Why Shoulders Hurt


Your shoulder is brilliantly designed to allow your arm to reach, grab, throw, push, pull, etc., etc., etc., but I’m sure if you have experienced shoulder pain in your lifetime you might argue that there are some flaws in the blueprints.  I have seen shoulder pain bring some of the toughest guys to their knees and frozen shoulders put women’s lives on hold for 1-2 years.  I personally, have dislocated my shoulder multiple times and eventually had surgery on it in 2001.  My shoulders and I are not friends, but I have learned how to keep my enemies close and under control.

Knowing what I know about biomechanics and anatomy, I would still have to support the idea that the shoulder is extraordinarily designed, but I would make the case that it should come with a detailed instruction manual of how to actually use it properly.  Your shoulder is a complex ball-in-socket joint that’s function is intimately tied to the posture and alignment of your ribcage and thoracic spine.  ‘Normal’ movement in your shoulder requires the ball to spin in the socket, the shoulder blade to slide over your ribcage and your torso to remain in a relatively stable position; a problem in any or all of these factors will lead to dysfunction and eventually pain in your shoulder.

It is not hard to determine what structure in your shoulder may be damaged and hurting, but it can be harder to understand why you damaged anything in the first place.  Sometimes why is easy.  You may have tried tackling a two hundred pound Kiwi rugby player determined to run through you and your shoulder lost the battle like mine did, but most of the time ‘why’ is more complex than you would like.  Shoulder pain usually involves a combination of factors that over time lead to the insidious onset of pain.

Top 5 factors related to persistent shoulder pain: (The WHY)
(Click here to watch video Why Shoulders Hurt illustrating points below)

1.    Poor posture in the mid-upper back
a.    Too hunched forward
b.    Too braced backward
2.    Poor muscle balance around the shoulder girdle (tightness & weakness)
3.    Poor awareness of proper shoulder blade-trunk stability
4.    Bad movement patterns developed from sport or childhood
5.    Alignment & stability issues in your upper ribs

Top 5 painful/irritated/damaged structures due to the above factors: (The WHAT)

1.    Rotator cuff impingements
2.    Biceps tendonitis
3.    Strain in the muscles from the shoulder to the neck
4.    Tension on the nerves from the neck to the shoulder
5.    Bursitis

HOW the above WHYS combine to create the above WHATS:

When you lift your arm all the way above your head it may reach about 180 degrees, about 120 degrees of this movement should happen in the ball and socket part of your shoulder and about 60 degrees is accomplished by your shoulder blade upwardly sliding on your ribcage.  Most shoulder problems arise when something restricts the proper movement of your shoulder blade.  Having a really rounded upper back will naturally tip your shoulder blades too far forward.  Having a really flat upper back may allow your shoulder blades to rest too low on your trunk.  Having a sway back and over activity of your lats will cause your shoulders to sit too low and restrict the upward movement of your shoulder blade.

When you attempt to lift your arm up and the shoulder blade is either starting in a bad place or just not moving well, you will force too much movement to happen in the ball in socket joint and are way more likely to pinch or rub very sensitive muscles or tendons.  Your rotator cuff isn’t one structure, it is four muscles that work together to help hold the ball in the socket; these muscles (as well as your bicep) turn into tendons and attach all around your shoulder.  Pinching these tendons under one of the bones of your shoulder blade called your acromion is the most common cause of acute shoulder pain and is referred to as a rotator cuff impingement.

Acutely pinching a tendon in your shoulder can be very painful and can result from one specific incident, or over time, by moving poorly and repeatedly rubbing a tendon and creating too much friction.  The latter can lead to tendonitis and or bursitis in your shoulder.  ‘itis’ simply is a suffix meaning ‘inflammation of.’  So tendonitis is just inflammation of the tendon and bursitis is just inflammation of the bursa.  The bursa is a thin fluid filled sac that you have around most major joints, they are like airbags for your joints.  If you start developing too much friction by moving poorly, they swell up and get inflamed; resting them and icing them helps, but you have to fix the movement problem to make them stay away.

The neck is closely linked to the shoulder by both muscles and nerves.  There are a handful of muscles that attach from your shoulder up into your neck and it is very common for persistent shoulder problems to irritate the neck and compound the problem.  The nerves that come out of your mid to lower neck are the electrical wiring for all the muscles in your shoulder and arm, so if they get annoyed you will likely end up with some referred pain and muscle tension into your shoulder, arm and even fingers.  Nervy arm pain will just further degrade your movement patterns and can start a vicious cycle of your shoulder irritating your neck and your neck irritating your arm; if this is the case, calming down the neck irritation should become priority one.

Muscles from shoulder to neck.      Nerves from neck to shoulder/arm

Following a process of Release, Re-educate, Rebuild is the best way to fix most shoulder problems with lasting results.  If you have got to the point of pain, you likely have a handful of muscles that have tightened up and are making ‘normal’ movement challenging or even impossible; releasing these muscles is an important first step to decreasing pain and restoring movement.  I have found that Intramuscular Stimulation (IMS…click here for details) is hands down the best way to release the bracing muscles around a joint.  Once muscles have been released, pain is typically significantly improved and movement is easier.  Establishing proper movement and control of your shoulder is what I mean by Re-educate and it is the key to preventing shoulder problems from surfacing again.  If you spend the time addressing your posture and arm movements before attempting to strengthen anything you will get to where you want to be faster and end up functionally stronger.  Once the movement dysfunctions have been corrected, shoulder, core and general body strengthening exercises can be very helpful for prevention and performance of your arm.

The following videos illustrate some of the concepts and exercises I am talking about:

Please leave a comment below if you have any questions and I will try my best to answer them.

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  • Clyde Smith

    I am on a mission about this:)
    No where do you, or any other article I have seen, is there talk of the 1/3 of the day that shoulders hurt and why! That would be the sleeping postures pain. I believe that 80% of shoulder pain is manageable IF a sleeping posture can be constructed that allows for proper circulation. Night (shoulder) pain is a result of vascular insufficiency. The same mechanism that produces pressure sores in the invalid and neurological deprived.
    You can do everything right during the day but (but negates everything before it) if you do not solve the night pain the problem persist and the exercise become a dog chasing its tail.

    • Brent

      Great point Clyde. I am a side sleeper and have pretty much had to sleep on my right side for 12 years since I started dislocating my shoulder and even after surgery. It eventually started creating right shoulder pain which is most likely a vascular issue as you say. Do you have any suggestions or resources you would suggest for sleeping positions. I’d be happy to make a video with you and have it on the site. Let me know….thanks!

      • Clyde Smith

        That would be great. I use soft pillows ( Bed Bath and Beyond has some great ones for this)or even a towel in some cases…the idea is to support the spine along it’s entirety and remove what I call the swinging bridge effect. It creates a lumbar support when on the back and on the side. I have them place it under the sheet if it moves around. When it is in the right place they will sleep with out the constant turning from side to side. This is where the shoulders and the hips are the stress points and the spine sags in the middle like a swinging bridge. The theory is to transfer the pressure over a greater area and not on the shoulder or the hips. I instruct and demo to patients that have shoulder, hip, LB and in some cases the cervical region. Try it in the clinic and pull the towel out and they will feel an immediate change. It does not take much to make a big change. I Taught this trick by pregnant patients….go figure. I have some thoughts on how to demo this by the use of pressure pads.
        Obus had a mattress trying to accomplish this but I do not think one size fits all.

        • Brent

          Thanks for that Clyde. I will track down your email and we can talk about throwing a short video together as a resource for clients.

          • Dana Ranahan

            Hi guys
            I’ve been following the discussion. I have also used a body pillow in front so that the lower body and trunk don’t over-rotate, in which case there is more force downwards on the shoulder and hip and less torque in the spine. The top arm can rest on the pillow also which is good for the painful one being on top too. I have tried your trick Clyde with lower back pain or t-spine pain but not for shoulders/hips. I will have to give it a try. Thanks for the discussion! Cheers,

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