One of the most common reasons my clients come into see me as either a new complaint or a recurrence of a previous injury, is shoulder pain.
“Shoulder Pain” is not a very specific complaint as it can mean pain anywhere from the upper arm, up to the angle of the neck, and down to the shoulder blade.
So my first task is to find out what my client means and then get to work. So you can have a basic understanding, I will separate the most common shoulder issues into 4 sections.
1. Upper shoulder pain – Upper Traps or Levator Scapula musclesThis is pain felt between the neck and the shoulder joint - the area you hang your handbag or backpack from. The most common muscles to cause problems here are the upper trapezuis (left) and levator scapula muscles (right).
2. Shoulder blade pain – Rhomboids and Mid TrapsBy this I am talking about the pain you may get between the shoulder blade (scapula) and the spine. Some feel that it is “under the shoulder blade”. The most common offenders here are the rhomboid muscle (highlighted) and the mid-traps.
3. Shoulder joint pain – Rotator Cuff, and CapsuleThis is actually pain felt in the “ball and socket” shoulder joint. This usually involves the muscles which create rotation movements of the arm at the shoulder. Collectively they are known as the rotator cuff. Another common problem with the shoulder joint is impingement. This is when you get pain in certain “arcs” of movement, usually when lifting the arm above shoulder level.
4. Upper arm pain – Deltoid and Bicep Tendon
Trigger points and muscle tears in the deltoid or biceps muscle are the usual culprits.
What’s the cause?
If I was to be pinned down to only one answer, I would say, “Poor posture”. This seems quite a broad, non-specific answer to different and sometimes complicated problems. So let me break it down to each of the above issues listed.
1. Upper Shoulder PainThe upper traps and the levator scapula muscles run from the shoulder blade to the base of the skull and upper neck respectively. When we sit, which we all do pretty much most of the time, our head shifts forwards. This creates more stress on these muscles as they have to “hang on” to the head. A good way to understand this is imagine your head is a waiter’s tray. It is much easier to put your hand under the tray and balance it than it is to grip it by the edge.
When this takes place day in and day out, the upper shoulder muscles get strained. Trigger points and scar tissue develop and pain will either develop slowly over time, or it may happen suddenly as the weak tissue is suddenly “pushed over the edge”. Like the proverbial “straw that broke the camel’s back.”
2. Shoulder blade pain
I am able to continue my argument that it is poor posture created by sitting too much that causes this type of pain too. While our head tends to drift forwards causing the problems explained above, our shoulders also round forwards. This causes our chest muscles (“pecs”) to shorten and be over active while the mid-back muscles (rhomboids and mid-traps) become lengthened and inhibited (switched off). The cruel “double whammy” that is delivered to the mid-back muscles is that while they are being stretched and inhibited they have to work to support the upper body and neck.
3. Shoulder joint pain
Posture and the shoulder joint? This may seem unrelated to you, but because the shoulder joint is a union of the upper arm and the shoulder blade, and the shoulder blade is really just “floating” in muscle attachments around the ribcage, the positioning of the shoulder blade plays a critical role over the mechanics of the shoulder joint.
Try this: Sit up straight and lift your arms out to the side all the way to your ears. Now slouch and do the same. Not as easy…
When you slouch the shoulder blade tips forwards. This position means that your arm bone bumps against the outer edge of the shoulder blade when you lift your arm right up, pinching the tendons and joint capsule. If you do this over and over you develop an “impingement”.
4. Upper arm pain
Poor posture makes the levers acting around the shoulder much less efficient. This in-turn makes the muscles have to work harder, causing strain. Long term anterior head carriage will cause the joints in the neck and upper back to stiffen up. Chiropractors call this a vertebral subluxation which is characterised by nerve interference. With the messages to the muscles being effected some of the muscles around the shoulder are inhibited. This means that they don’t perform efficiently and you body has to compensate. This leads to focal stress and injury to what ever muscles have to pick up the extra work-load – often the deltoids and biceps.
So what can you do?
The good thing about there being one primary cause of several problems is that you can work on a few issues and clear up lots of issues.
All we really need to do is reverse the effects of the flexed posture (“Oi! Sit up straight!”)
1. Forward Head – Anterior head carriage
There is a very effective exercise that you can do to help correct this. Sit up tall and look straight ahead. Tuck your chin towards your throat while elongating you neck. Aim to create double / triple chins – not my best look. You should feel the muscles under the base of you skull stretch while the neck flexors work. Hold for 5 seconds and repeat 10 times. Do this 3-4 times per day. A great time to perform this exercise is when you are driving in your car.
2. Rounded shoulders
To address this problem you need to stretch your chest muscles AND strengthen your mid-back muscles. The picture shown is an exercise you can copy to take care of both these needs at once. Reach behind your back and interlace your fingers. Draw your shoulder blades down and together while opening your chest.
If you are unable to interlace your fingers you can hold a towel in the above position to create the same effect.
I hope that this gives you a better understanding about shoulder pain as well as some tools as to how to improve and avoid it.
Understanding how your body works allows you to be more involved in your own health care.
Get well, stay well!