Why Does My Shoulder Hurt?

Shoulder pain frequently gets in the way of fitness goals.  Injuries to your rotator cuff are among the most common exercise-related problems in the upper body.  Keep reading to further understand this complicated joint and how you can protect it.

What is are my rotator cuffs & what do they do?
The rotator cuff is a group of muscles and tendons that surround the shoulder joint, keeping the head of your upper arm bone firmly within the shallow socket of the shoulder. Your rotator cuff (one on each side) consists of 4 different muscles:  the supraspinatus, infraspinatus, teres minor, and subscapularis.  They originate on the shoulder blade and attach to different spots on the upper arm.  Because of these different attachment points, you may feel pain in the back, front, side, or top of your shoulder when your rotator cuff is injured.

Anytime your arm rotates in or out, your rotator cuff is being used.  Most upper body movements require these muscles to some degree.  Think of the motions that take place when you wash your hair, scratch your low back, or turn your steering wheel.  These motions are made possible by actively engaging your rotator cuff.

The rotator cuff is also used to stabilize your arm as you do a motion.  Think about how your shoulder is contracting to hold your arms up while you are typing or looking at your phone.  Rather than actively moving, your shoulder is being used in an endurance way to hold a position.  As you can see, the rotator cuff is used a lot.

What are some common ways it is injured?
A rotator cuff can be injured by a single traumatic event such as a car accident, a fall, a collision while playing sports, or poor lifting technique during exercises where the shoulder is the main weight bearing joint like the bench press.  It can also be from using it too much or improperly over a period of time.  Think of it like boiling a frog.  At first it may feel a little tight and maybe a little achy at times.  Then it starts feeling that way constantly with some sharp pain mixed in.  Eventually it keeps you from being able to function.

How do you prevent a rotator cuff injury?
1. Joint symmetry:
The shoulder is one of the most mobile joints in the body.  Nine different muscles crossing the joint allows for an extensive range of motion.  Every direction of movement requires different muscles to make it possible.  With that many moving parts, coordination and symmetry become especially important.

Try looking in the mirror from the side.  Your ear, shoulder, and hip should line up.  To determine how symmetrical your shoulder is, see if your shoulder is being pulled forward or up.  This could indicate that your pecs &/or lats are overpowering the other muscles of your back or shoulder.  It automatically puts the other muscles at a disadvantage, limits your progress, and sets you up for possible injury.

Two muscles that can help stabilize your shoulder and contribute to shoulder symmetry are the rhomboids and serratus anterior.  Your rhomboids attach your shoulder blade to your spine, which helps to pull your shoulders back.  They can be strengthened by doing rows.  Focus on pulling your shoulder blades together to ensure that you are engaging the right muscles.

The serratus anterior is a group of muscles that are also known as the “boxer’s muscle”.  They go from the shoulder blade to the front of your rib cage.  Try doing a pushup plus or scapular pushup to strengthen these.  Get into a pushup position and instead of lowering your body towards the floor, push your body even further away from the floor.  You will notice another 1-3” of movement happening.  This same concept can be applied on a bench with a barbell or dumbbells.

2. You are only as strong as your weakest link:
This is commonly said in team sports.  Look at the shoulder as a number of different players that work together to function as a team.  The rotator cuff usually ends up being the weakest link in the shoulder’s team.  A weak rotator cuff can lower the ceiling on the progress of your upper body workouts.

You may be asking “what is the best way to exercise my rotator cuff?”  I have found bands or cables to be the best equipment for this.  First, let your arm hang at your side and bend your elbow to 90 degrees.  Place a rolled-up hand towel between your elbow and rib cage to ensure that your arm doesn’t flail around as you exercise.  If it does, the towel will fall.  Then hold the cable at the same level as your elbow and rotate your arm towards your belly button.  Then do another exercise where you rotate away from your belly button.  As you do these two exercises, you will feel the tension and contraction around your shoulder blade.

3. Warm-up & Stretch:
A good warm-up and stretching routine is crucial to getting the most of your workout and avoiding injury.  The two exercises mentioned above can be done at a lower intensity to warm up your rotator cuff.  You can also do warm-up sets for each of your upper body exercises with lighter weights.  This prepares your rotator cuff to either support throughout the exercise or actively move.

When it comes to stretching the shoulder, I recommend the towel stretch.  First, hold the end of a towel in your right hand and throw the rest of the towel over your right shoulder.  Put your left hand behind your back and hold the other end of the towel near your low back.  Then bring your right hand towards the ground, causing your left hand to be pulled up your back.  You should feel the stretch build throughout your shoulder.  Do a couple of sets where you relax and hold for about 15 seconds each time.  Repeat this for the other side.

4. Control your movements:
I frequently see people swinging a dumbbell around at the gym, claiming to be working on their rotator cuff or shoulder.  I end up resisting the urge to give them a card and tell them “you’ll be needing this”.  One of the laws of physics states “objects in motion stay in motion until acted upon”.  In the exercise world this applies to controlling the weight that you are moving.

Think about a bench press.  Often, people drop the weight towards their chest and strongly contract right before or as the weight makes contact with their chest.  Something has to counter the extra momentum and the weight to stop the barbell and push it back up.  This increases the odds of a muscle getting strained or “tweaked”.  By controlling all aspects of your movements, not only will you decrease your chance of getting hurt, but you will also get a better workout.

How do you treat an injured rotator cuff?
1. Stop what hurts!
First, I recommend decreasing the intensity of any painful exercises.  Cut the resistance in half and do 5-8 reps to test the waters.  If that is not pain- free, then remove that lift and try adding it back in as you start to feel better.

It is very common for different forms of bench press and military press to hurt or even cause the shoulder injury.  These lifts focus on the pecs and deltoids, which tend to be pretty strong muscle groups.  This is where the concept of “you are only as strong as your weakest link” comes into play.  Eventually that weak link will break if it gets overpowered or overworked.

2. Change up your exercise routine
Do you continuously find yourself with a nagging injury or pain that seems to keep coming back?  This could be your body telling you that your routine needs to change.  There are 3 easy ways to do this.

First, try alternative lifts for a body part.  For example, maybe you notice that when you do triceps kickbacks with a dumbbell, your shoulder flairs up for a number of days.  Do triceps extensions with the cables to see if it’s a more favorable position for your body.

Second, decrease the number of times per week that you do shoulder exercises.  Some people try to exercise each muscle group three times per week.  Try twice a week for each muscle group to allow for more recovery.  (For more information on recovery, see my article titled “Exceed your goals by maximizing your recovery”).

The third way is to change your sets and reps.  If you’re always lifting heavy to focus on strength and power, try lifting lighter with higher reps to build your endurance.  Doing both will challenge your muscles in different ways.

3. See a doctor
If the other options don’t help, it’s time to see your doctor.  They may decide to do an MRI to see the extent of your injury and if surgery is needed.  If you don’t need surgery then try some conservative treatment options by going to a chiropractor or physical therapist that specializes in sports injuries.  It is common for them to try a combination of therapeutic exercises, deep muscle work/ trigger point therapy, and joint mobilization or manipulation.

Conclusion:
The shoulder is a complicated joint that can make or break the effectiveness of your workouts.  Prevent some of the common shoulder injuries by maintaining joint symmetry, strengthening your weakest link, warming up & stretching, and controlling your lifting momentum.  If you are already dealing with shoulder pain, get it under control by stopping what hurts, changing up your exercise routine, and seeing a doctor.


About the author

Dr. Stephen Workman is a chiropractic physician practicing in Cedar City, Utah.  Dr. Workman specializes in sports injuries and performance. He has treated many professional athletes, dancers, and musicians over the years. In addition to his Doctorate in Chiropractic, he has a Master’s degree in Sports Medicine and two Bachelor’s degrees in Human Biology and Exercise Science.  Dr. Workman enjoys all forms of exercise, sports, and outdoor activities. He is also a drummer and an avid foodie. Dr. Workman can be reached at DocSWorkman@gmail.com.

Disclaimer: This content is for informational purposes only and is not meant as medical advice, nor is it to diagnose or treat any medical condition. Please consult your physician before starting or changing your diet or exercise program. Any use of this information is at the sole discretion and responsibility of the user.

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