Let's Talk Shoulder Pain!

Why does my shoulder hurt? – unfortunately this isn’t an easy question to answer. What we normally think of as the shoulder is made up of a complex of 3 joints: 1. The glenohumeral joint, or the standard golf-tee-and-ball joint that we normally think of as the shoulder, 2. the acromioclavicular joint, or the joint between your collarbone and shoulder blade, that acts as your shoulder’s only bony connection to the rest of your body, and 3. The scapulothoracic joint, the connection between your shoulder blade and ribcage. This is not a true joint more an articulation.

As well as these joints, there are lots of muscles connecting the shoulder to the body, controlling the various joints and ensuring dynamic stability when moving your shoulder. As the shoulder is so complex, it is difficult to determine what structure exactly is causing your pain. However, there are some likely culprits – number 1 being the rotator cuff.

What exactly is the rotator cuff? – the rotator cuff is the name for the group of muscles and tendons in your shoulder, which are responsible for stabilizing your shoulder during movements. If we think of the shoulder joint as a golf ball on a tee, the rotator cuff’s role is to keep the golf ball on the tee as your arm moves.

What does the rotator cuff have to do with my shoulder pain? – most likely, quite a bit. As your rotator cuff is responsible for proper shoulder dynamics, rotator cuff dysfunction will result in abnormal biomechanics in your shoulder. This can result in tendon impingement manifesting as a deep ache in the back of your shoulder. Furthermore, your big “mover muscles” around your shoulder will begin to take over the stability role, which can overload them very quickly. This can cause further pain in the front of your shoulder.

Do I have a tear in my rotator cuff? – Depending on your age, probably. Does this matter? More often than not, no! Evidence suggests that most rotator cuff abnormality occurs because of loading or aging, and usually remain completely asymptomatic. One study found 50% of participants had some form of tissue irregularity in their rotator cuffs with no shoulder symptoms present [1]. Unless you have had a specific incident of trauma (fall etc.), a rotator cuff tear is not likely to be causing your pain.

So, what can physiotherapy do for my shoulder? – Quite a bit! After a thorough assessment has determined your functional abilities, your pain level and what structure is most likely causing your issue, your physio will use manual therapy to ease your symptoms and may tape your shoulder to deload the overworked muscles around the area. Your physio will also give you exercises aimed at easing your pain, increasing your range of movement, and increasing your rotator cuff’s control over your shoulder joint. Furthermore, as most shoulder pain occurs concurrently with some thoracic (mid back) spine dysfunction, your physiotherapist may use manual therapy to mobilise your spine, and give you exercises to improve the function of your shoulder blade muscles.

Shoulder pain can be frustrating and can take some time to fully recover. However, physiotherapy can be very helpful in ensuring your recovery is optimized and you can get back to what you love, pain-free, as soon as possible. If you think you might have shoulder pain or have any questions, come visit the team at the clinic for a consultation.

[1] Johansson, F., DeBri, E., Swärdh, L., Cools, A., Adolfsson, A., Jenner, G., & Skillgate, E. (2014). MRI FINDINGS IN THE SHOULDER OF COMPLETELY ASYMPTOMATIC ADOLESCENT ELITE TENNIS PLAYERS. British Journal Of Sports Medicine48(7), 612.2-612. https://doi.org/10.1136/bjsports-2014-093494.142

Written by


Harry Pearce