Are you experiencing shoulder discomfort or pain?
Surprisingly, it’s one of the most common forms of injury to suffer from and daily. Thousands of people struggle to get a good night’s sleep because of agonising shoulder pain. Even regular gym goers and athletes are suffering and some struggle to complete overhead exercises without feeling pain.
By understanding how the shoulder works, you’ll understand what is causing your pain and this is the most critical aspect to treating any shoulder injury. Once you know the mechanics of the shoulder, you’ll understand how specific scientifically backed exercises will help to reduce the debilitating pain you’ve been suffering from.
The shoulder is a ball and socket joint, which is intended to have large amounts of movement. Imagine a golf ball and tee – that’s what the bony design of the shoulder is essentially like. The long bone in your upper arm, which runs from the elbow to the shoulder, is the humerus. The head of the humerus is the golf ball, and when the arm is moving around this needs to be supported within the tee, which is known as the glenoid fossa. If this doesn’t happen, then the golf ball slides around inside of the shoulder joint causing irritation and sometimes a pinching sensation as it presses against the different structures of the inner shoulder.
Night pain is one of the most frustrating and common symptoms of shoulder irritation. At night, the tendons at the front of the shoulder, which have been irritated by your activities throughout the day, have a chance to rest and rehydrate. Unfortunately, the rehydration causes the joint to swell and consequently, this causes the pain levels to increase and when you’re trying to sleep. This can become unbearable.
Now that you understand the main aim for the shoulder is to stabilize the head of the humerus inside of the socket (think of the golf ball and tee), let’s look at the reasons why so many people fail to prevent injury to their shoulders.
For such a complex joint, shoulder injuries are relatively simple and evidence shows that approximately 95 % of shoulders are deficient in at least one of three areas.
The culprits are:
- Poor shoulder position
- Poor scapular movement
- Poor rotator cuff activation and/or strength
1. Poor shoulder position
Our modern lifestyles cause us to spend 95 % of our day in a forward’s posture, or hunched position. Everything we do is in front of us, whether it’s at the gym doing forward facing activities like bench press or at work hunched over a computer or desk. This type of posture puts the shoulder into a poor position. It forces the shoulder joint forwards and downwards, which closes the space at the front of the shoulder and causes the head of the humerus (golf ball), to slide forwards. This becomes evident when you move your arms up to the side, or into an overhead position.
You have tendons which attach muscle to bone and bursa’s, which are small fluid filled sacks, that lie under a tendon to cushion them, in the shoulder space and because of the forwards translation of the head of the humerus, it causes them to become irritated. One of the common diagnosis is ‘bursitis’, this is the inflammation of the bursa. This diagnosis, is not one that I particularly like as there are many reasons for the bursa to become inflamed, I must become detective and use my extensive investigatory skills to identify the cause, allowing me to fix it.
Overtime, your shoulder position is at risk of becoming worse, causing an increase in forwards translation of the head of the humerus. The head continues to slide forwards and irritates the tendons and bursae at the front of the shoulder and unfortunately, the irritation correlates to night pain.
2. Poor scapular movement
Poor scapular movement and poor shoulder positioning go hand in hand. When shoulders are positioned poorly, they struggle to move in the way that they should.
The shoulder blade, called the scapular, should upwardly rotate as you raise your arm. Without the rotation, compensation strategies occur. Instead of rotation, the shoulder can shrug upwards or even rotate forwards to gain that last bit of lift. Some of the key muscles that limit the correct movement of the scapular are your lats (downward rotation of the scapular), pec minor (pull the shoulder anteriorly) and teres major (pulls the arm medially and scapular downwards).
If you want to test your scapular movement, sit with your back up against a wall and bring your arms straight up in front of you until they touch the wall. They should both be able to touch the wall and feel the same. If they don’t, this indicates a problem with your scapular movement.
3. Lack of rotator cuff activation and/or strength
The main role for the rotator cuff is to stabilize the head of the humerus (golf ball), in the socket (tee) throughout the arm movement. Without this activation or strength, the head of the humerus can slide forwards and once again, cause issues to the structures at the front of the shoulder. When exercising, many of us go straight to heavy weights and we forget to activate these muscles. Overtime, this leads them to become inactive and causes the shoulder to become ‘unstable.’
Another reason why these muscles can become weak/inactive, is because some of the rotator cuff tendons which run through to the front of the shoulder become irritated. Once irritated, they become weak and inactive causing the head of the humerus to slide forwards even more. You can see it is a nasty cycle that keeps repeating and getting worse.
One of the biggest issues I encounter in my professional practice, is the disastrous attitude of ‘It will just get better.’ This couldn’t be any further from the truth, which is why I’ve taken the time to explain it to you.
Here are my five top exercises that you can easily do today to help reduce your shoulder pain.
1. Shoulder dislocates
As bad as the name sounds, this exercise is a great way to get some movement into the shoulder. If your pain is greater than 5/10 I would suggest using a massage ball to release some of the tight muscles or visiting your healthcare professional.
2. Thread the needle
A classic, but around for such a long time because it’s highly effective. This should be a staple exercise in any shoulder rehab program.
3. Overhead kettle bell carries
Using a light kettle bell, this exercise adds in a more dynamic scapular stabilization and, some rotator cuff activation.
Grab onto the handle of the kettle bell and bring your arm up into a 90-degree shoulder and elbow flexion, so the kettle bell is nearly in front of your eyes
4. Breast stroke on an exercise ball
A great exercise to target your mid back and gain some thoracic extension
5. Supported dumbbell reverse fly
One of my favourite gym based exercises to build posterior shoulder strength.
Although shoulder injuries are one of the most common forms of injuries in the athletic population and in particular when, completing an overhead exercise or the bench press, it can be night pain that effects people the most. By understanding how the shoulder moves and incorporating a few effortless and simple exercises, you can massively reduce the pain, if not eliminate it. Also improving your lifts and gym workouts is an added bonus!