Shoulders are complex joints capable of a wide range of movements. In fact, they are the most mobile joint in your body. Unfortunately, that means that they are also the most unstable joint, and that instability means that they are prone to injury and pain.
I suffer from occasional shoulder pain – especially when I have overdone it in the gym or on the tennis court. I especially notice it when I try to lie on my side and go to sleep.
Although not as common or as serious as back pain (I’ve recently published a full guide on back pain relief), I think that many readers of Days to Fitness will be glad to discover how to avoid and treat shoulder pain.
Because the shoulder is so complex, it might only be made up from two bones but there are lots of muscles and ligaments involved, there are several different causes of shoulder pain. It’s always useful to discover the cause of the problem before trying to fix it and the most common sources of shoulder pain are:
- Poor posture – if your shoulders are protracted (pushed forward) or turned inward, this place a lot of stress on the entire joint including the muscles, ligaments, tendons, and the bones.
- Lack of strength – the weaker your shoulder muscles are, the more unstable and therefore more injury-prone your they become.
- Overly tight muscles – if your chest, shoulder, back, or even your arm muscles are too tight, they can affect shoulder mobility and cause pain.
- Overuse – if you do a lot of tasks where you have to hold your arms above your head, e.g. painting a ceiling or cleaning above head-height, this can soon lead to shoulder pain.
- Some sports – tennis, swimming, and weight lifting are often associated with shoulder pain, mainly because of overuse.
- Arthritis – like any joint in the human body, your shoulders can become worn and roughened on the inside. This is osteoarthritis, and a natural part of the aging process.
- Injury – it’s very easy to injure your shoulders if you have a fall, exercise with bad technique, or otherwise expose the joint to unnatural forms of traumatic stress.
Daily habits to avoid shoulder pain
In my opinion, the best way to deal with shoulder pain is to avoid it in the first place. That may mean making changes to your habits to reduce your risk of accident or injury. Here are some daily habits that may help reduce your likelihood of suffering shoulder pain.
- Exercise – working out will help keep your shoulders strong and supple. Whenever you exercise, your joints produce a special lubricant called synovial fluid which helps to keep them in good working order. If you are sedentary, your joints will be dry, and that will increase wear and tear which could lead to pain and arthritis. Also, weak shoulders are more prone to injury – especially of you experience a fall.
- Good posture – when you slouch, you restrict the natural movements of your shoulders. In many cases, this also causes inward rotation of your upper arms which further compromises shoulder joint health. Try to sit and stand in good posture to make sure your shoulders are properly aligned.
- Stretch – tight chest, arm, back, and shoulder muscles can pull your shoulder joints out of proper, natural alignment. Long periods of sitting and badly designed workouts can leave you with very tight muscles, leading to restricted shoulder movement and pain. Daily stretching can help restore and maintain flexibility, which can help treat and prevent shoulder pain.
- Mobilize – one very effective way to reduce shoulder pain is to simply get up and move more often. Shrug your shoulders up to your ears, roll them forward and backward, raise your arms forward and out to the sides. Do this several times a day to prevent your shoulders from stiffening up and to reduce shoulder pain.
- Avoid exercises behind the head – many gym goers create their own shoulder problems by doing exercises seemingly designed to hurt! Behind the neck presses and behind the neck pulldowns are probably the most common cause of gym-related shoulder pain. If you do these exercises, it’s time to stop before your shoulders become unfixable!
The most obvious symptom of shoulder pain is, well, the pain! If your shoulders hurt, you have a problem that needs fixing. In many cases, that pain only comes on during specific movements e.g. when you raise your arms over your head. This often reveals the cause of the pain, and will help a medical professional identify the type of shoulder problem affecting you. However, in addition to pain, you might also have the following symptoms:
- Reduced range of motion – for example, if you are unable to raise your arm above your head or put your hand behind your back. This could be the onset of frozen shoulder, covered later in this article.
- Weakness – your body will inhibit or turn off muscles that are damaged or injured. If you notice your shoulders feel weak, there may be a problem that needs fixing. Strength should return once the issue has been dealt with.
- Creaky joints – if you can hear or feel your shoulder joints creaking or clicking when you move, this suggests that you may have arthritis or, at least, the articular surfaces of your joints have become roughened. It may also indicate that your shoulders are out of alignment and are unable to move smoothly.
- Swelling – swelling is your body’s way of protecting itself from further injury, and is also part of the natural repair process. If you can see swelling, you should get it checked out. Swelling is often accompanied by reddening and increased skin temperature.
- Coldness – if the skin around your shoulder is cold or pale, this would suggest a reduction in blood flow which could be the cause or a symptom of your shoulder pain. Reduced blood flow will also slow your recovery as your body needs oxygenated blood to repair most injuries.
- Loss of muscle – loss of function in the shoulder may cause or be caused by a reduction in muscle size. Look out for an obvious difference in muscle mass from one side to the other.
- Sleeplessness – if you wake up frequently and have to change position often, this could be a symptom of shoulder pain.
Shoulder pain Relief
When you are in pain, it can be very tempting to pop a few pain pills. Pain pills will relieve the symptoms that are bothering you, but do nothing for the cause. Whatever is making your shoulders hurt will still be there when the pain pills wear off and, unless you have had some kind of treatment, it will not get any better even though the pain was relieved.
One of the biggest problems with pain pills, in addition to the fact that don’t fix the cause of your problems, is they can fool you into thinking everything is okay when it’s not. Just because your shoulders no longer hurt doesn’t mean you are fixed!
Pain is very useful; it tells you something is wrong, and warns you not to do anything that makes the pain worse. But, if you remove the pain, it’s very easy to do more of what caused the problem in the first place which a) makes things worse, and b) delays your recovery. You’ll probably find that, once the pain pills wear off, your shoulders hurt more than they did before!
Pain pills can also be unhealthy when used for prolonged periods or in high doses. Some cause stomach problems, while others are hard on your kidneys. Some of the stronger ones are even addictive.
For all these reasons, I prefer to deal with pain more naturally and, whenever possible, with exercise. Food supplements such as anti-inflammatory curcumin and omega 3 fish oils, as well as ice and heat pads, can also be beneficial.
Prevention and relief exercises
Of course, if you have serious shoulder pain, and your doctor has prescribed them, some pain medication may be necessary but, and wherever possible, I recommend you try and deal with your pain with exercise. Here are five of my favorite shoulder pain exercises.
5 Exercises for Shoulder Pain
1. One minute shoulder stretch sequence
Lack of time can make it hard to find opportunities to stretch your shoulders. This 60-second sequence is the perfect antidote when you are short of time but still need to stretch your shoulders. Each stretch, although only held briefly, targets different parts of your shoulders to help alleviate stiffness. If you have got more time, you can hold each one for 30-60 seconds to make this series of stretches even more effective.
2. Shoulder dislocations
Contrary to the name of this exercise, you won’t really be dislocating your shoulders; that would be painful and crazy! Instead, this exercise moves your shoulders through a wide range of motion to stretch and mobilize them, as well as increasing synovial fluid production to nourish and lubricate your joints. You can do this exercise with a towel or with a broomstick as preferred. Just try and move your hands a little closer together as the weeks pass.
3. Wall angels
This exercise is a very good posture exercise that is also good for your shoulders. By pulling back and resetting your upper back and shoulder girdle, you eliminate many of the causes of shoulder pain. If you find this exercise hard, and I know I did at first, you can do it lying on the floor which is much easier. Do it daily to fix your posture and your shoulders at the same time!
4. Band Pull Aparts
This is probably my favorite shoulder pain preventing exercise. It works the muscles between your shoulder blades which are responsible for keeping your shoulders back and in good alignment. This puts your shoulder joints in the best possible position for optimal, pain-free function. If you spend a lot of time sitting at a desk or driving, this exercise is for you. You’ll need a resistance band for this exercise but, at no more than a couple of dollars, this is a very good investment.
5. External rotations
Many incidences of shoulder pain are caused by weak external rotators – the muscles that turn your upper arms outward. Sitting at a desk all day and too many push-ups can cause this. Using nothing more than a cheap resistance band, you can fix this problem in just than a few minutes a day. It’s also a good exercise for your posture. I keep a resistance band in my desk at work so I can do this exercise every couple of hours to break up long periods of sitting.
In some instances, shoulder pain can be caused by something called adhesive capsulitis, better known as frozen shoulder. This happens when the tissues of your shoulder joint become thicker and tighter, and scar tissue develops. This reduces space within the shoulder joint which, in turn, limits movement and causes joint stiffness.
You can learn more about the causes and symptoms of frozen shoulder in this video:
The first signs of frozen shoulder
In most instances, the first signs of frozen shoulder are pain. You might put this down to general aches and pains, or even a pulled muscle, but even with rest, the pain will continue, and probably get worse.
Gradually, you’ll start to notice that your shoulder feels stiff, and that you cannot move your shoulder as much as before. For example, you may find reaching up to a high shelf much more difficult. If allowed to progress, you may find that everyday tasks such as dressing become more difficult. For example, you may be unable to pull on a t-shirt or a sweater because of lost shoulder mobility.
While frozen shoulder is more common in people aged 40-40, it can affect anyone. Common causes include inactivity due to an injury, illness, or surgery, hormonal imbalances, diabetes, or a weakened immune system. Long-term use of an arm sling is another potential cause of frozen shoulder.
Frozen shoulder diagnosis and treatment
Frozen shoulder is typically diagnosed by a doctor. They will do a physical examination, palpating the underlying tissues of your shoulder. They will also do movement and strength tests to assess the severity of the problem. To eliminate other, more serious, problems, you doctor may also schedule you for an X-ray or an MRI scan to check that you don’t have something like a torn rotator cuff or arthritis.
Once diagnosed, the most common treatment for frozen shoulder is physical therapy i.e. stretching and strengthening exercises. These can normally be done at home and require minimal equipment. It can take from a few weeks to 9-12 months to restore full movement but, in most cases, exercise will get the job done. Sometimes medications such as anti-inflammatory drugs will be prescribed to help speed up your recovery.
In a very small percentage of instances, frozen shoulder is treated with steroid injections and even surgery, but it’s much better to try and treat the problem with exercise before risking anything so invasive.
Frozen shoulder exercises
Treating a frozen shoulder requires a combination of stretching and strengthening exercises. These exercises should be gentle, progressive, and be done every day. If any of the exercises feel too hard right now, choose an easier one, and then come back to it when you feel you are ready. Expect some muscle and joint soreness, but if the pain is too much, speak to your doctor.
1. Pendulum swing
This exercise gently stretches and mobilizes your shoulder capsule and joint, especially the area at the back of your shoulder. It’s very passive and requires next to no effort so you should be able to do this one several times a day. You can do this exercise using just your arm weight or hold something like a can of food or a bottle of water in your hand to get a little more out of the exercise.
2. Finger walking wall stretch
The key to any mobility or stretching exercise for your frozen shoulder is increasing the range of motion gradually. This self-limiting exercise is the perfect way to achieve this. You simply walk your fingers up a wall as high as you can and try to go a little higher from one day to the next. I’ve used this exercise with friends who have had frozen shoulder, and they all report it works really well; I learned it from another friend who is a physio.
3. Pole assisted mobility exercises
One of the biggest problems facing someone with frozen shoulder is that the shoulder is stiff, but you still have to move it around. One way to crack this issue is to use a pole so you can use your unaffected arm to move the side that you are treating. This sequence of frozen shoulder exercises is just like working with a physical therapist except you will be the one providing the help!
4. Child’s Pose
This yoga pose gently pushes your arms above your head while simultaneously opening your chest, mobilizing your upper back, and stretching your lower back. Talk about efficient! It’s a very gentle stretch which is also relaxing and helps eliminate stress. I like to do this one even though I don’t have frozen shoulder because, in my opinion, it’s a great way to prevent the problem in the first place.
5. Shoulder strengthening exercises
You don’t just need mobility to treat and prevent frozen shoulder, you need strength too. But, and this is the problem, you have a limited movement which can mean many traditional strengthening exercises are impossible. Luckily, you can strengthen your muscles without making big movements with a type of exercise called isometrics. In this video, you’ll see four exercises that are perfect for strengthening a frozen shoulder. Just work within your current, comfortable range of motion.