3 Keys to not losing out on ew Year's resolutions due to shoulder pain

Shoulder pain can be one of the harder things to train through at the gym. Whether it is painful with overhead lifts, bench presses, or just holding a dumbbell, how the shoulder is provoked gives clues as to how to both heal it AND train around it while it is healing. While most people know about the rotator cuff, there are a bunch of structures that can contribute to shoulder pain. In fact,upwards of 80% of shoulder pain is the neck and upper back in disguise.  How you injured it is important as well. Did you just wake up with it, did you fall on it, did you feel something give way when you lifted something, or were you reaching for something in the back seat. Each one of those ways of injuring can attack different structures in your shoulder. In addition, women entering perimenopause and menopause have a higher likelihood of developing frozen shoulder (also called adhesive capsulitis). In this post, I’ll talk about what to look for to know where the pain is coming from. Understanding if it is a mobility(what your joint can do) versus a strength issue(how your muscles are controlling movement). Then in key number three, we’ll look at strategies at the gym or home to start healing it. 

First, let's cover what the shoulder is(and it is more than just the rotator cuff) and how it often gets injured. 

First, talking about the shoulder, it is actually a series of 4 joints. There’s a joint where your collarbone connects to your breastbone, a joint where your collarbone connects to the shoulder-blade(just above and to the inside of the shoulder joint itself), there’s the ball and socket joint where your arm meets the shoulder, and there’s how your shoulder blade interacts with your ribcage.  Issues(usually mobility) with any one of those joints means the other joints have to work harder in order to lift your arm overhead. 

This can cause 

Impingement or a pinch to the muscles and tendons in your shoulder as you’re raising your arm as they get pinched underneath the shelf of bone on top of your shoulder, 

Knots to your muscles as they are overworked and painful as they try to control your shoulder motion.

Stiffness to your shoulder where one side seems to sit more forward than the other. 

You just might be able to point to a spot on the front of your shoulder where the pain seems concentrated. 

Or your shoulder may pop and click in ways it didn’t do before(and you can’t figure out why). 

Key 1: How to know where your pain is coming from

How to know your neck or upper back might be involved

Is your shoulder pain worse after sitting for a while, after working on the computer, or have you been told your posture might be to blame for your shoulder? As a Doctor of Physiotherapy-I often hear this in my patients whose shoulder pain ends up being from their neck or upper back. 

Why?

First, the nerves for the shoulder come off the neck and pass under the muscles of the shoulder and often if the neck is irritated(even if it doesn’t currently hurt), this irritation can spread to the shoulder. The upper back, if it is too rounded forward, blocks lifting your arm overhead and it will often feel stiff or pinchy as you reach overhead. 

How to know if it might be frozen shoulder aka adhesive capsulitis

One of the big things to start to suspect that frozen shoulder might at the root is if my patient is a woman either in perimenopause or menopause and the pain is on one side, came out of nowhere, and most movements are painful all around the shoulder.  Also, people who are dealing with Diabetes are also at risk for frozen shoulder

Why?

One of the more recent discoveries is that there are hormone receptors specifically for estrogen on the shoulder capsule(and maybe some other joints as well), but as women start having the reduction in estrogen, it somehow provokes a pain/protective response in one shoulder(they’re still researching this, so check back for updates). In fact, a researcher and orthopedist at Duke on a recent podcast talked about HRT helping perimenopausal or menopausal women with frozen shoulder. If you are wondering if this is your problem, talk to your doctor about the possibility or contact us for local functional medicine physicians. 

How to know if your rotator cuff is involved

This one is a bit more tricky because when the shoulder hurts, everybody you talk to will tell you it is your rotator cuff(most of them are probably referring to the shoulder capsule but the cuff is the main structure they know about). Most of the people who are dealing with a rotator cuff injury injured it while reaching behind them to pick up something in the back seat of their car and will sometimes hear a pop in their shoulder with immediate loss of being able to lift their arm. There may or may not be a tear and if there is a tear, they come in a couple of varieties. There’s a PASTA tear(partial, joint sided) and a full tear of the supraspinatus tendon. While this sounds bad, torn rotator cuff tendons are found in up to 20% of people with no symptoms while tendonopathy(tendonitis) of the rotator cuff is in upwards of 89% of people with no symptoms. 

The good news is that this is not an immediate date with the surgeon and I’ve worked with people with supposed complete rotator cuff tears who were able to restore full mobility and strength without a tendon repair(as there is some built in redundancy in the shoulder). Take advantage of our free consultation(link at the bottom) to see if you can heal this naturally. 

Other causes(bursitis, tendinopathy, trigger points, labrum)

Often if you can point to the spot, and it is in the front of your shoulder but there wasn’t a specific event, tendinopathy or bursitis of the area is more likely and we typically treat this with some gentle hands on treatment combined with figuring out the right load and exercises to calm this spot down while building up your stabilization muscles which help protect the shoulder. 

If you notice tight tender spots between your shoulder blades or on top of your shoulders that are made worse by posture or moving your arms or sleeping awkwardly, trigger points(knots in the muscles) are more likely to blame. These often do really well with Dry Needling combined with some mobility exercises to treat root causes(usually in the neck). 

If you fell on your shoulder or it had impact with a fixed object or player pulling your arm back, your shoulder capsule or labrum may be more likely. This also something we can test at our free consultation(and if you need to see an orthopedist-we can recommend several that would be a good fit for you). 

Key 2: Understanding Provocation: Is it a Load issue?

Some people only have their shoulder pain when they lift a certain weight. Usually when we lift a load and get pain, we don’t explore the amount of weight that doesn’t provoke. Recently, I worked with somebody who only had their shoulder pain when they benched with greater than 60 pounds. Their goal was for muscle growth and anything less than that weight didn’t get them the growth or pump they were looking for. Recent research into muscle growth showed that you can get hypertrophy or growth at higher reps, upwards of 30 reps and a much smaller portion of your 1 rep max. People who have loading as their issue with their shoulder will also have a trigger point in the back of their shoulders and dealing with the trigger point first usually lets the person get back to their desired weight faster. 

Key 3: Don’t train your Rotator Cuff like your Pecs or Delts

Our rotator cuff’s role is in stabilization of the shoulder which means that it senses when the shoulder is out of the precise position and corrects. It doesn’t get better at this by doing three sets of 10. It does this by doing longer duration holds with the arm being held usually in an overhead position or rack position and it gets feedback from the nervous system to correct for errors(i.e. The arm isn’t pointing up at the ceiling). Bottoms up kettlebell carries, rack carries, and turkish get-ups are some of my preferred go to’s for dialing in the control of your rotator cuff. 

Confused about where to start? Book a call from the comfort of your home or office and  on your schedule with one of our Shoulder Pain Specialists. You can schedule your call here.  Need help now? Come by and talk with one of our Doctors of Physical Therapy at no charge. We offer FREE consultations, which give you the opportunity to come in and meet us and see for yourself how we can help you.

Here are just a few of the things you will learn in one of our free consultation:

• What is the underlying cause of your pain? (hopefully nothing too serious!)

• Roughly, how long will it take to fix the problem?

• What to do to help – which doesn’t include painkillers, resting or surgery etc.

• What other, natural, drug free methods are there to speed up recovery alongside treatment?

Our consultations are great for anyone that may be “unsure” if physio is right for them, and they give you the opportunity to ask questions and see for yourself if we can help you.

If you’d like one of our limited free consultation sessions, please click here to schedule your free consultation or CALL us on 850-765-2779 to make a no-obligation enquiry.

Dr. Brandon is the owner and a Physio at Body Mechanix Physiotherapy and Fitness. Four of his favorite people call him daddy while he's been married to his other favorite person for 23 years. He enjoys teaching martial arts and is a Mestrando in Capoeira while in the mornings, he can be found working out with the guys in F3 around town.  He's the author of 4 pain relief guides for sciatica, low back, shoulder, and knees and the lead contributor to the Active Tallahassee Blog.