Shoulder Pain and Injury Recovery: Your Shoulder 101 Guide
Updated: Jul 12, 2019
Shoulder injuries are very common and they can sideline an elite athlete's career as much as they can make activities of daily living difficult and painful for anyone. Whether you live in New York City and walk for miles carrying a heavy bag on your shoulder or whether you play tennis 3 times per week, the shoulder is a vulnerable part of the body that requires preventive care and proactive treatment to recover from injury.
Personal training and clinical massage can relieve chronic shoulder pain.
There are many different shoulder injuries that have both unique and overlapping causes and treatments. Some require shoulder surgery while others respond well to conservative treatments such as Physical Therapy, Sports Massage, Acupuncture and Active Release Techniques. Below is a short introduction to shoulder anatomy, a brief overview of the most common shoulder injuries and easy to follow videos for shoulder rehabilitation and injury prevention exercises.
Below are also some videos showing Active Release Technique treatments for shoulder pain and recovery.
How common are shoulder injuries?
Not surprisingly, the risk of shoulder pain and injury increases significantly depending on the sport one plays, the exercises one chooses, the job one has, the chores one does at home, force trauma, falls and many other factors. In 2006, approximately 7.5 million people visited a doctor's office for a shoulder problem of some kind.
The risks of shoulder injuries for starting pitchers at any level but especially professional players is extremely high. In fact, according to numerous studies and Major League Baseball itself, the incidence rate of shoulder injury for pitchers is 50%. Elite pitchers such as Clayton Kershaw, Jacob de Grom (below) and Stephen Strasburg have all taken trips to the disabled list due to shoulder problems.
In my practice as a clinical massage therapist and active release techniques provider in NYC, I'd say about 30-40% of all my clients either come to me initially for treatment of shoulder pain or come to me later for follow-up sessions because of a new shoulder injury. These shoulder injuries include shoulder impingement, frozen shoulder, rotator cuff strains, shoulder instability, shoulder bursitis, biceps tendonitis, labrum tears, chronic trigger points and arthritis.
Why are shoulder injuries so common?
The key words here are mobility, complexity and (lack of) stability. In short, the shoulder is a complex and highly mobile joint. Unlike the knee and elbow, for example, the shoulder is a complicated joint built for mobility in pretty much every direction possible. Much more movement occurs at the shoulder joint and shoulder blade (scapula) than does at any other joints in the body. And while this is a great thing because it allows humans to accomplish complicated tasks and play in exciting sports, it also causes problems.
The shoulder joint is a ball and socket joint, like the hip joint. However, unlike the hip joint which has a deep socket that the ball (head of the femur) sits in with very thick cartilage and ligaments to stabilize it, the shoulder joint does not have a deep socket. The ball (head of the humerus) does not have a deep cavity which it can slide and glide in and the cartilage and ligaments that help hold it in the socket are smaller and weaker than those in and around the hip joint.
When mobility takes place at the expense of stability, bad things can happen. In the case of the shoulder, too much mobility without dynamic stability can lead to irritation of muscles, tendons, ligaments, cartilage and bone. In general these irritations occur when too much mobility leads to, in essence, things getting knocked around more than they should and/or stuck. If the rotator cuff doesn't, for example, effectively do its vital role of stabilizing the shoulder joint during movement, it can lead to rotator cuff tendonitis and strains, shoulder impingement and bursitis, among other things.
The 4 Joints of the Shoulder
The shoulder complex is actually comprised of four joints. Most of what has been discussed above pertains specifically to the Glenohumeral (GH) joint which is the ball and socket joint. However all 4 of these joints play an important part and work together collectively to control, produce and withstand movement and force. They include:
Sternoclavicular (SC) joint (between the sternum and the collar bone) – this is actually the only bony connection that the shoulder has with the main skeleton.
Acromioclavicular (AC) Joint (between the collar bone and the point of the shoulder called the acromion, which is part of the scapula or shoulder blade).
Glenohumeral (GH) joint between the glenoid part of the scapula – the socket – and the head of the humerus (HOH) – the ball.
Scapulothoracic (ST) joint is the ‘false joint’ between the scapula and the rib cage that it rides over. It's referred to as fake sometimes because it is not a typical joint with cartilage, synovial fluid and ligaments.
Often times more than one of these joints are involved in some way when there is a shoulder injury and thus needs to be addressed in the injury recovery process. It's important for shoulder injury specialists and clients alike to understand that these joints function both independently and collectively. For this reason, optimal shoulder injury recovery should address not only the very local intricacies of each structure and pathology but also understand how these joints interact and affect, both positively and negatively, each other and their function as a whole and complex unit.
The Most Common Shoulder Injuries:
We won't go into to much detail about each one because it is a lot of info. Entire studies have been done on any one of these injuries and entire books have been written about shoulder anatomy and shoulder injuries. But here is a brief description of the most common shoulder injuries. Causes, symptoms, prognosis and treatment vary from one to the next and depend on the length and severity of the injury. Remember, there is no one-size-fits-all approach that can heal all injuries or that will work for everyone with the same injury.
If you have intense and/or chronic shoulder pain, you should see a sports medicine doctor for an evaluation and diagnosis. An intake, physical examination and often times x-rays are used during an initial visit. As with any injury or medical condition, an accurate diagnosis is vital. Without one, you may still get better but having one can be a game-changer.
Shoulder Impingement: A compression of the supraspinatus (one of the 4 rotator cuff muscles) tendons by the front edge of the scapula (shoulder blade). It can cause sharp pain with overhead and other movements, a significant decrease in range of motion, muscle weakness and can cause a tear in the tendon.
Biceps Tendonopathy: The long head of the biceps crosses the shoulder joint and is located in what you could say is the grand central station of the shoulder (GH) joint. So many muscles and tendons have very close attachment points to the biceps creating a high point of force directly into the tendon. Additionally, any time there is already a shoulder injury such as shoulder impingement or instability, the biceps very often gets injured secondarily.
Any time the biomechanics are altered in the shoulder complex, the biceps tendon can get knocked around, so to speak. This is a very common injury among male weightlifters who bench press heavy weight, often with improper form using a straight bar. It is also not uncommon in athletes who perform forceful shoulder movements such as tennis and baseball players.
Rotator Cuff Injuries: The rotator cuff is a group of four muscles that form a cuff around the head of the humerus. These muscles are small and yet central to providing shoulder stability, especially during all types and direction of movement. These muscles and their tendons often get strained, torn and/or inflamed because they are small muscles with an important job. Often times they are fighting against much larger muscles in the shoulder such as the pectoralis major, latissiums dorsi and upper trapezius to maintain stability and proper alignment.
Moreover, if there is a ligament or cartilage laxity in the shoulder joint itself, these muscles will have to work extra hard and can suffer from repetitive strain and overuse. Full tears often require surgery while minor to moderate strains/tears usually respond well to any number of less invasive treatment.
Shoulder Laxity/Instability/Dislocations: A laxity is a mild to moderate weakness and looseness of the cartilage and ligaments that hold the ball and socket of the shoulder joint in place. A severe weakness and looseness in these structures is called shoulder instability and can lead to a partial or complete dislocation of the glenohumaeral joint as well as secondary injuries such as rotator cuff and biceps strains, impingement and labrum tears. Treatment often involves aggressive physical therapy to strengthen all of the stabilizing musculature that can compensate for the joint looseness.
Arthritis: Of the four joints that comprise the shoulder complex, the AC and GH joints are most prone to arthritis. In short, arthritis of the GH joint is when the smooth cartilage that normally covers the surfaces of the ball (humeral head) and socket (glenoid) is lost. The result is that there is bone on bone rubbing between these two joint surfaces. This can create pain, swelling and a decreased range of motion.
Arthritis can be slowed by therapies that improve shoulder biomechanics so the wear and tear is lessened. In late stages of arthritis in the shoulder when there is bone on bone, a complete shoulder replacement surgery becomes an option, as it does with the knee and hip.
Frozen Shoulder: This injury is very different from other shoulder injuries and as the name implies, it involves a significant and usually debilitating loss in range of motion at the shoulder joint. This can be a very painful and lengthy injury that requires consistent and frequent treatments.
Labral Tears: the labrum is a fibrous cartilage that surrounds the socket to help stabilize the joint. “The labrum deepens the socket by up to 50% so that the head of the upper arm bone fits better. In addition, it serves as an attachment site for several ligaments” (Ortho Info). The labrum often gets torn during single and repetitive overhead movements involving force and weight as well as from other shoulder injuries such as during a shoulder dislocation. Treatment may involve anti-inflammatory medications and physical therapy but in serious cases often require surgery.
These shoulder injuries are the most common ones. They often times will occur simultaneously, either one leading to the other or resulting from the same activities and method of injury. Accurate diagnosis by a a shoulder doctor is very important in determining the proper course of injury recovery strategies. A second opinion is a good option if you're not confident in the diagnosis or with the progress of treatment.
Treatments for Shoulder Injuries:
There are so many treatment options at your disposal for recovery from shoulder injuries. Which treatments will work for you will really depend on which injury you have, how long it's been present and how severe it is as well as what your sports performance and daily living goals are.
As emphasized above, getting the right diagnosis is crucial so be sure to consult an orthopedist who specializes in shoulder pathology. When recovering from a shoulder injury it is in your best interest to work closely with a qualified injury recovery therapist such as a physical therapist, clinical massage therapist and athletic trainer. Unless there is a clear tear or pathology of some kind that definitely requires surgery, you should opt for less invasive rehabilitation therapies instead.
One such treatment option for shoulder injury recovery is Active Release Techniques (ART). ART is a patented, state of the art manual therapy that treats soft tissues of all kinds: muscles, tendons, ligaments, fasica and nerves. It is movement-oriented and specific to a particular muscle or group of muscles. It separates muscle adhesions, breaks up scar tissue from old sports injuries, relieves trigger points, increases nutrient and blood flow, improves range of motion, increases muscle elasticity and enhances joint biomechanics.
Active Release therapy is one of many options at your disposal for the the treatment and resolution of many common shoulder injuries. It is great in combination with other injury recovery therapies such as physical therapy, corrective exercises, temporary use of anti-inflammatory medications, acupuncture and other types of manual therapies such as Graston, myofascial release and sports massage.