Shoulder pain is a common issue
Shoulders are probably the most common area of complaint after spine and pelvic issues.
Shoulder problems can develop whilst causing little to no symptoms and over a very long period of time.
They affect so much of what we do.
They are notorious for not resolving quickly.
And worst of all...
They are predominantly caused by how we have used them.
But that’s the bad news done and out the way. Plaster torn off. So now for some better news.
They can get better.
There are improvements you can make.
We can help.
At least we help the vast majority of people who come to us with shoulder problems and those we know we can’t help, we can at least point in the direction of someone that can.
The main cause of shoulder pain and dysfunction
One of the founding principles and fundamental tenets of Health HQ is to help people combat their symptoms by figuring out and helping them to understand WHY they are getting symptoms so we are able to change things for the better and get things working well, get things working right so they feel great and don't end up unwittingly causing the same problem again.
When it comes to shoulder pain, unfortunately shoulders are one of those areas where people come to us and say, "It just came on" or, "I haven't done anything different" and I have to tell them that nothing in our bodies goes wrong for no reason. Just because you don't know what the reason is, doesn't mean there isn't one and the most common fundamental, underpinning reason that people get shoulder problems is from what they have been doing with their shoulders, and more importantly HOW they've been doing it. And in my experience, long-term, low-grade poor posture is the main cause of shoulder pain and dysfunction.
Here's why. With good posture our chest is up, our shoulders back and down and our upper arms hang by our sides. When our posture is bad the way we use our shoulders changes MASSIVELY!!! It might not look like a big change, but from a mechanical point of view it's a radical change that puts a tremendous amount more stress on many of the structures in our shoulders. With poor posture our chest drops, shoulders come up and forward and then to do anything in this posture our arms reach forward and our elbows lift up and out. This puts so many of the structures in and around our shoulders AND our upper back AND neck, in positions where they have to work far harder and whilst stretched or squashed. And does that sound very comfortable to you? No. It does not.
If I asked you to raise your arms up and out to the side and hold them there, how long before your shoulder muscles started to feel the burn? Five minutes? Fifteen minutes? Half an hour? An HOUR..??
Probably not that long. But when we use our shoulders with poor posture, this is essentially what we’re doing. And if we are at a desk it’s what we are doing for sometimes eight hours a day, five days a week! If anything it’s astounding that the shoulders do as well as they do for as long as they do.
This posture can also make you more susceptible to conditions like Thoracic Outlet Syndrome, which is where the nerves or blood vessels that go down your arms get squashed as they pass through the front of the neck, chest and shoulder and can cause weakness, numbness, tingling or pins and needles (paraesthesia) in the arms or hands.
There is a lot we can do to calm down stretched, squashed or overworked muscles, but if people continue to misuse and abuse their shoulders the same way, they will never see the improvements they could and should.
The shoulder structure
To understand why these positions are so different on the shoulder it helps to understand its structure.
Shoulders are a ball and socket joint, just like your hips. The two big differences between shoulders and hips, however, are: One, that hips have a deep, bony socket for the ball to sit in and Two, that Shakira was correct in attesting that "Hips don’t lie" (Who doesn't enjoy a 2006 pop reference). On the other hand shoulders have almost no bony socket at all! All they have is a small, slightly dished portion of the scapula (shoulder blade) that the head of the humerus (the ball part) sits against, and even worse, shoulders lie all the time! (I will explain this shortly)
The main reason the shoulder has almost no real socket is to allow it a much greater range of motion than we get from the hip. And it works! Without that deep bony socket, however, all that Mo-bility comes at the expense of an awful lot of Sta-bility, but that’s where your rotator cuff muscles come in. The rotator cuff muscles are a set of four relatively small muscles whose job it is to keep the ball pulled securely into the socket/dish and help to keep the shoulder joint stable. They also help to move the arm. Under normal circumstances they do an amazing job! However, we tend to unwittingly upset them. A LOT.
Now you may remember that I said that shoulders can lie. Well, what I mean by that is that there are a lot of muscles around the shoulder that can cause referred upper back pain, arm pain, neck pain and even headaches. We commonly see people coming in with these symptoms, sometimes having worked on them until they're blue in the face, either by themselves or with other health professionals, only to learn that where they feel the pain is not the area that has gone wrong. See, shoulders are liars.
Part of the reason this happens is that when we sit supported with good posture all the boney bits (arm, shoulder blade and collar bone) sit in a way that all the soft tissues (the muscles, tendons, ligaments etc) have space to move and aren't being squashed. When we sit with poor posture, our shoulders become elevated and protracted (rolled forward) and our arms flex (move forward), abduct (move outwards from our sides) and internally rotate (turn in) which over-stretches some of the muscles at the back of the shoulder, shortens some at the front AND closes down some of the gaps that some of the soft tissues move through and compresses them.
This compression irritates, damages and inflames the soft tissues that pass through those areas and that, on its own, can cause pain but imagine what happens when you move the arm with the shoulder in that position.
All those compressed muscles, tendons and ligaments have to floss back and forth through those closed down gaps, and if you've ever worn a piece of clothing that rubs, you know how quickly and how badly things can get very irritated, inflamed and sore and how long it can take to calm down and fully heal and repair.
Now picture that happening every time you move your arm when you’re not sitting right. Ouch. This is how this process can be a factor in conditions such as subacromial impingement syndrome, glenohumeral bursitis, bicipital tendonitis and rotator cuff tears. Not good if you have them, but great if you play Scrabble.
So what can be done about it?
Well, rest & ice and painkillers and cortisone steroid injections can all help to bring down that inflammation caused by the compression and friction and over/misuse, but they're not going to stop the compression and the subsequent re-inflaming or re-irritation.
Surgery can help fix complete rotator cuff muscle tears and can also remove some of the underneath of the Acromion (bone on the top of the shoulder) to create more space and help prevent the compression, impingement, inflammation and pain, but it won't fix your posture, Thoracic Outlet Syndrome or the rest of the problems that poor posture can cause in your neck, head or upper back. And shouldn't surgery, as incredible as it is, really be a weapon of last resort? To be used after trying things like using it properly and not continuously upsetting it?
Shoulder problems are renowned for not resolving overnight and I hope now that you can start to appreciate why. Healing and repair don't happen overnight anyway and changing the way we sit for most of our day and how we have done for most of our lives isn't going to change overnight either. So we don't want to try and force that.
Believe it or not, with the right treatment to the shoulder, and some simple changes to certain habits, shoulders can calm down in a few weeks. Getting them fully functional and working correctly takes a bit longer. Exactly how long depends on the individual and the extent of the original issue, but the way I describe it is like braces on teeth; you can't just crank up your braces and wake up the next day with a perfect set of gnashers, and if you tried you'd be in agony or worse, break something.
All it requires is sufficient consistent pressure over time to encourage your body to change how it works. So if you're getting shoulder problems, stop looking at just your shoulder. Look at the bigger picture, and get a professional to help do that, and you are far more likely to see improvement.
I hope that creates a little ray of light in the darkness at least. Rest, Ice and painkillers can and do help to manage symptoms when used correctly in the short term, but they are not long term strategies and they do nothing to treat the cause. I have advice on ‘What to do when I'm in Pain’ and ‘How to best use Heat or Ice' in posts that I have written specifically on those topics, so feel free to check them out for some great tips on how to manage pain in general.
I do want to reiterate the importance of good posture and I demonstrate how to do it in my ‘Sitting Comfortably’ post, but I want to leave you with a really clever, really simple little mobilisation for your shoulders that builds on the basics demonstrated in my ‘Move It Or Lose It’ blog.
Shoulder mobilisations
Before we go through them though it is VERY important to remember that these are not shoulder stretches, they are shoulder mobilisations. We will be taking your arms and shoulders through full, normal, pain-free range of motion, NOT pushing on them to go further! If you find any of this painful, stop and contact your Chiropractor.
Now you can do this sitting, in case you feel self conscious in the office, but standing does work better.
Start with your arms by your sides, knuckles out and palms towards your legs. Lift your chest and collarbones UP (this is not quite the same as chest OUT). Bring your arms back behind you as far as is comfortable. Hold for a beat and then swing them forwards and raise your arms up and over your head until they are in line with your ears, or even a little behind if you can (without forcing it). Hold here for a moment before bringing your arms back down to your sides and repeat a couple of times.
Now turn your palms forwards and your knuckles back. Keeping your chest UP, lift your arms out to the sides and all the way up over your head as far as you can comfortably. You may be able to cross your arms at the top and have your biceps touch your ears. Don't worry if you can't. Just go as far as is comfortable. Little and often is better than trying to force things. Pause a moment at the top, then back down to the starting position before repeating a couple of times.
This next part can be particularly restricted and painful. If it is, remember, only go through PAIN FREE ranges of motion. DO NOT push anything. You are not making things better. You can upset things even more and you will likely make things worse! If you have concerns or questions, stop and consult your Chiropractor.
Next bend your elbows to 90 degrees (so we look like a robot or old action figure) and then lift your elbows out the side so they are 90 degrees to the rest of your body and in line with your shoulders with your fingers pointing forward.
This is the starting position.
From here externally rotate your arms so that your upper arm is still at 90 degrees to your shoulder, but now your fingertips are pointing as close to upwards as comfortably as you can (you should now look like someone has told you to surrender). From here internally rotate the shoulder 180 degrees so that your upper arms are still pointing out sideways, but your forearms and fingers and now pointing as close to straight down as is comfortable. Repeat this a few times. Whilst doing this exercise you should look like one of those little waving cat toys. You are also very likely to hear a lot of grinding in the shoulder. Don't worry about noisy. Worry about painful. Remember to only go through these movements as far as is comfortable and not to push or force anything.
I would recommend doing these every hour. That might sound like a lot but they take seconds to do and they get quicker the more practiced you become with them and about 4 minutes of mobilisation spread across an entire day, is not going to negatively impact on your time, but done consistently it will have a positive impact on your shoulders.
Time passes whether we like it or not. How we will feel next week, next month, next year, depends on the decisions we make and the actions we take NOW. How do you want to be in a month's time? If you want more of the same, keep doing the same. If you want better, less painful shoulders, well, this isn't a bad way to start.
If you want ways of helping other areas to start getting better, check out our other blogs and if you can't find what you need, let us know and tell us what you want to see added. We are always working to help as much as we can, but for now that's all you need to know for shoulders. Shoulder pain can be debilitating, but there is hope! If you have any questions or concerns always make sure you consult your GP or Chiropractor, otherwise remember to keep an eye on your posture and do something nice for your shoulders. They do a lot for you.