate the symptoms. Avoiding this will allow the shoulder to heal properly which will lead to a decrease in shoulder pain. Another factor is to maintain or learn good movement patterns for the shoulder joint and blade (Bollock et al, 2005). Having improved movement patterns will allow the ball and socket to move more freely with one another and cause less chance of impingement. A good assessment can help establish this and from there you can learn to move the shoulder joint correctly.
Simply avoiding or decreasing sedentary behaviour can assist the shoulder from hurting because it can help the shoulder from deconditioning. The longer we spend in a sedentary position the higher risk we are in having a rounded/stooped posture (Auvinen et al 2005). This will typically lead the postural muscles to become weaker and start to overload the chest and shoulders. Which increase the chance of impingement or bursitis as discussed above.
Doing some postural strengthening exercises is a big factor that should be taken into consideration for everyone because we spend most the day in a rounded or forward facing position. So it gives the postural muscles to become more deconditioned or weaker.
What Is The Best Exercise For Shoulder Pain?
“The Shoulder Big 3”
Thank you to the great Andrew Lock @Andrew_Lock_Strength for this great sequence.
This is vital in everyday life because most (if not all) of the activities we do are forward facing, i.e typing, sitting, cooking, welding, bricklaying… you name it it’s pretty much there.
So What Does That Mean?
Our bodies overdevelop at the front and begin to roll forwards especially our shoulders which can lead to tightness in upper traps and neck. Therefore strengthening the upper back muscles become crucial in assisting with shoulder pain
There are 3 parts to this exercise and they need to be done in succession with one another to really get the full activation.
#1 – Prone Rear Fly or T
Repeat 25 times
#2 – Prone Arm Raise (Palms Facing Up)
Repeat 15-25 times
#3 – Prone Arm Raise (Palms Facing Down)
Repeat 10-25 times
After completing the 3rd exercise, I would encourage repeating them all again
For more information please check out Aarvi’s blog post on the shoulder big 3.
Hope this blog post can give you an idea on how shoulder pain can arise and what are certain things to watch out for or include to prevent any further shoulder pain
The most important thing to do is to have the pain properly assessed because it can assist in establishing why the shoulder pain is occuring
Correcting poor postures and addressing stress can also be vital in fixing this very painful and persistent injury.
Special exercises prescribed by your Physio are often required to alleviate the pain and prevent a recurrence.
ProPhysio+ are trained and experienced in the treatment of shoulder pain and will work closely with yourself to overcome this painful area