Lady with shoulder pain

A major new review suggests that around 28 million adults in the UK are affected by some type of chronic pain (that’s pain that lasts for more than three months).  Shoulder pain is often chronic and can have a massive effect on daily life, movement patterns and emotions. In this article, we are going to take a closer look into the anatomy of the shoulder, look into why shoulder pain is so common and what steps you can take if you are suffering.

Movement vs stability

The shoulder is the most mobile joint in the body. The main shoulder joint – the glenohumeral joint – is a ball-and-socket joint. But the joint is also the most unstable joint in the body, due to the way that the head of your upper arm bone (the humerus) sits in the shoulder socket (the glenoid fossa): it is akin to the way a golf ball sits on a tee. This means that even very small changes to the way in which the muscles that surround the joint behave can cause the joint to cease to work smoothly. This often translates into a loss of movement or varying degrees of pain when moving.

Diagram of shoulder jointThe rotator cuff is a group of four muscles that are positioned around the glenohumeral joint. The muscles are called:

  • Supraspinatus
  • Infraspinatus
  • Subscapularis
  • Teres minor

There are three bones in the shoulder region: the collarbone (clavicle), the shoulder blade (scapula) and the upper arm bone (humerus). The scapula is a triangular-shaped bone that has two important parts to it: the acromion and the glenoid. The three bones in the shoulder region form part of two main joints:

  • The acromioclavicular joint between the acromion of the scapula and the clavicle.
  • The glenohumeral joint between the glenoid of the scapula and the humerus.

The rotator cuff muscles work as a unit. They help to stabilise the shoulder joint. The four tendons of the rotator cuff muscles join together to form one larger tendon, called the rotator cuff tendon. This tendon attaches to the bony surface at the top of the upper arm bone (the head of the humerus). There is a space underneath the acromion of the scapula, called the subacromial space. The rotator cuff tendon passes through here. The subacromial space is filled by the subacromial bursa. This is a fluid-filled sac which helps the rotator cuff to move smoothly. It has a large number of pain sensors.

Rotator cuff disorders usually cause subacromial pain, and it is the most common cause of shoulder problems. Rotator cuff disorders are extremely common and can happen to anyone. There are many reasons you can develop pain:

  • an injury such as falling on to your arm
  • Overuse, either through sport or repetitive movement
  • Chronic or persistent tension in neck or back muscles
  • Part of a general condition such as rheumatoid arthritis or osteoarthritis
  • A tear of one of the rotator cuff muscles
  • Subacromial impingement
  • Calcific tendonitis

The main symptoms are a pain in and/or around the shoulder joint and pain when moving your arm. If there has been an injury, the pain may come on suddenly. Pain is often at its worst when you use your arm for activities above your shoulder level. This means that the pain can affect your ability to lift your arm up – for example, to comb your hair or dress yourself. Swimming, basketball and painting can be painful but writing and typing may produce little in the way of pain. Pain may also be worse at night and affect sleep. Occasionally your shoulder or arm may also feel weak and you may have reduced movement in your shoulder. Some people feel clicking or catching when they move their shoulder.

What to do when you have shoulder pain

Assessment is a very important part of understanding why you have shoulder pain – sometimes something very simple could be causing it and changing your daily movement patterns can hold the key to easing the pain. A good therapist will be able to undertake an assessment of your shoulder which will show if there is an imbalance or weakness in the muscles of the rotator cuff. You can also ask your doctor for an x-ray or ultrasound scan, both of which can help to reduce fears and provide further information. The majority of cases of shoulder pain can and do ease with the right bodywork, movement and rest within 2-4 weeks.

It’s most important when you have shoulder pain that you don’t stop moving altogether. There is a balance between rest and movement which is important – as is respecting which movements really hurt and trying not to do those. Simple exercises which are focused on strengthening or opening up key rotator cuff muscles can be very useful but they need to be done every day for several weeks in order to start to feel the benefit.

Massage, myofascial release, muscle energy techniques, passive stretching, trigger point work and the use of heat and cold can all help to ease any pain and improve movement through the glenohumeral joint. Often a shoulder which does not move very well when you are actively moving it yourself will free up when the therapist passively asks for movement. Taping the shoulder for support can also be useful.

Don’t suffer from rotator cuff pain

If you are suffering from rotator cuff pain, don’t leave it and don’t think that it isn’t possible to get rid of it – much of the time something small is causing the pain and it can be easily dealt with when you commit to regular bodywork sessions, start moving your body well and educate yourself with regards to how your shoulder works!


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