June 29th, 2021
If you’re experiencing shoulder pain, rest assured that you aren’t alone. In fact, about 70% of people will experience shoulder pain at some point in their life.
From a rotator cuff tear to impingement syndrome, shoulder pain can seriously get in the way of you enjoying your life, participating in physical activities, and achieving your fitness goals.
So, why does shoulder pain happen? And how can exercise help you overcome that nagging pain that just won’t quit and finally help you get back to the activities you love? We’re about to find out.
We are excited to announce the start to our mini series, which will dive deeper into anatomy and attempt to explain your aches and pains. Each blog will dive a little deeper into anatomy, movement, biomechanics and will include a few exercise tips to best help you.
The Shoulder: What Should You Know?
Did you know the shoulder is one of the most vulnerable joints in the human body? This is because it is a “ball-and-socket joint.” A strong and functional shoulder joint can be the most mobile joint in your body. A healthy shoulder can move in flexion (moving the arm straight above the head), extension (moving the arm behind your back), abduction(arm moves away from the body), adduction(arm moves toward the centre of the body), internal (shoulder rotates towards the belly button) and external rotation (shoulder rotates away from the belly button.
Your shoulders allow you to lift your arms straight over your head or swing your arms in a circular motion. And for some of the world’s greatest athletes, this means they can throw a 168 km/hour baseball pitch, and weight-lift 700+ pounds over their head!
For most people the shoulder is only needed for regular functional movements required for daily activities, such as reaching up onto a shelf, gardening, or lifting a loved family member.
The shoulder joint consists of various muscles, tendons, ligaments, bursa, and bones.
What we’ll look at today are the rotator cuff muscles – and how to strengthen them along with the shoulder girdle.
The shoulder girdle muscles and the rotator cuff must work together harmoniously. When they do this prevents injury and promotes longevity.
The Rotator Cuff Muscles
The rotator cuff consists of four main muscles which synergistically work together to keep the shoulder in its socket (head of the humerus bone in the gleno-humeral socket). They include the:
These muscles work together with the shoulder blades to keep your shoulder joint intact and stabilized through many different movements, including rotating the shoulder and moving the arm away from the body.
The shoulder has a few other notable anatomical features, such as the subacromial space. Which is an open space that sits above the ball and socket joint and becomes narrow during overhead movements.
There is also a bursa that sits inside each shoulder joint, and a healthy bursa will release lubrication into the shoulder joint (think Tin man), which will reduce friction between bones and create comfortable and pain-free movement.
Now that we’ve got a better idea of what’s going on beneath the surface, let’s take a look at common causes of shoulder pain. Why is your shoulder hurting?
What Causes Shoulder Pain?
The shoulder isn’t a simple joint – which means, pain in your shoulder can be due to several reasons.
Shoulder pain is commonly caused by:
- Repetitive overhead movement – without sufficient rotator muscle rest.
- General wear and tear – which leads to obstructive scar tissue. More times than not, wear and tear is accelerated if your rotator cuff muscles are imbalanced.
- And physical trauma – such as a fall.
Beyond these common reasons for pain – which for the most part can sort themselves out – with a regiment of PRICE combined with the right customized set of exercises and stretches to follow – sometimes the rotator cuff becomes injured.
Rotator Cuff Injuries
The rotator cuff can become injured, due to a strain by a fluke movement, or from chronic repetitive overuse and general neglect.
Sometimes people slip and/or fall onto an outstretched arm and this can result in a tear. A youthful shoulder has forgiving abilities, and you can keep yours by maintaining a flexible, long, strong and balanced rotator cuff.
Without properly preparing the body for activity it can be subjected to impingement syndrome which happens when the rotator cuff tendons become irritated and inflamed within the subacromial space.
If untreated (by a qualified Physiotherapist, Athletic Therapist or Chiropractor), inflammation will narrow the space available for the joint to move, leading to more pain, restricted range of motion, and weakness.
Sometimes, shoulder pain has nothing to do with the shoulder at all. Pain in the shoulder may actually be pain stemming from your neck or arm, which is called referred pain. This is why it’s very important to seek out a proper diagnosis from a physiotherapist or doctor when pain arises. This ensures you get to the bottom of your pain, without risking further injury.
Other, but less common, causes of shoulder pain include:
- A pinched nerve
- Frozen shoulder
- Dislocated shoulder
Rotator Cuff Exercise TIPS
Exercise can be your greatest resource to reduce and prevent shoulder pain. However, if you’re experiencing severe shoulder pain, use your best judgement and consult your doctor or physiotherapist to get a diagnosis.
For all exercises:
- Keep your shoulder blades down and back,
- Don’t hold your breath,
- Maintain control in all of your movements,
- Never push yourself past the point of a mild (lactic acid) burn,
- If in doubt consult a professional.
ways to exercise your rotator cuff
1. Dynamic Rotator Cuff ExerciseS
our favourite: Banded External Rotation
This exercise is great for stabilizing the shoulder joint because it strengthens the tiny muscles at the back of the shoulder. This exercise can prevent and minimize the chance of pain or injury.
- Hold an elastic band or tubing (Thera-band) at your side with your elbow at 90 degrees, and rotate your shoulder outwards (external rotation)
- Start with 15-20 reps and repeat two times per side.
You can do this exercise many alternative ways, such as side lying with a soup can as resistance.
2. Active Loosening ExerciseS
Our Favourite: The Pendulum Exercise
If you suspect you have an impingement issue, this exercise will help you find the most relief.
- Bend forward at the hips and let one arm to hang loose like a pendulum, and use your other arm to support your body.
- Gently swing your arm in a circular motion, just like a pendulum. Repeat 10 times clockwise, then counterclockwise.
- Repeat with the other arm, and do this twice daily.
This action will release lubrication (synovium) in your shoulder joint and help to open space (in the subacromial space of the shoulder). After doing this you will feel noticeably freer and looser in your shoulder joint and surrounding muscles.
3. Static Contractions
Facts about Static contractions
- Static contractions are the amongst the safest form of exercise because they do not require dynamic movement. They can strengthen any one of your muscles, and produce minimal soreness.
- Often confused with Isometrics, static contractions do not require an all-out maximal effort.
- Static exercises will also give you the most control over how much resistance you apply to your muscles, and resulting pressure you may feel in your joints.
Static contraction exercise set-up tips:
- Locate a sturdy wall, and have a towel if you want additional comfort.
- Aim to hold each exercise for 10-15 seconds,
- Push anywhere between 15-60% of your maximal effort,
- Contract/hold for 5 seconds (overtime build your way upto 30 seconds), and repeat 3 times,
- Do not forget to breathe – and do not perform these exercises if you have high blood pressure / are hypertensive.
- With your arm at your side and your elbow at 90 degrees press your arm into the wall.
- Keep your neck and shoulders upright, spine straight and your knees slightly bent.
- You will need to engage their supportive muscles to remain in this stance as you push your arm into the wall.
- Feel each targeted muscle contracting as you push – keep your mind present and in the muscle.
- You will also feel several of your other muscles working hard to keep you in your upright stance – it’s not only your shoulder rotators we are targeting.
Exercise one: Static Shoulder Abduction
Rotator Muscle Targeted: Supraspinatus
Importance: When correctly strengthened and calibrated the supraspinatus muscle is the most effective muscle at keeping your joint in the socket, and it is responsible for lifting/abducting your arm up to the first 40 degrees.
If it is weak or not working properly then other muscles poorly take over – which takes away from their effectiveness and often leads to premature wear and tear, pain and injury.
Execution: For this one you’ll need to push / try to lift your arm-up while it is supported against the wall.
It’s likely you’ll feel your opposite side oblique muscle among many others working too.
Exercise two: Static Shoulder Flexion
Rotator Muscle Targeted: Subscapularis
Importance: This muscle keeps the front of your ball and socket shoulder joint smoothly integrated into place. If not strong and flexible enough, it may strain and possibly tear when lifting something overhead – or when doing a push-up or a similar real-life movement such as pushing in someone’s chair.
If it is damaged you’ll likely have a pinching feeling at the front and deep into your shoulder.
As with all compromised rotator cuff muscles, if it’s not working effectively, your shoulder joint will be prone to premature aging.
Execution: For this one you’ll need to push / press-away one of your arms from wall. The trick here is to resist that from happening.
It’s likely you’ll feel the muscles from the top your shoulder blade – through to your ankles working together to resist the rotational force that you’ll be creating.
Exercise three: Static Shoulder Extension
Rotator Muscles Targeted: Teres Minor + Infraspinatus
Importance: This the “breaking muscle”. It’s the muscle that puts on the brakes when your arm goes through a throwing or reaching motion. And whether it is working properly or not, will make or break the future health of your shoulder.
For most people this muscle is often short, inflexible, weak and tight – and that’s why the most common go to exercise is a form of dynamic external rotation (see band exercise above).
The good news is these muscles are relatively easy to strengthen – when strong they help to support a functional shoulder joint, and optimally aligned posture.
Execution: Press your arm/elbow into the wall. You’ll need to work extra hard to keep your shoulder from lifting up.
Exercise four: Static Shoulder Internal Rotation
Rotator Muscles Targeted: Subscapularis + Supraspinatus
Importance: If you feel shoulder pain while reaching for your seatbelt, or want to reduce any tension or tightness in your neck, then having strong internal rotators is essential.
When balanced, it will always be easy for your shoulder to move smoothly through its full range of motion.
When these muscles are synchronously working together, other joints and muscles will not be overly stressed. The result will be better posture, and a smooth strong functioning shoulder.
Execution: Press your palm into the inside of a doorframe or equivalent. Resist moving any part of your body, especially your neck.
I encourage you to try these exercises for yourself, and comment and share your experience below.
BONUS: STatic StRETCHING
Our Favourite: The Chest Stretch
Stretching the chest muscles can relieve tension in the area(s) which may be pulling your shoulder joints forward. This tension can create various imbalances, causing pain and poor posture. Only stretch after you have warmed-up.
To perform the chest stretch, find a doorway or wall and place your arm slightly higher than the floor or ground. Keep a mini-bend in your elbow, and use your finger-tips or palm to support you.
Rotate your body slightly away from the wall, while keeping your core engaged and your hips firmly in place. If you do this right you will feel an effective stretch through your chest. Hold to a point of tension and not pain. You can hold this stretch for 15 seconds – two minutes, and repeat it twice daily.
If you want more guidance and a customized approach to your fitness goals, then apply for a complimentary fitness assessment + first workout.
In your assessment we will gently assess your joint mobility, flexibility and muscle strength (including your shoulders), and talk about ways to improve your overall function, longevity and quality of life.
We look forward to hearing from you soon.