As a chiropractor, I frequently encounter patients struggling with shoulder pain and stiffness. This common issue can be debilitating, affecting your ability to perform basic tasks such as dressing, and compromising your quality of life. Today, we will delve into the primary causes of shoulder pain, why they often happen and discuss some exercises that can help alleviate discomfort.

Causes of Shoulder Pain

Shoulder pain can stem from various sources, such as inflammation from overuse, trauma, or degenerative diseases. The complex structure of the shoulder, which is composed of numerous joints, tendons, and muscles, leaves it vulnerable to a wide array of problems. Additionally, the incredible range of motion the shoulder possesses comes with the trade-off of less stability compared to other joints. The following are the most common reasons for shoulder pain:

1. Rotator Cuff Injuries: The rotator cuff is a group of muscles and tendons that stabilize the shoulder. The shoulder is a ball and socket joint with a very shallow socket, so these muscles are crucial for keeping the shoulder in a balanced and neutral position. Overuse or acute injury (including dislocation) can cause tendinitis, strains, or tears in the rotator cuff, leading to pain and weakness.  Overuse is the most common cause of rotator cuff injury and causes an imbalance in the muscles that pull forward and backward as well as up and down. This changes the starting position of the shoulder for all arm movements and can wear on tendons and muscles over time. This is commonly job related, as our jobs are usually quite repetitive. When shoulders begin hurting without a known cause, this is frequently the culprit.  Fortunately, these injuries respond very well to conservative care.
2. Frozen Shoulder (Adhesive Capsulitis): This condition involves stiffness and pain in the shoulder joint, often worsening over time and then gradually resolving, typically over a year or more. This often occurs after prolonged immobilization due to injury or surgery. For example, an injury that kept you from using your full range of motion due to pain while healing occurred. You may find you have lost a portion of your movement even when the other positions of your shoulder are now pain free. These occasionally spontaneously resolve, but take a long time. Conservative care is best to start with surgery occasionally becoming necessary.
3. Arthritis: The most common form, osteoarthritis, typically affects people over 50 years of age. It is a degenerative disorder that results from wear and tear over time, causing pain and limiting movement. This is a bony change to the structures of the shoulder and does not respond as well to conservative treatment. There are 3 types of shoulder anatomy and depending on the shape of joints, history of use, and history of injury, some people will be more likely to degeneration. The two joints affected are the Acromioclavicular joint and the glenohumeral joint. This type of pain responds the least well to conservative care, however, improved movement is often helpful.
4. Bursitis: Bursae are small fluid-filled sacs that cushion the bones, tendons, and muscles near your joints. Overuse or repetitive motions can inflame these sacs, leading to pain and discomfort. The irritation is usually due to increased pressure on the bursae, often due to muscular  imbalances in the rotator cuff. Treatment to improve bursitis would include conservative care similar to that for the rotator cuff, as well as icing to assist with inflammation.            

Understanding the cause of your shoulder pain is critical for effective treatment. Treating the incorrect area not only delays relief, it can allow smaller more easily fixable issues to turn into something worse. Consulting a healthcare professional, like a chiropractor, can provide an accurate diagnosis and personalized treatment plan to return you to moving well and pain free.

Exercises for Shoulder Pain Relief

In conjunction with chiropractic treatment, soft tissue work and dry needling, certain exercises can help strengthen your shoulder muscles, enhance flexibility, and alleviate pain. The following exercises are for information and to help generally. As always, remember to consult your healthcare provider before starting any new exercise regimen.

1. Soft tissue mobility: This is an easy at home way to mobilize some of the tight tissues, release tension, and get some range of motion returned. We typically like to use a lacrosse ball, but a tennis ball or other massage ball will work as well. TIP: If you have trouble getting the ball in the correct area, put it in a sock and hang it where it is supposed to be.  A video from our office can be found here and here. 
2. Scapular Mobility: The shoulder blade (or scapula) is an integral part of shoulder movement and stability. Many of the muscles of the rotator cuff attach here. Ensuring proper stability and movement of the shoulder blade can alleviate many overuse type shoulder pains. The following video has 2 at home movements that can be done with no equipment. 
3. Pendulum stretch: Stand beside a table, lean forward slightly, and allow the affected arm to hang down. Swing the arm in a small circle – about a foot in diameter. Perform 10 revolutions in each direction, several times daily. This is more helpful for frozen shoulders than the other types of issues as it gently attempts to add range of motion without pressure. 
4. Shoulder stability: Stand facing a wall at an arm’s length. Place your palms on a ball on the wall at shoulder height. Begin with clockwise and counterclockwise circles that become increasingly larger. Repeat 15 times, twice a day. Here is a perfect example. This video shows an exercise ball, but a smaller (but still light) ball could be substituted. 
5. Shoulder strengthening: Hold a resistance band with one hand with your side to the wall. Keep your wrist at waist level to begin. There are several versions of this for different muscles in the rotator cuff. They can be seen here, here, and here. Repeat 10 times, twice a day. You will need a light to medium resistance band for these exercises.

Regularly performing these exercises can help improve shoulder mobility, strength, and function. However, it’s important to listen to your body. If an exercise causes pain, it’s best to stop and consult your healthcare provider. Also remember that pain is typically one of the last symptoms to show up. If pain improves, but your movements are still not symmetrical or smooth, continuing or following up with a musculoskeletal provider would be best.

At Integrated Health Solutions, we take a functional rehabilitative approach to shoulder care. By focusing on the lost and incorrect motions, we are able to address the primary cause of pain and re-engage the musculature that is not performing optimally. This type of care has longer lasting results, as it commonly alleviates pain, and also protects the area from future reinjury due to continued overuse and misuse.

Conclusion

Shoulder pain is a common complaint, but understanding its causes and adopting the right exercise regimen can significantly aid in managing and relieving the discomfort. Regular, gentle exercises that maintain balance in the joint can keep your shoulder joint flexible and strengthen the muscles that support it, reducing the likelihood of future injuries.

In conjunction with exercises, functional chiropractic care can play a crucial role in shoulder pain relief. Commonly, mid back tension is linked with shoulder pain. Chiropractic adjustments can help align your body properly, relieving pressure, reducing inflammation, and promoting healing. Other modalities such as soft tissue (fascial) work and dry needling might also be incorporated into the treatment plan for faster and more complete results.

Remember, consistency is key when it comes to exercise, especially in the beginning. Performing these exercises and stretches once a week will not have the same effect as daily. However, any sudden increase in pain or new symptoms should be immediately reported to your healthcare provider. It’s also worth noting that while exercises and chiropractic care can alleviate many cases of shoulder pain, some conditions may require additional medical treatment, including injections or surgery.

In conclusion, shoulder pain can be a hindrance, but it doesn’t have to dictate your life. Through a combination of understanding, targeted exercises, and professional care, you can navigate your way to relief and regain the freedom of movement you once enjoyed. The vast majority of shoulder pain can be improved with conservative care.

Content provided by Dr. Elizabeth Bouse

References

1. Johns Hopkins Medicine. (n.d.). Rotator cuff injuries. https://www.hopkinsmedicine.org/health/conditions-and-diseases/rotator-cuff-injuries
2. Mayo Clinic. (2020, March 17). Frozen shoulder. https://www.mayoclinic.org/diseases-conditions/frozen-shoulder/symptoms-causes/syc-20372684
3. Arthritis Foundation. (n.d.). Osteoarthritis. https://www.arthritis.org/diseases/osteoarthritis
4. American Academy of Orthopaedic Surgeons. (2011, June). Bursitis. https://orthoinfo.aaos.org/en/diseases–conditions/bursitis/
5. Harvard Health Publishing. (2019, May). The best exercises for your shoulders. https://www.health.harvard.edu/shoulders/stretching-exercises-frozen-shoulder
6. American Academy of Orthopaedic Surgeons. (2010, December). Shoulder Pain and Common Shoulder Problems. https://orthoinfo.aaos.org/en/diseases–conditions/shoulder-pain-and-common-shoulder-problems/
7. NHS. (2019, April 23). Shoulder pain. https://www.nhs.uk/conditions/shoulder-pain/
8. Cleveland Clinic. (2020, August 11). 3 Best Exercises for Shoulder Pain. https://health.clevelandclinic.org/3-best-exercises-for-shoulder-pain/
9. Physiopedia. (n.d.). Shoulder Rehabilitation. https://www.physio-pedia.com/Shoulder_Rehabilitation

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