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9 Expert Tips for Shoulder Pain
By: Dr. Anna Staehli Wiser, DPT, FAAOMPT
The shoulder joint is one of the most mobile joints in the body. Mobility at this joint is very important for being able to do things like reach across your body to put on your seatbelt, reach behind you to tuck in your shirt, and reach overhead to retrieve dishes from the top shelf. Having so much mobility can put this joint at risk for injury. In order to attain such high levels of mobility, the glenohumeral (shoulder) joint must be somewhat shallow as compared to other ball and socket joints in the body such as the hip. The shallow nature of this joint allows for increased mobility, but at the sacrifice of stability, and so it relies heavily upon muscle strength to maintain alignment. If there is a muscle imbalance around the shoulder, wear-and-tear can start to occur. Wear-and-tear injuries can occur gradually over time and may not be related to a specific incident.
If you are experiencing nagging pain in your shoulder, there are some common themes in regards to the types of muscle imbalances and postural problems that need to be corrected. Most people with Insidious nagging shoulder joint pain will have problems with 1.) poor flexibility of the posterior and inferior shoulder including the muscles and ligaments, 2.) tightness in the pectoralis and biceps, 3.) weakness in the middle and lower trapezius, rotator cuff, and serratus anterior, 4.) joint restrictions affecting the upper ribs, thoracic spine, and lower cervical spine, and 5.) forward head and rounded shoulder posture. Specific exercise to address all of the above-mentioned impairments are very effective in reducing pain and restoring shoulder function.
1. Sleeper Stretch: The sleeper stretch is a great way to stretch out tight muscles in the posterior shoulder1. Although it is effective, it can be painful initially, and so therapeutic interventions may need to come first before this exercise is tolerated.
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2. Latissimus Dorsi Stretch: Just about everybody has some tightness in the latissimus and could benefit from stretching this area. The latissimus is a very strong muscle which anchors itself along the iliac crest of the pelvis and courses up the lateral torso to insert on the proximal humerus. It contributes to strength and stability of the torso and shoulder. When this muscle becomes tight it can be a major inhibitor to reaching overhead. This can be a difficult muscle to stretch out initially if there is impingement with overhead motion. This stretch may have to come in later along in the rehab process when pain is not as much of a factor.
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3. Rotator Cuff Strengthening2: Rotator cuff strengthening exercises, if done in the right way can have a regenerative effect on injured muscles and tendons. High repetitions and low resistance is the key for rehabilitating an injured rotator cuff. In the early phase of rehab, the resistance should be low enough that you can perform 20 to 30 reps and 3 sets. As your pain diminishes and you feel stronger, you can increase the resistance so that you are performing 10 to 15 reps and 3 sets with adequate fatigue.
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4. Chest and Biceps Stretch3: Postural issues as well as daily routines can lead to muscular imbalance with tightness of the pectoralis and biceps muscles in the front of the body and weakness of the posterior muscles such as the middle and lower trapezius and posterior rotator cuff. Stretching out the pecs and biceps can be difficult initially because some of the traditional stretching methods for these muscle groups can put the shoulder in a position that is uncomfortable.
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5. Posterior Scapula Strengthening4,5: Lying face down, raising the arms, and squeezing the shoulder blades from various positions is one of the best ways to strengthen the upper back with no equipment needed. As with other exercises, keep your range of motion in the pain-free zone. Technique is important here - keep the shoulders down and back, the neck straight, and do not lift the arms beyond the plane of your body. This will keep your shoulders safe from impingement as you go through these exercises.
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6. Thoracic Mobility Exercises6,7: Many people with shoulder problems tend to have stiffness through the thoracic spine and ribs. This will have an influence on shoulder pain due to regional interdependence between the thoracic spine, ribs, and shoulder joint. One of the best ways to loosen up this area is through rolling on a foam roller and doing some thoracic rotation stretches.
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7. Serratus Anterior Strengthening: The serratus anterior is a very important stabilizer of the shoulder blade and is often overlooked during shoulder rehab. Ways to strengthen this muscle include weight bearing through the arms such as with planks or push-ups. Not everyone can tolerate planks and push-ups, especially early on when the shoulder really hurts, and this exercise may have to be modified.
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8. Posture Correction3: Slouched posture with rounded shoulders is really the root of all evil when it comes to chronic shoulder problems. When you're sitting, use a lumbar support cushion and keep your computer monitor at eye level. Avoid looking down at devices for prolonged periods. It is the rounded-shoulder, slouched position that sets us up for muscle imbalances over time, and if not addressed, will lead to neck pain, headaches, shoulder impingement, back pain - and it just plain looks bad!
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9. Sleeping Position: Using your arm as a pillow, or bolstering your pillow with your arm under it puts the shoulder into an end range position which can impinge on the soft tissues in between the bones and create irritability and inflammation. Done night after night, and this alone can cause subacromial impingement syndrome. Use extra pillows, a folded towel under the neck, or a contour pillow to get your neck comfortable without using your arm as a support.
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All of these exercises should be done without increased joint pains in the shoulder. After doing them for 2-4 weeks, there should be a noticeable improvement in the way the shoulder is feeling. Of course, if pain persists, then an evaluation by your physical therapist is recommended. Although many of the same exercises can be effective, each person has their own unique set of impairments and challenges that may require one-on-one attention from a healthcare professional. Dr. Anna will identify the specific impairments that are unique to your situation and then provide comprehensive treatment tailored just for you. Spinal manipulation of the cervical, thoracic, and adjacent ribs, soft tissue massage, and dry needling are all treatments that can be extremely helpful in getting pain under control so that you can start rehabilitation exercises. Click the link below to read the research and learn more:
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Although spinal manipulation is usually thought to be synonymous with chiropractic care, osteopractic physical therapists and osteopathic doctors are trained in spinal manipulation as well. Soft tissue massage is usually thought to be exclusively performed by massage therapists, but this is a technique that the osteopractic physical therapist is also well trained in. Lastly, dry needling is very similar to acupuncture in that both techniques employ the insertion of acupuncture needles and share the goal of promoting healing and reducing pain.
References:
1. Tahran Ö, Yeşilyaprak SS. Effects of Modified Posterior Shoulder Stretching Exercises on Shoulder Mobility, Pain, and Dysfunction in Patients With Subacromial Impingement Syndrome. Sports Health. 2020;12(2):139-148.
2. Singh H, Thind A, Mohamed NS. Subacromial Impingement Syndrome: A Systematic Review of Existing Treatment Modalities to Newer Proprioceptive-Based Strategies. Cureus. 2022;14(8):e28405.
3. Chang MC, Choo YJ, Hong K, Boudier-Revéret M, Yang S. Treatment of Upper Crossed Syndrome: A Narrative Systematic Review. Healthcare (Basel). 2023;11(16). doi:10.3390/healthcare11162328
4. Ravichandran H, Janakiraman B, Gelaw AY, Fisseha B, Sundaram S, Sharma HR. Effect of scapular stabilization exercise program in patients with subacromial impingement syndrome: a systematic review. J Exerc Rehabil. 2020;16(3):216-226.
5. Abd El-Azeim AS, Mahmoud AG, Mohamed MT, El-Khateeb YS. Impact of adding scapular stabilization to postural correctional exercises on symptomatic forward head posture: a randomized controlled trial. Eur J Phys Rehabil Med. 2022;58(5):757-766.
6. Dunning J, Butts R, Fernández-de-Las-Peñas C, et al. Spinal Manipulation and Electrical Dry Needling in Patients With Subacromial Pain Syndrome: A Multicenter Randomized Clinical Trial. J Orthop Sports Phys Ther. 2021;51(2):72-81.
7. Hunter DJ, Rivett DA, McKiernan S, Luton R, Snodgrass SJ. Thoracic Manual Therapy Improves Pain and Disability in Individuals With Shoulder Impingement Syndrome Compared With Placebo: A Randomized Controlled Trial With 1-Year Follow-up. Arch Phys Med Rehabil. 2022;103(8):1533-1543.
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