Why does my shoulder hurt?

Why does my shoulder hurt?
(and what can I do about it?)

shoulder-pain

Shoulder pain is a common complaint for numerous athletes, ‘weekend warriors’, and gym users, and it’s often left either poorly treated (rest, painkillers, and/or cortisone shots) or only partially treated through incorrect exercises or an inadequate variety of exercises.  If you’re currently experiencing shoulder pain (or you want to prevent it in the future) then it’s time to figure out what’s wrong and get some treatment.

The shoulder complex is made up of the glenohumeral, scapulothoracic, acromioclavicular, and sternoclavicular joints, and is one of the most vulnerable areas in the body due to the extensive range of motion it has available. During full body movements, forces produced in the lower extremities, hips, and trunk are transmitted through the shoulder complex to the the arms and hands. If the shoulder complex is unstable, immobile, or otherwise dysfunctional it will be unable to cope with the load placed upon it, exposing you to injury.

Joints of the Shoulder Complex

Joints of the Shoulder Complex

The main region for most shoulder injuries is below the acromion process, and generally involves tendons of the rotator cuff muscles and biceps being impinged/’squished’ between bony structures. This is known as subacromial impingement syndrome.

Acromion Process

Acromion Process

Having healthy shoulders (without subacromial impingement) depends on a number of factors, including rotator cuff strength, appropriate ratio of pushing to pulling exercises, adequate warm ups, good exercise technique, and (perhaps most importantly) good posture. Ensuring good posture (consisting of optimal shoulder and thoracic spine [upper back] position) gives the scapula (shoulder blade) a stable base and enhances its ability to move freely on the rib cage, allowing full mobility.

Poor Thoracic Posture

Poor Thoracic Posture

During movement of the upper extremity, the scapula and humerus (upper arm bone) move in tandem to allow full motion (known as scapulohumeral rhythm). As previously mentioned, if either the scapula or humerus (and associated joints) are unstable or immobile then injury can, and probably will, eventually occur.


So how do we prevent shoulder pain from occurring?
Optimizing posture is key – reducing thoracic kyphosis (hunchback) and forward shoulders will allow proper biomechanics of the shoulder. The following drills and exercises will help improve these elements.
  • Thoracic extensions over the foam roller
    tspine-1  tspine2
  • SMR Lats
    lat-smr
  • Lat Stretch
    lat-stretch
  • SMR (LAX ball) Pecs
    pec-smr
  • Pec Stretch
    pec-stretch

Another possible cause is a weakness of the serratus anterior – this is the muscle that holds your scapula/shoulder blade to your rib cage. If it is weak then ‘scapula winging’ can occur, which obviously puts the scapula into a suboptimal position.

  • Scap Push Ups
    scap-push-up-1  scap-push-up-2
  • Cable bear hug
    bear-hug-1  bear-hug-2

Ensuring your rotator cuff muscles are strong and healthy is also essential, as these act as dynamic stabilizers of the shoulder (holding the humerus in the correct place during motion).

  • External rotations (never perform these to failure)
    ext-rot-1  ext-rot-2
  • Bottoms up kettlebell presses
    bottom-up-kb-1  bottoms-up-kb2

Having an appropriate ratio of pushing to pulling exercises will also balance out the musculature on the front and back of your shoulders – excessive mirror muscle exercises (bench presses, curls, shoulder presses) will cause shortness and imbalances in anterior (front) muscles (a syndrome known as upper crossed).

  • Try and have a 2:1 ratio of pulling to pushing exercises, so more rows and vertical pulling!

Warming up adequately will prevent injury by increasing the temperature (and therefore extensibility) of your muscles, and will increase mobility at the joints required for exercise.

  •  A 10 minute jog on the treadmill is not an appropriate warm up prior to lifting. Performing a well thought out warm up routine that includes mobility and activation drills for all the joints and muscles associated with the workout is the best option. Raise (heart rate and temperature) – Activate (muscles) – Mobilize (joints).

Finally, good exercise technique is imperative. Find a qualified strength and conditioning coach to go through correct exercise technique with you, particularly for barbell, kettlebell, and dumbbell exercises (such as the bench press).

bench-bad-elbows

Incorrect shoulder/elbow position in the Bench Press. Elbows are flaring, placing the shoulder in a compromised position and prevent retraction of the scapula.

bench-good-elbows

Correct shoulder/elbow position for the Bench Press – elbows are tucked.

bench-retract

Scapula retraction for the Bench Press. Shoulder blades should be squeezed together throughout the whole movement, lift the chest up high, and attempt to ‘snap’ the bar in half by trying to turn the thumbs upwards.


*Remember to always consult a physician (or a physical therapist) if you’re experiencing pain, and prior to beginning a new exercise/treatment regime. Your shoulder pain may not be due to the reasons mentioned in this post, so get it checked out first!* 

References

Does a low load assessment of scapular kinematics predict performance at greater loads?

https://www.shoulderdoc.co.uk/section/9

http://ericcressey.com/shoulder-hurts-start-here

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About scotthobbsstrength

Scott Hobbs - Strength and Conditioning Coach Scott graduated from St Marys University, London (UK) in 2014 with a B.Sc (Hons.) in Strength and Conditioning Science (First Class) and has almost completed his masters degree (M.Sc) in Sports Rehabilitation. He is a Registered Strength and Conditioning Coach (RSCC) and Certified Strength and Conditioning Specialist (CSCS) through the National Strength and Conditioning Association, a Level 1 British Weightlifting Coach, a Level 1 USA Track and Field Coach, and a certified personal trainer. With over seven years experience in the strength and conditioning field (and more than ten in the fitness/health industry), Scott has worked with amateur/club level to elite national and international athletes in sports including rowing, football, rugby, powerlifting, sprint hurdling, weightlifting, lacrosse, and tennis (amongst others). Scott currently works as an assistant strength and conditioning coach at the United States Military Academy (West Point) where he works with Army Football, Men's Rugby, Men's and Women's Tennis, and Women's Basketball. He also runs the analytics program for football and basketball, which includes GPS and readiness monitoring. Prior to West Point, he gained experience in D1 athletics at the University of Pennsylvania and Lehigh University. Before leaving the U.K. he was graduate assistant lecturer at St Mary's University where he taught undergraduate students on the Strength and Conditioning Science degree program. Other previous experience includes work with athletes at DeSales University, London Irish Professional Rugby Club, St Mary's University, and London Rowing Club. In his spare time, Scott actively competes in strength-based sports, having won a national competition in the UK and won two state meets (setting a state record in New York) in powerlifting. He also enjoys outdoor and combat-based sports. Scott currently lives with his wife, Anna, in Highland Falls, NY (USA).

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