Shoulder pain?
Shoulder Pain?
After 15 years of personal training, it is my experience that complaints of shoulder pain is in a close race with knee pain as the second most commonly injured or painful area on the body, second to lower back. There can be many causes, but most are often overlooked. People are usually diagnosed with rotator cuff tendinitis or an impingement, sent off to the physical therapist where they will be given a list of exercises aimed directly at strengthening and stretching the rotator cuff muscles. Even though these exercises will be helpful, often times they are not addressing what caused the problem in the first place. In the instance of an acute injury where the treatment was either rest or surgery, these exercises may be very helpful, but for the chronic shoulder pain sufferer they are usually just a short term fix. People will tend to rest the injured area and perform their exercises while they are in physical therapy, start feeling better, and then get back to their normal routine only to have the shoulder start hurting again. If this is the case then you can bet your money the cause of the problem was not addressed.
Frequently the site of pain is usually not the problem area. It may be the painful area, the area that is being most affected, but it is not the problem area. It’s important to realize that your body is an amazing machine that will do what it needs to in order to get the job done. If something isn’t functioning properly, it will recruit another part to help get the desired effect. This is especially true in people who are very athletic and skilled. For example if your knee starts hurting, and you didn’t have any acute injury (stepping in a hole, missing a stair, etc), the problem area could be your ankle or your hip. Always look at the joints above or below an injured joint. Look at muscles around a painful muscle. If your hip or ankle is not functioning properly, your knee will usually take the brunt by being forced through a motion it wasn’t really designed to go through. It’s often said your knee is a slave to your hip.
Muscles never work individually, there are always many muscles working together when you perform an exercise. Some muscles work as prime movers, some are synergists, and some are fixators. A muscle can be a prime mover during one movement, and a synergist or a fixator during another movement. Prime movers are just that, they end up being the prime source of force for moving the body parts involved. Synergists are muscles that will help along with the movement, provide some force, but are also responsible for providing some control and direction of that force produced by the prime mover to keep the joint moving correctly. They assist the prime mover. If they end up hurting, it’s probably because you’re using them as prime movers to compensate for a compromised prime mover. They don’t like that, they will start to get angry and hurt. They’re essentially helpers. Muscles can also act as a fixator which means they will essentially prevent motion or lock a joint in place so the joint next to it can do its job better. Think of your wrists when you do an arm curl. If your forearm muscles didn’t lock your wrist when you go to curl, your wrist would just buckle. Your back, shoulder, and leg muscles would also act as fixators during an arm curl so you didn’t fall over.
It’s important to understand this because how you move affects which muscles are used. Often times, if you have pain in either a joint or muscle, or both, it’s because it is either doing more than it should, because something else isn’t doing its job, or it’s working in a way it wasn’t designed to work. Why isn’t it doing its job? There are a few reasons. Most often is has to do with how someone is moving. If you move incorrectly, you use your muscles incorrectly and they respond by becoming either short or long over time, thus weaken. This may cause you to use muscles as prime movers instead of synergists. How you move (or don’t move) is often affected by daily activities, or repetitive motions. Sitting at a computer all day will affect your posture, which will affect muscles. Some will get short, some will get long, and in both instances they will become weak because they are not at there ideal length-tension relationship. Take the above example, sitting at a computer; your muscles in the front of your body, your chest, stomach, hip flexors will tend to shorten along with your hamstrings. Your muscles on the back side, your lats, rhomboids, traps, glutes, and spinal muscles will lengthen, and become weaker. Think of a dried out overstretched rubber band, it has no recoil. Same idea. Think of a rubber band that is not stretched. If it’s not stretched it’s not going to snap back. Same thing with shortened or tight muscles. They may be tight but it doesn’t mean they are producing force like they should be. Now this person who is tighter in front and loose in back may start having shoulder pain. Is the root of the problem with the shoulder joint? Probably not. Tighten up the back muscles, loosen up the front muscle, work on your posture, and this will help realign things. Put the shoulder in a more optimal position for it to function correctly and magically the pain will start to subside. Now very often these things go on for a very long time and since the joint was used incorrectly for a very long time it may end up degrading the joint surface, roughing or tearing up cartilage, fraying tendons, irritating bursa, etc…now you do have a shoulder problem but you can still relieve much of the stress by correcting your mechanics. Surgery isn’t always the only or best option.
Here are 2 common causes of shoulder pain;
1) Rounded upper back or kyphosis- when your upper back curvature is greater than normal it may cause tightness in some areas, looseness in others. Tightness may be in your shoulder muscles, chest muscles, neck muscles, and in your joint capsule, and weakness in you upper back muscles. It prevents your shoulder blades from moving normally because of the exaggerated curvature. Your shoulder blades are part of your shoulder joint. If your shoulder blades can’t move, or move correctly, your joint and other soft tissue take the abuse and start hurting. It may cause your rotator cuff muscles, or biceps to do more than they’re supposed to, or do something they’re not really designed to do. Restore your upper back flexibility, work on straightening up, restore normal scapular movement and stress will be taken off your shoulders joint.
2) We often see restrictions in the hips, and many times, the opposite hip of the dominant hand. Your muscles are connected to each other from head to toe. One muscle ends, its tendons converge into fascia where other tendons converge from other muscles and connect to your bones. If one tightens it will produce tension along the whole chain. So if you’re restricted in your hips, it will produce tension up your back to your opposite shoulder preventing it from moving correctly. If the shoulder blade can not move freely then the joint can not function properly, then something hurts because it’s getting overworked trying to compensate for the faulty shoulder blade which is because of the tight hip. Focusing on the shoulder will not remedy the problem. Loosen up the hip, remove the tension on the muscle connecting to your shoulder blade, restore normal movement around the shoulder blade and hip and whatever is inflamed and aggravated will be relieved because it doesn’t have to fight with the more powerful hip muscles which were restricting it. This isn’t too common with people who are inactive because they don’t move enough for it to affect the shoulder. If you’re a weekend warrior, if you’re very active working out or playing tennis, golf, etc. check it out.
It’s also important to realize that situations like this can sometimes make their way through your whole body before you end up experiencing pain. In the above example, you may not experience shoulder pain first, you may experience neck pain because some major neck muscles originate from the shoulder blade and insert into the skull or on the cervical vertebrae. If one side of your neck is getting pulled because of a restricted shoulder which is caused by a restricted hip, the opposite neck muscle may have to work extra hard to maintain alignment and at some point will ending up hurting, getting trigger points, etc. So it started in the hip, up across to the shoulder, up to the same side neck then over to the opposite side neck to counteract the force.
It is hard to figure out sometimes and follow the path so what I do is take everyone through some sort of assessment. I’ll check basic movements, look for restrictions or tightness, look for weaknesses, and look for common compensation patterns. For example, if someone squats they may shift their hips to one side and this may cause back or hip pain. In actuality they’re shifting their hips because they have a restriction in one knee or ankle and shifting is their way of getting around it. So then the back or hip is put through an abnormal motion. Certain muscles will try to kick in and may get overworked, or certain soft tissue will end up becoming overstressed and inflamed but they are not the problem. It’s the restriction in the knee or ankle.
The bottom line is that it is very often not the site of pain where the problem lies. Are you tight somewhere else in your body? Is that affecting how you move?
Things to think about;
- Do you have an old injury somewhere that you may be working around?
- Did you have a C-section and never get those trunk muscles working like they used to? This is one that blows me away. They will cut right through all your abdominal muscles and never even think of sending you to rehab (Can you draw your stomach in towards your spine without moving your shoulders or low back? Do you know how to engage the muscle to do that?)
- Is your diet so poor that it is aggravating your digestive system which is irritating the nerves that control your trunk muscles causing you to not have good trunk activation and stability? (Can you pull your stomach in? Can you tighten it without it bulging out? )
- Are you breathing incorrectly by using your shoulder muscles during inspiration instead of your diaphragm? (overworking the shoulder and neck muscles) Take a deep breath while looking in the mirror. What do you see happen? Did your shoulders rise? If so, your using your shoulder and neck muscles.
- Do you wear high heels all day? (Ankle restriction)
- Do you sit all day? (Rounded upper back or lower back, tight hip flexors, tight hamstrings, weak glutes, weak rhomboids)
- Even worse, do you sit at a computer all day?
- Do you perform repetitive motions day after day? (overuse injury?)
-Are you a sloucher?
The simplest approach would be to have someone go through an assessment and first look for restrictions. More often than not you will find some areas that are surprisingly tight. Then look for trigger points, or knots in those muscles. Get rid of the knots first before stretching. This usually can be done with direct pressure on the knots until they start to dissipate. A tennis ball is great for spots on shoulder blade and in the legs. Lean up against a wall with the tennis ball on the hot spots or roll around on the ground with the tennis ball under the target area like hips, quads, calves, etc. Usually relieving tension in one muscle will produce a cascading effect on muscles along the same chain. Trigger points will usually not go away in one shot, check on those areas day after day and keep working on them. Sometimes they will pop up in other areas. Just keep on them. If you see the large foam rollers lying in your gym and you don’t know what they are for, well now you do. Roll around on them, ask someone who’s familiar with them for help or just go online (foam rolling, self myofascial release).
Some common areas to check out are around the shoulder blade, especially around the top inside corner of the shoulder blade. Other areas commonly loaded with knots are deep hip and butt muscles, lats, and the outside corner of your thigh (vastus lateralis), although they can show up anywhere.
Once you’ve worked on the trigger points, regained some muscular flexibility and joint range of motion back, make sure your incorporate this new range of motion into some exercise. Learn how to move with your new range, learn how to produce force correctly. Preferably, try some resistance exercise to strengthen the once tight and/or lengthened muscles. Take a yoga class. If you don’t teach yourself to move correctly, your body will resort back to what is was familiar with. The muscles will shorten, others will lengthen and the cycle will continue. Good Luck.