Why Does My Shoulder Hurt When I Exercise?

This week we are going to talk about the shoulder joint and the common shoulder pain lifters feel when exercising. There are of course many reasons why an exerciser or athlete can have pain that are specific to the lifter in front of us, but we can detail the general concepts in assessment and treatment that can addresses this common problem.

Shoulder pain

Now, there is never one problem that creates shoulder pain while exercising, but there is a common generic issue that is often behind most of the painful movements. Poor movement mechanics. When our shoulder complex (humerus bone, scapula, clavicle) is not being moved or controlled in a coherent and efficient way, we leave certain tissues susceptible to damage.

Pain and injury can come from muscle of the rotator cuff becoming damage, labrum injury, biceps tendon injury, and more. The classic “shoulder impingement” diagnosis is often really a shoulder complex stability issues that lets the supraspinatus muscle become pinched and injured from repetitive motions. The same can be said for labrum injuries, rotator cuff tears or strains, and more. Without proper timing and centration of these muscles and bones, we can expect certain tissues to undergo excessive loading and therefore damage from overuse in mechanically disadvantageous positions.

What can we do about shoulder pain?

First, a comprehensive and specific evaluation based off your presentation and body is best. But, to describe generally what can be done about shoulder pain, we can start with mobility. First and foremost, we need to make sure we are not lacking the required motion in the participating joints and muscles of the shoulder complex. After this, we can begin working on stability of these joints. In the last phase, we would integrate our mobility and stability training back into the movements, exercises, or sport that created pain in the patient’s shoulders in the first place. Here we make sure to get the transfer from the rehab process into the performance of the important and specific movements that brought the patient to the clinic in the first place. Here are some brief examples of exercises and drills we used to get transfer throughout the rehab and performance process for shoulder pain.

Shoulder mobility

First, a soft tissue and joint mobility exam would be done. Then soft tissue and chiropractic adjustment techniques can be used to start the process of building mobility into the shoulder. Beyond this, we can use exercise and drills to help create mobility in the shoulder. Here is an example banded joint mobilization we can use to create more range of motion in the shoulder joint.

Shoulder stability

There is plenty to be done in term of building shoulder stability. A few key concepts here is to build specific muscle strength and endurance while also improving coordination of these joints with good joint centration. When I say joint centration, that means we are moving the joint through space while keeping good bony positioning in the joint. This requires that small muscles of the shoulder complex are working to maintain and perform these small and specific movements to keep things where they need to be so the bigger muscles can create the force needed to move external loads without compromising the shoulder joint. Here is an example exercise to build shoulder complex strength and endurance and another to emphasize more joint centration and coordination.

Performance integration

In this later phase, we need to make sure we can get the patient to perform the previously painful exercises with good mechanics and without issue. Here we can build the different aspects of the movement back along with higher and higher loading over time. We use verbal and physical cueing to make sure we take the principles of the rehab exercises and integrate them into the higher intensity movements. This stage of the process is highly dependent on the goals and assessment of the patient.

Conclusion

Determining the true anatomical source of shoulder pain is important, but a clear understanding how everything else in the shoulder complex is moving and performing is equally important. We must be able to decipher where mobility is needed, where stability is needed, and how well the patient creates proper movement patterns with the entirety of the shoulder complex under load. With these understandings, we can build a plan to address the damaged tissue AND all the issues which were the root cause of the pain and dysfunction in the first place.

-Dr. Nick DC, TPI, CSCS

If you would like to learn more about your body, pain, and performance, send Dr. Nick an email at contact@integratedrpc.com or call at (585)478-4379, or schedule a FREE discovery visit at Contact.