Why does shoulder pain occur?
Pain in the shoulder is very common but often lacks a clear and obvious cause. The shoulder is a complex joint, which relies on a unique functional balance between dynamic stability and mobility.
The shoulder complex is a combination of 3 bones and 4 joints. The bones that make up the shoulder are the humerus (upper arm bone), clavicle (collar bone) and the scapula (shoulder blade).
Movement in the shoulder occurs as a result of the continuous coordinated movements of all four joints, but the stability of the shoulder relies on dynamic muscular control. Within the shoulder complex, muscles act to manoeuvre the scapula around the thorax and stabilise the head of the humerus within the socket. The dynamic muscular control and mobility of the shoulder are easily lost and modern life and its stresses are often to blame.
In short, the shoulder is the most mobile joint in the body allowing us to climb, reach, crawl, pull, push, turn, thrown and hang. But this mobility comes at a cost – a greater range of movement means a higher chance of poor mechanics and may ultimately lead to injury and pain.
Types of shoulder pain injury
Problems or injury to the shoulder typically fit into one of three categories.
Stiff & painful shoulder – This includes conditions such as arthritis and frozen shoulder. In these instances, it is the passive joint structures such as the joint surfaces, capsules and ligaments that are to blame.
Weak and painful shoulder – This includes conditions such as a shoulder strain, shoulder impingement, trapped nerves and repetitive strain injuries.
Unstable and painful shoulder – Instability in the shoulder can be due to poor muscular control, but true instability is more often a result of a traumatic injury. Like with the stiff painful shoulder, an unstable shoulder relates to the passive structures but rather than not allowing enough movement, they don’t act properly to restrain it.
Two of the most common causes of mechanical shoulder pain are poor dynamic stability of the shoulder and a lack of control of the shoulder blade. The first often occurs because of weakness or injury to the associated stabilising muscles. This may lead to secondary problems such as impingement and may occur gradually over time or suddenly after a period of overuse or trauma. The later can occur due to a lack of movement, gradual postural changes or in more dramatic cases, a sudden nerve or muscle injury.
Both of these problems can boil down to doing too much of a bad thing or too little of the right. For example, if have ever spent the day working on some heavy DIY, you may be all too familiar with the nagging shoulder pain and weakness that can occur the following days or weeks. It’s not just isolated incidents of overuse, for example, overtraining in the gym of the larger shoulder muscles without paying attention to the smaller and deeper ones can have the same effect. Alternatively, if you work a desk job 8 hours a day five days a week and never push the shoulder to move outside of this narrow range, you may soon begin to experience a different type of pain. Move it or lose it! If you never lift your arm over your head, hang from a bar, weight bare through your hands or reach behind your back, it won’t be long before you lose the ability altogether.
So how can Physiotherapy help shoulder pain?
Your physiotherapist will be able to assess and diagnose your shoulder problem and begin the process of rehabilitation. This may involve gentle stretching and mobilising some of the tissues around the joint and help you with some exercises. We may also use acupuncture and specialised taping techniques to reduce pain and support the delicate muscles around the shoulder and neck.
If you have been suffering for a long time, it is important you seek advice so that a small issue does not escalate into a much bigger one due to inaction. Being proactive is much better than being reactive! If you are unable to use your shoulder to its fullest potential then you should begin to make changes now before it escalates to shoulder pain.