I often get people who come and see me at work that are experiencing pain around their shoulder. They're not necessarily suffering 'injuries' in the common sense of the term. For example, there's been no accident or major trauma that might cause them to be sore.
These people are office workers, labourers and general gym-goers who're experience pain and stiffness around their neck and shoulders.
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It's no easy issue to tackle, and I always recommend following up with a specialist. That being said, there are many interesting points about the shoulder most people don't realise.
If we understand these, it can become easier to understand what might be causing shoulder pain and how to fix it.
Your shoulder joint - interesting in its design
You and I have 3 bones in each shoulder. Namely the clavicle (collarbone), scapula (shoulder blade) and humerus (bone in your upper arm).
Additionally, surrounding the bones are a whole range of muscles, tendons and ligaments.
What's interesting about the shoulder is the socket, or rather the lack of a proper socket. Most other joints in your skeleton (the joints that are designed to move anyway) have a socket or capsule where the bones meet.
Think of your hip, for example. There is a deep socket in your pelvis into which the ball of your femur sits securely.
Conversely, in your shoulder, the ball of your arm bone has no deep cavity to sit in. The scapula is a relatively flat bone, with just a curved indentation rather than a socket. Essentially, your arm bone moves against a flat surface of your shoulder blade.
Hardly any connection at all
It might surprise you to know that your whole shoulder is barely connected to the rest of your skeleton.
The only bony connections between your shoulder and your skeleton are via your collarbone. At the tip of your shoulder is your acromioclavicular joint. Most physios, physical therapists and trainers may refer to this as your AC joint. The is at the lateral end of your clavicle.
At the other end of your collarbone, the medial end, you'll find a connection to the sternum. Just at the base of your neck, your collarbone attaches to your breastbone.
These loose connections result in the shoulder joint being one of the most mobile in your body. At least it should be anyway. That's what it's designed to do - move. We want to be able to move our arms in almost any direction. The free movement of our shoulder girdle allows this.
Your shoulder joint relies on its surrounding muscles
Moreso than any other joint in your body.
Like we said, your shoulder is barely attached to the rest of your body. 8 muscles have an important part to play in allowing your shoulder to move. These same muscles also must make sure the joint stays stable.
A tough task, which is why a lot of shoulder pain is a result of strains to these muscles.
Knowing what's causing shoulder pain is the first step in fixing it
Due to the intricacies of the joint design mentioned earlier, there are several factors to consider when tackling shoulder pain.
Any issues in one or more of the individual parts can cause you to feel pain in your shoulder.
One of the easiest things you can do to understand your shoulder pain better is to identify exactly what part of your shoulder hurts. For example, is the pain at the front, the back or 'inside' the shoulder. Is it coming from the surface or does it feel deeper down? Are you feeling it more towards the midline of your body, or more towards the outside?
Answers to these questions may help you suss out exactly where the problem lies.
Shoulder pain is actually really common
In the US, nearly 8 million people visit their GP for something shoulder-related each year.
The majority of these problems involve issues with the rotator cuff. You're probably heard of your rotator cuff before, but you might not know exactly what or where it is.
Your rotator cuff is essentially a group of 4 muscles whose job is to keep the humerus in the right place relative to the scapula. They're only relatively small muscles, each about the size of a finger.
These muscles act to stabilize the bones in your shoulder. Additionally, they enable you to be able to lift your arm and reach overhead.
Injuries to your rotator cuff are often caused by pulling on objects too quickly. Similarly, when things we're holding rotate at awkward angles, your rotator cuff takes the brunt of the force. Thirdly, just general overuse is often the culprit.
It's easy to see then why sports are a common cause of shoulder injuries. Things happen quickly. Objects get pulled, thrown and pushed. Body parts twist and turn in reaction to what's happening with our hand.
Your rotator cuffs have a hard job in keeping your arm bone in the right place. Sometimes they just get pushed to hard and can't cope, resulting in shoulder pain.
Your shoulder is the most mobile joint in your body, probably
At least it should be. If you're suffering from shoulder pain, or have underlying issues then it's likely you won't be able to move your arm the way you'd like to.
Think of all the ways your arm is supposed to move.
We can bring lift it up and down. It can rotate inwards and outwards. We can reach out in front, off to the side, up high or down low. We can even lift our whole arm in a shrugging movement.
Your shoulder is truly a 3D joint - it can move in all planes of direction.
As a result, it's more susceptible to injury. Also, when dealing is a problem, it can make it harder to treat. We have to get the shoulder back to moving the way it should so the joint can function properly. This can take a lot of time to ensure we're not causing more pain.
There can be a huge range of causes of shoulder pain
It's important to be aware of many factors that may point to an underlying cause.
You might be experiencing something mild, or possibly a more severe issue. Consider the following issues:
- tendonitis
- muscle strain
- frozen shoulder
- rotator cuff tears
- bursitis
- osteoarthritis
- dislocation
- subluxation
Given the sheer number of reasons why your shoulder pain may exist, there is often no quick fix. That's why it's important to see a specialist, or someone appropriately trained like a physio or sports doctor who can help you pinpoint the cause. They'll also be able to formulate a suitable treatment plan for your specific issue.
Surgery is often not the answer
You can be forgiven for thinking if you've got a problem with your shoulder, you need surgery.
In the case of severe trauma, then yes, that's probably a good choice. As a general rule though, most people don't need surgery.
Modern medical practice encourages conservative treatment with an action plan geared towards rehabilitation and recovery. The old RICE acronym - rest, ice, compression & elevation will often be your first port of call.
Gradual return to physical activity, or sport, can be discussed with your specialist. Usually, you'll have a well-designed recovery program including stretching, strengthening and mobility exercises to follow.
Often, you'll find that by following your therapists plan you'll have a shoulder which functions much better and gives you a lot less pain.
An age-old problem
As we get older, the likelihood we develop osteoarthritis increases. This is particularly true in our shoulders. A lifetime of moving our arms can take its toll.
Although common, osteoarthritis isn't considered a 'normal' part of ageing. That is to say, it doesn't have to be inevitable just because we get older.
As individuals age, their likelihood of developing osteoarthritis of the shoulder significantly increases. In fact, osteoarthritis, which is a degenerative condition that affects the smooth cartilage on the end of a bone, is the most frequent cause of disability in the United States. It is not considered a normal part of the ageing process. It can, however, be quite debilitating and impact a person’s ability to perform routine activities of daily living, including the ability to sleep.
Keeping your shoulders strong and healthy will give you a better quality of life
Shoulder pain can interfere a lot in our day-t0-day activities. It can become debilitating if we let it. Your routine activities from walking the dog to brushing your teeth can become inhibited.
Even our ability to sleep gets questioned. If we are unable to lie in certain positions it can be difficult to stay comfortable.
It's not all doom and gloom though. Most cases of shoulder pain are resolved once we identify the underlying causes. If we look after our bodies, they will reward us with a long and happy, pain-free life.
