The shoulder is undoubtedly the most complex joint in the body. Because of this, its range of motion and possible positions can provide lots of opportunities for painful injuries.
If you have no shoulder pain, you must take the correct steps to strengthen your deltoids, upper traps, and rotor cuffs through multiple exercises that work each muscle in a full range of motion that allows a complete stretch and subsequent forceful contraction. If you do not, you will risk injury, but also miss out on the opportunity to become much stronger and build more muscle from being able to get into more biomechanically advantageous positions—the better your form, the more weight you can use, the more muscle you build.
Finding The Cause Of Your Shoulder Pain
If you are experiencing pain, it’s time to take a look at the underlying reason. Only then can a proper physical therapy solution be developed. The following are simple tests that can pinpoint the cause to your shoulder pain thereby allowing you to fix it. It is recommended that you do this with a partner.
1. Shoulder Impingement: Have your partner raise your arm to the front as well as overhead; your partner should do this by holding your arm and supporting your scapula.
The area that contains your rotor cuff tendons and shoulder bursa becomes compacted when your arm is raised straight up—if you feel pain it’s likely that the cause is impingement of either the tendons themselves or the bursa located on the top of your scapula.
The Solution: this is caused by tight and inhibited musculature. Sitting for hours in a slouched position is usually the cause—your chest and front delts become tight as your rear delts become lengthened. This resulting imbalance causes improper shoulder movement and therefore pain.
To fix it, perform daily myofascial release on your chest, front delts, back delts, and rhomboids using a lacrosse ball. If done for 21 days consistently, your body will remodel the old movement pattern and your pain should be gone.
2. Bicep Tendonitis: Raise your arm to the front while turning your palm up towards the ceiling; have your partner push your extended arm down while you fight it—if pain is felt this points to bicep tendonitis as the likely cause of pain.
This debilitation occurs through repetitive, asymmetrical training. It is very common in tennis players, for example—more specifically the forehand where the bicep is contracted thousands of times over the course of a week of practice.
The Solution: If you feel pain in a muscle group, the answer is almost always to strengthen the antagonist.
Every area in the body is comprised and antagonist and agonist muscles—as one “side” contracts, the other stretches. In this case, the biceps and triceps are at play, and the solution would lie in strengthening the triceps.
3. Labrum Tear: Lie down with your arms out to your side like, forming a T shape with your body; next bring your elbows to a 90 degree angle so that your forearms are perpendicular with the ground; lastly have your partner push your arms so that your hand moves back towards your ear, creating external rotational pressure—if you are unable to move much at all and find pain when trying to push it at all, a torn labrum is likely the culprit.
Overall, this injury causes great instability in the shoulder region. Upper-body exercises such as bench press and pushups will elicit considerable pain due to this and are also a way to confirm diagnosis.
The Solution: Depending on the cause of the tear and the severity, surgery may or may not be needed. Because the area has such a rich supply of blood, a large portion of tears are able to heal by themselves. Furthermore, myofascial release is found to be highly beneficial, especially in cases where the underlying issue involved the rotor cuff rubbing against the labrum.
4. AC Joint Separation (Acromial-Clavicular): While seated have your partner place one hand on the rear of your shoulder and one hand on the front; next have your partner slowly apply increasing pressure to your shoulder by firmly pressing both sides—if pain is felt during compression, this is the likely culprit.
The Superior Acromial Clavicular is the highest point on your shoulder—it’s where your scapula and clavicle connect to create the encapsulating shell for your rotor cuffs. In addition to the test above, pain will be felt while sleeping as well as while raising one’s arm up.
The Solution: this injury is undoubtedly caused by asymmetries in musculature that then lead to asymmetrical movement patterns; an easy example is the gym-goer who decides to use a partial range of motion on bench press. This focus only on a partial range then leads to uneven muscular development, which then further causes improper form. It is a vicious cycle, but it can be broken.
By focusing on performing all exercises with a full range of (safe) motion, a full stretch and contraction can occur. This ties in heavily with the concept of antagonist muscle groups introduced earlier—focus on developing even musculature to avoid this issue if it doesn’t already apply.
BUT, it’s hard to fix this once you’ve dug a hole for yourself—your pain doesn’t allow you to lift in a full range of motion. The fix is myofascial release 5 minutes or less before each exercise. This means before you perform an upper body movement, use a lacrosse ball to release tension in your deltoids, chest, rhomboids, lats, and traps. This will provide the needed short-term relief in pain and lack of mobility to allow you to complete your exercises correctly.
This should only take a few weeks to resolve itself using this method.
5. Rotor Cuff Tear: While seated have your partner raise your arm out to the side until it is parallel with the ground; once you have fully relaxed your arm, have your partner let go—if your arm drops and you are unable to keep it raised, your pain is likely caused by this.
Rotor cuff injuries are undoubtedly one of the most popular. It normally happens as a result of too much force applied to the shoulder without scapular retraction. Ever wondered by powerlifters and strength athletes arch their back? It isn’t unsafe—it’s actually because they are retracting their scapula as hard as possible to keep their shoulder capsule safe and tucked away, allowing a majority of the force needed to move the weight to come from the large muscle groups of the chest and back.
The Solution: Undoubtedly, the best solution is to never encounter this in the first place; by training external and internal shoulder rotation using exercise bands, you can build strength in the tendons that make up your shoulder.
Contrary to popular belief, most injuries occur not because of a lack of stretching, but because of a lack of strengthening. More specifically, only strengthening one “side” of the antagonist muscle group described earlier. A common reason many “gym bros” experience shoulder pain that eventually ends their benching and lifting career is because poor form is promoted and encouraged to move more weight, which leads to a stronger chest but very weak rear delts (due to the anterior shoulder positioning and lack of back tightness) and shoulder tendons (that do not grow as fast as the relatively large, blood-rich chest muscles).
Again though, if you’re already injured that doesn’t do much good. The answer is the same: myofascial release of all muscles affecting the shoulder area while simultaneously strengthening external and internal rotation (using power bands).
Unfortunately, the news isn’t as good when it comes to this specific shoulder debilitation. While most cases can be treated non-surgically, the average recovery time is around 6 months (it’s likely that this time could be greatly reduced by highly-motivated individuals who adhere religiously to their prescribed rehab protocol).
If relief is still not reached at that point, surgery is recommended.
6. Supraspinatus Tear: While seated lift your affected arm up and out to the side at about a 30 to forty-five degree angle; next turn your hand down as if you were holding a cup of water and wanted to pour it out on the ground—while your wrist is in this pronated position have your partner apply pressure downward against your arm. If pain is felt, this is likely why.
This is a very insidious injury that is heavily linked to individuals who have computer jobs or other career positions that require them to remain seated for a large portion of the day, leaned over while typing against a computer. Other modern factors contribute, such as driving, wearing a backpack, and looking down at a cell phone while texting.
The Solution: Using a rumble roller is highly effective for treating this area and getting it to release. While lying on your back on the injured side (on the rumble roller), hug yourself—this will pull your scapula all the way forward to help expose as much tissue as possible. Next, slowly work back and forth by rolling against the roller. To receive additional benefits, superset this with pushups from the knees (or regular pushups if your pain tolerates—never exceed a 1-2 out of 10 on the pain scale though).
7. Frozen Shoulder: No specific test is needed—if your shoulder becomes gradually inhibited and painful over time eventually causing pain while reaching overhead, pressing a barbell or dumbbell, or scratching your pack, this is likely the cause.
This is a result of all the causes already described—poor movement patterns that eventually manifest themselves as structural asymmetries and uneven muscular development, resulting in pain.
The Solution: Stretching the shoulder capsule and working to strengthen it over time with the rehab circuit below. Also, avoid overhead movements.
Shoulder Rehabilitation Circuit
- Shoulder wall-walk: begin at least 2 feet away from the wall; raise your arm up and slowly “walk” your fingers up and along the wall as high as possible, making sure not to contract traps (AKA relax your upper back).
- Shoulder Door Pectoralis Stretch/Barbell-Squat Rack Stretch: place your arm along a door frame so that your upper arm is parallel to the ground and your forearm is pressed against the wall and perpendicular to the ground; next lean forward and away from the side being stretched.
- Internal and external rotation using a Theraband
- Theraband flexion (raising arm up and forward), abduction (raising your arm up and out), and scaption (raising your arm up and at a 45 degree—the area between flexion and abduction)
- Levator Stretch (Neck-Table stretch): Place one hand behind your back and the other on the top of your head; next pull your head down and out as you stretch your neck.
- Wall slides: place your back against a wall and place your forearms on the wall above your head; next slide your arms up and down the wall.
- I-Y-T Circuit: this well-known strengthening circuit helps to engage the different stabilizing muscles of the shoulder compartment.
- Dumbbell Pull-overs for the seratus anterior: the Seratus Anterior is a muscle group that stabilizes the upper back and shoulders; it is rarely worked directly which can lead to imbalances—add this exercise to your list of regular back exercises and reap the benefits in your pressing movements as well.
- Face-pulls for the rear delts and upper traps: the rear deltoids are often neglected by many fitness enthusiasts who over-emphasize pressing movements such as bench without enough upper back and shoulder movements. Face pulls work to remedy this by lazering in on the rear delts, which actually play a huge role in the bench press and overhead press by keeping the scapula retracted and stabilized. This has a strong carry over to higher numbers when pressing.
By now you know how to diagnose your pain, as well as how to solve it with an intelligent shoulder rehab protocol.
In the end, the goal is to build a strong, mobile shoulder that can exert maximal force through all ranges of contractile motion. Using myofascial release couples with the correct movements outlined above will dissolve your old poor movement patterns and once again bring you symmetrical muscular development that in turn leads to pain free shoulders!