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Fix Your Shoulder Pain

So, your shoulder hurts. Welcome to the club!

Let's talk about something I've been seeing a lot of lately - shoulders. Starting with a VERY broad overview, shoulder pain falls into two categories : Traumatic (You know what you did and why it hurts) and Non-Traumatic (You really can't recall anything that should have made it hurt). For the purposes of our discussion today, we will be sticking to the Non-Traumatic category. I have to emphasize that if you know which movement made your shoulders hurt and there is even a chance that you may have caused damage, you should get a professional opinion before attempting to fix it yourself. That being said...

Non-Traumatic Shoulder Pain - "This sucks and I don't know why!"

Let's break this down a little further before we start getting into the "fix it" portion of this discussion : if you are the TL;DR type, keep scrolling till you hit the photos. Shoulder pain falls into two more broad categories after we rule out trauma and injuries like SLAP tears and rotator cuff tears. 

 

Category 1 : The "Tight as a drum/stiff as a board" shoulder
If your shoulder is so tight that you can barely even get your hands behind your upper or lower back, guess what: you're gonna have a bad time. A lack of basic shoulder mobility means that every time you load that upper limb with weight or try to do something athletically that you aren't limber enough to do, it's going to be akin to a minor strain of something in your shoulder. You may not even be able to find a comfortable position to sleep in because every position that you attempt puts excessive strain on the joint in some way. 

If this sounds like you, then you need to figure out how to loosen that thing up! Shoulder mobility drills, stretching, yoga, thoracic spine mobility, foam rolling, massage, ROMWOD, take your pick; All these things should help. Even better would be a combination of these and figuring out why your shoulder is tight in the first place.
Is it a repetitive motion you do that tightens your muscles up over time without balance? Looking at you, Mr. "Every day is chest day". Is it poor posture all day long that makes you feel stiff and sore, then you try to exercise anyway without addressing it?


Whatever it is that gets you to this point, try to break the cycle and add some mobility to your shoulders. Find a professional who can help you regain the mobility you don't have, or find tutorials you trust. No matter how you do it though, fixing your shoulders shouldn't make them hurt MORE - if that happens, seek out a professional.

 

Category 2 : The "Mel Gibson in Lethal Weapon / Floating in space" shoulder
If your shoulder has been previously damaged and torn, or is just naturally so loose that you can actually feel it moving in and out of place in it's socket - that's not good either. For these shoulders, REHAB and EXERCISE are important staples of daily life. You have to have STRONG, STABLE shoulders to be pain free. 

Let me put that another way : If your shoulders hurt because the joint is too loose, then your best friend is going to be stability exercise. 

This is not the time to try and "stretch it out" or "add some mobility" to your shoulders - the whole point here is that they are already too loose. If you have already made sure that there is not  extensive damage to the joint itself, then you've gotta get on the grind and add some muscle mass. 


A great place to start is rotator cuff exercises, usually internal and external rotation. Think Karate Kid "Wax On/Wax Off", circle in and circle out type motions. Depending on how poor your shoulder stability is, you may have to start at Square 1 with the exercises. With building basic stability though, following the KISS concept is usually best (Keep It Simple, Stupid).
Finding a trainer/physical therapist/clinician or at least catching some good educational instruction videos online is a place to start. Once you find someone you trust, Get After It! Same as with the tight shoulder though, if the pain is increasing instead of improving - get a professional to take a look. 

"Wait, didn't I read the term "extensive damage" a moment ago? Does he mean like... tears in the shoulder joint, or something?"

You sure did. There's a reason for that - Studies conducted on shoulder pain show that even with minor (i.e. not complete) tears of the rotator cuff and associated structures, REHAB and EXERCISE can have the same (or better!) outcomes than surgical repair when it comes to reducing pain and restoring functionality (study links at the end). So even if your shoulder does have a minor tear in it - try some exercises first. The worst that can happen is it doesn't work and you end up getting it fixed like you were planning on in the first place. Best case scenario is you avoid the cost and the hassle of going through shoulder repair surgery, which is usually on the "Do Not Recommend" section of most people's life reviews. 

 


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TL;DR
If you don't have a damaged shoulder joint, then you probably fall into one of these categories and you should do something about it. No matter what category you fall into, if what your doing still causes pain when you try to fix your shoulders, get some professional help. 


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TL:DR
If your shoulders hurt because they are too tight and your mobility is poor - fix it! Stretch, mobilize, loosen up.


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TL;DR
If your shoulders hurt because they are too loose, then stretching and mobility won't help. Strengthen and stabilize your shoulder.



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Dr. Paul Harris holds a Doctor of Chiropractic degree from Texas Chiropractic College and a Master’s of Exercise and Health Sciences from University of Houston Clear Lake. He is the owner of Delta V Chiropractic and Sports Medicine and an avid human movement specialist. 

Studies :
Treatment of non-traumatic rotator cuff tears: A randomised controlled trial with one-year clinical results.   
https://www.ncbi.nlm.nih.gov/pubmed/24395315



EXERCISE REHABILITATION IN THE NON-OPERATIVE MANAGEMENT OF ROTATOR CUFF TEARS: A REVIEW OF THE LITERATURE https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4827371/


Exercise therapy for the conservative management of full thickness tears of the rotator cuff: a systematic review.
https://www.ncbi.nlm.nih.gov/pubmed/17264144


Natural history of nonoperatively treated symptomatic rotator cuff tears in patients 60 years old or younger.
https://www.ncbi.nlm.nih.gov/pubmed/21310940

Outcome of nonoperative treatment of symptomatic rotator cuff tears monitored by magnetic resonance imaging.
https://www.ncbi.nlm.nih.gov/pubmed/19651947

Surgical and nonsurgical management of rotator cuff tears
https://www.sciencedirect.com/science/article/pii/S074980630278910X