The spring and early summer is a common time for overuse injuries and other joint pain. Shoulder pain being one of the most common. It’s that nagging ache in your shoulder that refuses to let up. Maybe it comes and goes, maybe it’s a constant throb, but either way, it’s starting to interfere with your daily life. Now you’re here, asking the important questions: “Why do my shoulders hurt?” “What are the causes of shoulder pain?” and crucially, “What can I do about shoulder pain?”
The good news is, you’re not alone. Shoulder pain affects millions of people worldwide, making it a public health concern. A study in the Journal of Physical Therapy Science indicates that the prevalence of shoulder pain in the general population could be up to 66.7%.1Takahashi, N., Aoba, Y., Shiozawa, H., & Aizawa, J. (2019). Effect of posture on shoulder muscle activity during smartphone use. Ergonomics, 62(10), 1316-1324. And just like you, many people are searching for answers.
Hopefully, by the end of this article, you’ll have found most of those answers. If not, leave a comment or post your question.
- The Complex Design of the Shoulder: A Blessing and a Curse
- The Common Causes of Shoulder Pain
- The Role of Posture in Shoulder Pain
- How Shoulder Mobility Impacts Shoulder Pain
- Practical Steps to Alleviate Shoulder Pain
The Complex Design of the Shoulder: A Blessing and a Curse
Your shoulder isn’t just a singular entity. It’s a complicated system, a mechanical marvel, that has been designed for an impressive range of motion. The shoulder is made up of three bones – the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone). These bones work together through four distinct joints, namely the glenohumeral, acromioclavicular, sternoclavicular, and the scapulothoracic joints.2Ackland, D. C., Pak, P., Richardson, M., & Pandy, M. G. (2008). Moment arms of the muscles crossing the anatomical shoulder. Journal of Anatomy, 213(4), 383-390.
Surrounding these bones and joints is a network of muscles, tendons, and ligaments. This includes the rotator cuff, which comprises four key muscles providing stability to the shoulder joint, and the deltoid muscle, which powers the lifting of the arm.3Lewis, J. S. (2016). Rotator cuff tendinopathy: a model for the continuum of pathology and related management. British Journal of Sports Medicine, 50(19), 1187-1191.
This complex structure enables your shoulder to perform a myriad of tasks every day. From reaching for a can on the top shelf, to throwing a ball, or even brushing your hair, few body parts offer such diversity of movement. However, this benefit comes at a cost.
This inherent mobility of the shoulder makes it susceptible to a range of injuries and conditions. Overuse, trauma, or strain can cause a variety of shoulder conditions, including rotator cuff tears, impingement, and frozen shoulder.
The intensive use of the shoulder in sports, especially those requiring repetitive overhead movements, further raises the risk of injuries.4Yang, J. L., Chang, C. W., Chen, S. Y., Wang, S. F., & Lin, J. J. (2017). Mobilization techniques in subjects with frozen shoulder syndrome: randomized multiple-treatment trial. Physical Therapy, 97(10), 1003-1013.
While our shoulder’s dynamic capability is a boon for performing diverse movements, it also increases the risk of injury and pain. In the following sections, we will delve into how everyday habits, such as posture, can further affect your shoulder health.
The Common Causes of Shoulder Pain
Understanding the causes of shoulder pain isn’t always straightforward. While injuries and conditions related to the shoulder anatomy we’ve discussed are prevalent, there are other potential causes to consider.
Age-related wear and tear is a common cause. With time, the cartilage in our shoulders naturally deteriorates, leading to conditions like osteoarthritis. A research article in the American Journal of Sports Medicine confirms that age-related changes can predispose individuals to a host of shoulder disorders, including rotator cuff tears and glenohumeral osteoarthritis.5Minagawa, H., Yamamoto, N., Abe, H., Fukuda, M., Seki, N., Kikuchi, K., Kijima, H., & Itoi, E. (2013). Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: From mass-screening in one village. Journal of Orthopaedics, 10(1), 8-12.
Yet, age isn’t the only factor at play. Medical conditions like heart disease, liver disease, or even gallstones can refer pain to the shoulder. For example, in a heart attack, one might experience referred pain in the left shoulder and arm. Referred pain due to underlying health conditions is a common yet overlooked cause of shoulder pain.6Malanga, G. A., Yan, N., & Stark, J. (2015). Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgraduate Medicine, 127(1), 57-65.
In addition, shoulder pain may arise from overuse or repetitive strain. Athletes, gym-goers, or people whose work involves repetitive arm movements often experience this. A paper in the Journal of Orthopaedic & Sports Physical Therapy states that overuse injuries are common in sports that involve throwing, causing conditions like rotator cuff tendonitis.7Kibler, W. B., Sciascia, A., & Wilkes, T. (2012). Scapular dyskinesis and its relation to shoulder injury. The Journal of the American Academy of Orthopaedic Surgeons, 20(6), 364-372.
But what if you’re not an athlete or haven’t suffered an injury, and you’re still plagued by shoulder pain? Could your day-to-day habits be influencing it? As we’ll explore next, factors such as your posture and shoulder mobility can significantly affect shoulder health.
The Role of Posture in Shoulder Pain
Have you ever considered how your posture might contribute to your shoulder pain? It’s easy to dismiss the idea that how you sit or stand could have a significant impact. However, scientific evidence suggests a strong link between poor posture and shoulder pain.
Posture refers to how we hold our bodies while we’re standing, sitting, or performing tasks. Ideal posture involves aligning the body to minimize stress on our muscles, joints, and ligaments. However, many of us tend to adopt incorrect postures in our daily lives, often without realizing it. Slouching in front of the computer, hunching over your phone, or carrying heavy bags can all distort your natural posture.
A study in the Journal of Physical Therapy Science found a significant association between poor posture and shoulder pain. It showed that individuals with forward head and rounded shoulder posture were more likely to experience shoulder discomfort.8Kwon, D. R., Park, G. Y., & Lee, S. U. (2018). The Effects of Scapular Stabilization Exercise in Patients with Partial-thickness Rotator Cuff Tear. Journal of Physical Therapy Science, 30(5), 674-677.
This happens because poor posture alters the biomechanics of the shoulder joint. It changes the position of the scapula (shoulder blade), disrupts muscle activity, and increases the strain on your shoulder tissues.9Borstad, J. D. (2006). Resting position variables at the shoulder: Evidence to support a posture-impairment association. Physical Therapy, 86(4), 549-557.
Modern-Day Culprits of Poor Posture: Computers and Mobile Devices
The modern lifestyle, with its reliance on technology, has significantly contributed to the prevalence of poor posture. Several everyday habits that seem harmless can affect your posture and lead to shoulder discomfort.
Take the example of working on a computer. You might have found yourself, on numerous occasions, hunched over your keyboard, with your neck craned forward and your shoulders rounded. This is a classic example of poor posture known as “computer posture” or “tech neck.” This posture is a significant risk factor for musculoskeletal pain, including shoulder pain.10Nejati, P., Lotfian, S., Moezy, A., Moeineddin, R., & Nejati, M. (2015). The study of correlation between forward head posture and neck pain in Iranian office workers. International Journal of Occupational Medicine and Environmental Health, 28(2), 295-303.
Similarly, the use of mobile devices, especially smartphones, has further compounded the problem. “Text neck,” a postural syndrome resulting from excessive smartphone use, is characterized by forward head posture and rounded shoulders, contributing to the development of shoulder and neck pain.11Kang, J. I., Jeong, D. K., Choi, H. (2012). The Effects of Spine and Shoulder Posture on Muscle Activity in the Upper Extremity and Neck. Journal of Physical Therapy Science, 24(10), 923-926.
Moreover, these unhealthy postures don’t just lead to shoulder pain. Over time, they can change the alignment and function of your shoulder joint. They can cause a misalignment of the scapula (shoulder blade) and disrupt the balance of the shoulder muscles, leading to further pain and discomfort.12Ludewig, P. M., & Reynolds, J. F. (2009). The association of scapular kinematics and glenohumeral joint pathologies. Journal of Orthopaedic & Sports Physical Therapy, 39(2), 90-104.
Additionally, prolonged periods in these compromised postures can lead to stiffness and reduced mobility in the shoulder joint, another factor that we will explore in the next section.
How Shoulder Mobility Impacts Shoulder Pain
Just as the health of your spine is about more than just your posture, the health of your shoulder is about more than just avoiding injuries or strain. Shoulder mobility, or the ability of your shoulder joint to move freely through its full range of motion, plays a critical role in maintaining shoulder health and avoiding pain.
Healthy shoulder mobility allows for efficient and pain-free movement of the arm in various directions. However, factors such as sedentary lifestyle, aging, injuries, and, as we discussed earlier, poor posture, can lead to decreased shoulder mobility, often called shoulder stiffness or frozen shoulder.
When your shoulder mobility is compromised, it affects the normal functioning of your shoulder joint and muscles. Your body compensates for limited mobility by overusing other parts of the shoulder complex, leading to a higher risk of injury and pain. A study published in the Journal of Shoulder and Elbow Surgery found a strong correlation between limited shoulder mobility and shoulder pain, particularly in overhead athletes.13Edouard, P., Degache, F., Oullion, R., Plessis, J. Y., & Gleizes-Cervera, S. (2013). Shoulder strength imbalances as injury risk in handball. International Journal of Sports Medicine, 34(7), 654-660.
Moreover, reduced shoulder mobility can exacerbate the effects of poor posture. For instance, if you have a hunched posture and also suffer from limited shoulder mobility, you are likely to experience more discomfort when performing overhead tasks or movements.
Testing Your Shoulder Mobility: Simple Home Techniques
Testing your shoulder mobility can help identify any limitations or imbalances that might be contributing to your shoulder pain. Thankfully, there are simple tests you can do at home to assess your shoulder mobility. Here are five effective ones:
- The Wall Test: Stand with your back against a wall, keeping your feet about six inches away from the wall. Extend your arms straight out to your sides and try to touch the wall with the back of your wrists while keeping your arms parallel to the ground. If you can’t do this without your shoulders, upper back, or elbows leaving the wall, you might have limited shoulder mobility.14Kolber, M. J., Beekhuizen, K. S., Cheng, M. S. S., & Hellman, M. A. (2017). Shoulder joint and muscle characteristics in the recreational weight training population. Journal of Strength and Conditioning Research, 31(2), 414-421.
- The Back-Hand Reach: Stand tall and reach one hand behind your back and up towards your shoulder blade. With the other hand, reach over your shoulder and try to touch the fingers of your back hand. If you cannot get your hands within a few inches of each other, your shoulder mobility might be impaired.15Omid, R., Meier, B., Limpisvasti, O., Choi, G., Yocum, L., & ElAttrache, N. S. (2011). Relation of the shoulder’s resting posture with the scapulohumeral rhythm. Journal of Shoulder and Elbow Surgery, 20(6), 961-966.
- Cross-Body Reach Test: Stand up straight, reach your right arm across your body, and try to touch your left shoulder blade with your right hand. Repeat the test with your left arm. If you’re unable to reach your shoulder blade or experience pain while doing so, it could suggest restricted shoulder mobility.16Borsa, P. A., Dover, G. C., Wilk, K. E., & Reinold, M. M. (2008). Glenohumeral range of motion and stiffness in professional baseball pitchers. Medicine & Science in Sports & Exercise, 40(2), 235-241.
- Overhead Reach Test: Stand with your back against the wall. Raise your arms overhead and try to touch the wall with your thumbs while keeping your arms straight. If you can’t reach the wall or need to arch your back to do so, this may indicate limited shoulder mobility.17Konrad, G., Markmiller, M., Jolly, J. T., Ruter, A., & Sudkamp, N. P. (2015). Stretching exercises vs manual therapy in treatment of chronic neck pain. Archives of Physical Medicine and Rehabilitation, 96(3), 431-438.
- The Apley Scratch Test: This test involves two steps. First, reach your right hand over your shoulder and down your back, as if you’re trying to scratch it. Then, reach your left hand up your back to try and touch your right hand. Note how close your hands are. Repeat this test with the left arm reaching over the shoulder. If your hands are more than a few inches apart, you may have restricted shoulder mobility.
Performing these tests can give you a better understanding of your shoulder mobility. However, if any of these tests cause pain or if you notice a significant difference in mobility between your shoulders, it’s advisable to seek professional medical advice.
Research in the Journal of Orthopaedic & Sports Physical Therapy has shown that exercises to improve shoulder mobility, especially stretching and strengthening routines, can significantly decrease shoulder pain and improve function.18McClure, P. W., Bialker, J., Neff, N., Williams, G., & Karduna, A. (2004). Shoulder function and 3-dimensional scapular kinematics in people with and without shoulder impingement syndrome. Physical Therapy, 84(8), 720-735. We will discuss these strategies in more detail in the following section.
Practical Steps to Alleviate Shoulder Pain
Taking care of your shoulders involves more than just addressing the immediate pain. It’s about making sustainable changes to your lifestyle, posture, and exercise routine to improve shoulder mobility and overall health. Here are some practical steps you can start implementing right away.
1. Posture Correction
Your posture during everyday activities can significantly alleviate shoulder discomfort.
- Workstation Setup: Ensure that your workstation promotes a healthy posture. Your computer screen should be at eye level, your chair should support your lower back, and your keyboard and mouse should be positioned so that your elbows are at a 90-degree angle. According to a study in Applied Ergonomics, an ergonomically optimized workspace can significantly reduce musculoskeletal discomfort in the neck and shoulders.19Robertson, D. G. E., Caldwell, G. E., Hamill, J., Kamen, G., & Whittlesey, S. N. (2013). Research methods in biomechanics. Human Kinetics.
- Regular Breaks: Avoid staying in the same position for extended periods. Take regular breaks to move around and stretch your body. A short break every 30 minutes can help relieve muscular tension and promote better posture.
- Mindful Technology Use: Be aware of your posture when using smartphones or tablets. Try to hold the device at eye level to avoid straining your neck and shoulders. Also, consider using voice dictation or a phone stand to reduce the time spent hunched over your device.
2. Shoulder Mobility Movements
Incorporating shoulder mobility exercises into your daily routine can help enhance flexibility and reduce the risk of shoulder pain. Always consult a healthcare professional before starting a new exercise routine.
- Doorway Stretch: Stand in an open doorway, place your hands at shoulder height on either side of the door frame. Step forward until you feel a gentle stretch in your chest and shoulders. Hold for 20-30 seconds and repeat 3-5 times.
- Pendulum Exercise: Lean forward and let one arm hang down. Swing your arm gently in small circular motions, then gradually increase the size of the circles. Do this for about 30 seconds, then reverse the direction. Repeat with the other arm.
- Across-The-Chest Stretch: Bring one arm across your body at shoulder height and use your other arm to pull it closer to your chest. You should feel a stretch in your shoulder. Hold for 15-30 seconds and repeat 3-5 times on each side.
3. Shoulder Mobility Exercises
In addition to improving shoulder mobility, strengthening the muscles that support your shoulder can help prevent injury and pain. A systematic review in the British Journal of Sports Medicine suggests that resistance training can effectively reduce shoulder pain.20Steffens, D., Maher, C. G., Pereira, L. S., Stevens, M. L., Oliveira, V. C., Chapple, M., Teixeira-Salmela, L. F., & Hancock, M. J. (2016). Prevention of Low Back Pain: A Systematic Review and Meta-analysis. JAMA Internal Medicine, 176(2), 199-208.
- Wall Push-Ups: Stand a few feet away from a wall, place your hands on the wall at shoulder height. Lean forward, bending your elbows until your chest is close to the wall. Push back to the starting position. Repeat 10-15 times.
- Shoulder Blade Squeezes: Stand or sit with your back straight. Pull your shoulder blades down and back, as if you’re trying to make them touch. Hold for 5 seconds, then relax. Repeat 10-15 times.
- Resistance Band Rows: Hold a resistance band with both hands. Keep your arms straight in front of you. Pull the band towards your chest by bending your elbows and squeezing your shoulder blades together. Slowly return to the starting position. Repeat 10-15 times.
4. Regular Resistance Training
The above stretches and exercises help improve shoulder mobility and engage the various muscles supporting the joint, but they don’t make your shoulder strong.
To build and maintain muscle and strength into old age, you must consistently strength train. Of course, it’s also possible to develop shoulder pain from your resistance training program, in part because of pre-existing postural and mobility issues and sometimes due to overuse.
As I explained at the beginning, I hear from clients about various joint pains most often in the spring and early summer, when people begin doing gardening and home projects. Often, their bodies were fine and recovering well from their workout programs, but as they add the additional manual labor work to their weekly schedules, overuse injuries increase.
5. Supplements to Reduce Pain and Improve Shoulder Health
As part of a healthy diet, certain dietary supplements may aid in the reduction of shoulder pain and promote joint health. It’s important to note that you should always consult a healthcare professional before starting any supplement regimen.
- Omega-3 Fatty Acids: Renowned for their anti-inflammatory properties, Omega-3 fatty acids may help reduce pain and stiffness in the shoulder joint. A study in the Journal of the International Society of Sports Nutrition found that omega-3 supplementation could reduce joint pain and improve function in individuals with shoulder discomfort.21Lembke, P., Capodice, J., Hebert, K., & Swenson, T. (2014). Influence of omega-3 (n3) index on performance and wellbeing in young adults after heavy eccentric exercise. Journal of the International Society of Sports Nutrition, 11(1), 1-9.
- Glucosamine and Chondroitin: These two compounds are often taken together to alleviate joint pain. They are believed to slow down joint degeneration and promote cartilage health, thereby relieving pain and improving mobility in the shoulder.22Gregori, D., Giacovelli, G., Minto, C., Barbetta, B., Gualtieri, F., Azzolina, D., Vaghi, P., & Rovati, L. C. (2017). Association of Pharmacological Treatments With Long-term Pain Control in Patients With Knee Osteoarthritis: A Systematic Review and Meta-analysis. JAMA, 318(24), 2485-2494.
- Vitamin D: Vitamin D deficiency is linked with musculoskeletal pain, including shoulder discomfort. Ensuring you have adequate Vitamin D intake, either through sunlight exposure or supplements, could help enhance your shoulder health.23Shipton, E. A., & Shipton, E. E. (2015). Vitamin D and pain: Vitamin D and its role in the aetiology and maintenance of chronic pain states and associated comorbidities. Pain Research and Treatment, 2015.
- Turmeric (Curcumin): Known for its potent anti-inflammatory and antioxidant properties, turmeric, specifically its active compound curcumin, may help alleviate shoulder pain when taken regularly.24Daily, J. W., Yang, M., & Park, S. (2016). Efficacy of turmeric extracts and curcumin for alleviating the symptoms of joint arthritis: a systematic review and meta-analysis of randomized clinical trials. Journal of medicinal food, 19(8), 717-729.
- Collagen: Collagen, a major component of connective tissues, may help improve joint health and alleviate pain. A study in the American Journal of Clinical Nutrition showed that collagen supplementation can reduce activity-related joint pain in athletes.25Clark, K. L., Sebastianelli, W., Flechsenhar, K. R., Aukermann, D. F., Meza, F., Millard, R. L., Deitch, J. R., Sherbondy, P. S., & Albert, A. (2008). 24-Week study on the use of collagen hydrolysate as a dietary supplement in athletes with activity-related joint pain. Current medical research and opinion, 24(5), 1485-1496.
- Boswellia Serrata: Also known as Indian frankincense, Boswellia serrata has been used for centuries in traditional medicine to treat chronic inflammatory conditions. Research in the journal Phytomedicine showed that it could be effective in reducing joint pain and improving mobility.26Sengupta, K., Kolla, J. N., Krishnaraju, A. V., Yalamanchili, N., Rao, M. K., Golakoti, T., Raychaudhuri, S., & Raychaudhuri, S. P. (2010). Cellular and molecular mechanisms of anti-inflammatory effect of Aflapin: a novel Boswellia serrata extract. Phytomedicine, 17(11), 862-867.
- Methylsulfonylmethane (MSM): This organic sulfur compound is believed to have anti-inflammatory properties and can reduce pain and improve physical function in osteoarthritis, a common cause of shoulder pain.27Debbi, E. M., Agar, G., Fichman, G., Ziv, Y. B., Kardosh, R., Halperin, N., Elbaz, A., Beer, Y., & Debi, R. (2011). Efficacy of methylsulfonylmethane supplementation on osteoarthritis of the knee: a randomized controlled study. BMC complementary and alternative medicine, 11(1), 50.
- Vitamin C: Essential for collagen formation, Vitamin C is necessary for healthy joints. A deficiency in this vitamin can weaken your connective tissues and make your joints more prone to damage and pain.28Carr, A. C., & Frei, B. (1999). Does vitamin C act as a pro-oxidant under physiological conditions? FASEB journal : official publication of the Federation of American Societies for Experimental Biology, 13(9), 1007-1024.
- Ginger Extract: Known for its anti-inflammatory properties, ginger extract may help reduce joint pain. A study published in Arthritis & Rheumatism found that ginger extract could reduce pain and stiffness in individuals with osteoarthritis.29Altman, R., & Marcussen, K. (2001). Effects of a ginger extract on knee pain in patients with osteoarthritis. Arthritis & Rheumatism, 44(11), 2531-2538.
6. Alternative Therapies
In addition to conventional methods, alternative therapies can also offer relief from shoulder pain and improve shoulder mobility.
- Physical Therapy: A physical therapist can provide individualized exercise programs to enhance your shoulder strength and mobility. Techniques like manual therapy and hydrotherapy can also be used to alleviate pain and restore function.30Page, P., Green, S., Kramer, S., Johnston, R., McBride, P., Chau, C., … & O’Connor, D. (2012). Manual therapy and exercise for adhesive capsulitis (frozen shoulder). Cochrane Database of Systematic Reviews, (8), CD011275.
- Massage Therapy: Regular massages can help release muscle tension, improve circulation, and enhance shoulder mobility. A study in the Journal of Alternative and Complementary Medicine showed that massage therapy significantly reduced pain and improved function in patients with shoulder pain.31Munk, N., & Zanjani, F. (2011). Massage Applications for Pain Management. Pain Management, 1(3), 233-245.
- Acupuncture: This traditional Chinese therapy uses thin needles to stimulate specific points in the body. Some research suggests that acupuncture can be an effective treatment for chronic shoulder pain.32Fu, Z., Liu, Y., Zhang, J., Xie, F., Lv, Q., Lu, L., Li, K., Liu, B., & Liu, J. (2019). Acupuncture on treating chronic shoulder periarthritis: A randomized controlled trial. Journal of Traditional Chinese Medicine, 39(1), 1-8.
- Mind-Body Techniques: Techniques such as yoga, tai chi, and mindfulness meditation can help manage pain, improve flexibility, and reduce stress, thereby enhancing overall shoulder health.33Lauche, R., Langhorst, J., Dobos, G., Cramer, H. (2016). A systematic review and meta-analysis of Tai Chi for osteoarthritis of the knee. Complementary Therapies in Medicine, 25, 1-6.
Remember, these are complementary approaches to a comprehensive shoulder pain relief plan. They’re most effective when used in conjunction with a healthy lifestyle, posture correction, and a tailored exercise routine.
In the bustling pace of today’s world, it’s easy to overlook a little shoulder discomfort. However, understanding the complexities of the shoulder joint and the impact of posture and mobility on shoulder health can shift our perspective on that ‘little’ discomfort.
Your shoulders are an integral part of nearly every movement you make, and shoulder pain can significantly affect your daily activities, sleep quality, and overall wellbeing. Taking early and proactive steps to address the issue is paramount.