The shoulder is the most mobile joint in the body. Because of its extensive range of motion, it’s susceptible to injury and pain. The shoulder can hurt after it has been injured or for no apparent reason. And though most shoulder problems are relatively short-lived, the pain is sometimes indicative of a more complex issue. Here’s a guide to what might be wrong and whether or not it’s a cause for concern.

Slight pain with elevation or when playing overhead sports is common. The four tendons that make up the rotator cuff or the biceps tendon (the combined musculature that drives the shoulder motions) can be inflamed by activities such as tennis, throwing, and lifting overhead. The tendons are covered by a thin layer called a bursa, which swells when irritated. While eliminating overhead activities and the occasional use of anti-inflammatories help the pain, that’s not an option for anyone wanting to continue to play sports or weight lift.
What To Do: I use corrective exercises to strengthen the rotator cuff, core, and postural muscles in functional patterns to address these shoulder irritations. Because we “get what we train” unconscious movement/poor habits can all put extra strain on the shoulder, neck, or back, and may be the root cause of your shoulder pain.

Pain that does not go away or that occurs without motion indicates severely irritated tissues. This degree of inflammation precedes more structural injuries—such as tears of the tissue or early arthritis. Treated early, full rotator cuff tears and eventual arthritis can be prevented. Most physicians now avoid injections of cortisone, as there is clear evidence that it weakens the tissues of the shoulder if used frequently. Once a definitive diagnosis is made, targeted therapy can begin. It is sad to see small injuries extend into more massive ones due to the lack of appropriate corrective exercises and client education.

What To Do: Your doctor may recommend injections of growth factors- PRP and lubrication with hyaluronic acid. These are great when combined with physical therapy to focus on shoulder mechanics, muscle strengthening/stability, and sport-specific training. Being that there are 17 muscles that attach to the shoulder complex, I need to assess its movement, along with that of the neck and upper back for the most complete picture. Often I see throwers with slight errors caused by weak scapular muscles or golfers with swing abnormalities originating in the core that bring on the shoulder problems. PT’s are movement specialists with an eye for identifying and correcting these muscle and movement imbalances.

Pain at night or pain not improving with therapy after 4-6 weeks are red flags. Pain radiating down the arm or up to the neck or to the back is also worrisome and may indicate injuries not just of the shoulder but of problems originating in the neck. Injuries need to be worked up carefully as instability of the shoulder, with the shoulder popping in or out of the joint, is another area best treated with early repair of the torn ligaments. A full rotator cuff tear will often present with night pain since when you roll over, you push the arm up into the socket through the tear. Torn rotator cuffs fall into two major groups: acute tears and degenerative ones. Acute tears in healthy tissue may be cured with injections, PT, and time. Larger ones, however, are almost always surgically repaired. Degenerative tears, associated with some degree of arthritis, fall into a more nuanced decision tree. Some should clearly be repaired, while non-operative treatment is the best course in others due to a high failure rate.

Diagnose and treat early. Fortunately, most of the problems in the shoulder can be repaired under a local block with an arthroscope as an outpatient procedure. Only the most severe arthritis cases require bionic (artificial) replacement. Biologic treatments using anabolic stimulation of the tissues with injections, physical therapy, exercise, and activity coaching are becoming more effective, more targeted, and more widespread. The key is to treat them early before full tearing of tissues leads to disability.

If you’re tired of pain, call EmPower Physical Therapy for a FREE Discovery Session at 208-309-0281. As someone who embraces the science of movement, I can help you get back to doing what you love!

In Health,
Kim Mazik, MSPT,CEAC
EmPower Concierge Physical Therapy
208-309-0281
kimmazik@gmail.com