Is it just me or does everyone around the Essendon/Pascoe Vale area suffer with some type of shoulder pain?! It is reported that approximately two-thirds of the general population will experience some kind of shoulder pain in their lifetime.1But what does this mean? Shoulder pain comes in so many different shapes and sizes because it is such a big area comprised of many different joints. You may have heard some of these; glenohumeral (GH), acromioclavicular (AC), sternoclavicular (SC) and scapulothoracic. You don’t necessarily need to know anything about them, but they are important in understanding why your shoulder pain is there.
Let’s just get some buzzwords out of the way first:
- Trap tension
- Carrying your stress
- You need to stretch out your chest
All phrases that you have probably used as a crutch to explain your pain, and whilst they might be true to one extent or another, they are not nearly specific enough to warrant being used. Just like anything in life if you don’t aim at something you won’t hit it, and this is the case here.
Personally, I break chronic shoulder pain up into two categories that frequently overlap. Shoulder pain derived from the neck, and subacromial shoulder pain (again, not exhaustive, but just two common varieties that I see).
Where they overlap is in the love of the shoulder to drop forward and up. This is because your body is actually quite smart (who’d have thought?) and knows that your neck is very important. So, imagine someone trying to tickle your neck, what does your shoulder do? Go up and forward! What muscles get activated a lot in that motion, levator scapulae, rhomboids and yes, our friend traps (Fun fact, traps actually rotate the shoulder blade up more than they directly lift it) So, what is it in the neck it’s trying to protect? Well this blog is not nearly long enough to go through that. (Those who have seen me know I can waffle on forever about this stuff, also, as seen by the amount of annotative brackets I have). But that is something we’d need to assess in house, to find the right target of which to aim at.
Subacromial pain usually starts with bursitis, leading into tearing on one of the rotator cuff tendons (supraspinatus) which may also involve biceps tendon inflammation.2 This is much more nasty than the neck derived shoulder pain, as it sounds. But inevitably comes from the shoulder dropping forward and up, as that narrows the subacromial space where these structures lie.
Now, let’s get into the interesting bit, what to do and what not to do. I’m mostly going to talk about exercises, as that is likely causing some of this pain and is completely in your control. You can often get a good result, relatively easily, if you just clear the bad and add in the good! Whether you do your own gym routine, see a PT, do F45 or pump classes, I’m sure you’re doing some of these (check out our Instagram for pics).
What not to do:
- Upright rows
- Banded shoulder internal rotation
- Heavy pressing motions
- Behind the neck press/pull
These all involve INTERNAL ROTATION on the GH joint, which is the narrowing on the aforementioned subacromial space. Think of these as major no no’s, there are very few reasons to do these, perhaps except bodybuilding/powerlifting.
So, what can you do? Pretty much the exact opposite. You want to EXTERNALLY ROTATE the shoulder, without lifting up the shoulder blade too much, therefore opening up the subacromial space and not irritating its structures.
This includes (again, check Instagram):
- Bent over row (under grip)
- Reverse grip Lat pull down
- Banded external rotation work (preferably with slight abduction)
Now all of this is in reference to more chronic shoulder pain, I specifically haven’t touched on acute/traumatic shoulder injuries because that’s a whole different kettle of fish!
Other rehabilitative techniques include
- Heat/Ice
- Oral/gel anti-inflammatories (improves pain, but not function)3
- Avoiding aggravating movements
- And of course, manual treatment!
Shoulder issues are generally extremely complex, this is a guide to help you understand a bit more about it but there are so many variables involved it is impossible to write all the information about it and keep your eyeballs on it. So it is absolutely imperative to get it assessed and or treated to know what to specifically do for your presentation. Thanks for reading!
Dr. Kieran Benton (Osteopath)
