Whether you’re placing a pile of dishes at the top of your cabinet shelf or throwing a ball across the field, your shoulders are at work. In fact, the shoulder is the most movable joint in the entire human body.
Unlike the knees, ankles, and elbows-which act more like hinges-the shoulders have a much wider range of motion. But having this kind of mobility is what makes them so prone to pain and injuries. In fact, shoulder pain is one of the most common reasons people see a physical therapist Robert Kaufman.
What causes neck and shoulder pain?
Shoulder pain doesn’t always come from a traumatic injury, however. Sometimes it’s a slow burn from repetitive use, and other times it comes from something completely unrelated to the shoulder, like gallbladder disease.
Here are nine common causes of shoulder pain and what you can do about them.
Lifting more than you can handle
Oftentimes, shoulder pain is a result of lifting something that’s heavier than what the shoulders can handle. For example, Kaufman says lifting a heavy suitcase can cause shoulder pain. “It’s a very common theme that the shoulder is simply overloaded and not trained for that,” he says. Overloading the shoulders too soon puts strain on the rotator cuff.
“The most common problems that we see in the shoulders are related to the shoulder cuff,” says orthapaedic surgeon Dr Miho Tanaka.
The rotator cuff is a sheath of muscles that connects the head of the upper arm bone to the shoulder socket, Tanaka explains. “It also helps with lifting and bringing the arms overhead,” she adds. When the rotator cuff is overused, it can lead to inflammation in the form of tendinitis or cause a tear in the cuff.
Making sure you vary the way you strengthen your shoulders is key to preventing muscle imbalances and improving joint flexibility, Dr Tanaka says. “Let’s say you’re always doing bench presses or bicep curls, and you never go to the row machine or do shoulder extension exercises, you’re going to have a training imbalance,” Kaufman says.
Like a cushion for your bones, bursae are fluid-filled sacs that help reduce friction between your joints. Shoulder bursitis can occur when the joint is overused or strained, causing the bursa to swell with more fluid. “If your movement is unvaried because of strength and flexibility issues around the joint, then any impediments in and around the joint can irritate the bursa,” Kaufman says.
Normal wear and tear
As we age, the rotator cuff thins and frays. “It can lead to inflammation in the rotator cuff, which typically presents itself as pain on the front and side of the shoulder," Dr Tanaka says.
Osteoarthritis is the most common form of arthritis, mostly affecting the hands, knees, hips, and spine. But that doesn’t mean the shoulders are immune to it. Osteoarthritis can cause pain deep in the back of the shoulders, and stiffness may become more of a problem as it progresses. With repeated use—like working a manual labor job or playing sports all your life—Dr Tanaka says the cartilage covering the ends of your bones and cushioning them from one another will begin to deteriorate. She notes that this usually begins when you’re in your 30s.
There are so many scenarios that can end in a traumatic dislocation of the shoulder, but sometimes you don’t need a hard hit to pop the ball from the socket. “Some people are just lax and prone to dislocations,” Kaufman says. This is called shoulder instability, and it can make people feel like their shoulder is about to come out of place at any time, or move back into the socket.
Just like other shoulder problems, strength training will be essential to recovery. Patients will specifically undergo training that stabilises the shoulders, Kaufman says. One exercise is to keep the arm and shoulder in one position (maybe somewhere close to where it dislocated) while holding a resistance band. Then, have someone else gently pull the band in different directions while you resist their motions. “So you’re turning your shoulder on to avoid it from moving,” he says.
Impingement syndrome (also called swimmer’s or thrower’s shoulder) is closely related to bursitis and tendinitis. It happens when the tendons in the shoulder get trapped and compressed in the acromion-the bony arch at the top of the shoulder blade. This leads to pinching.
“It’s a constellation of symptoms, but we don’t know how it happens,” says orthopaedic physical therapist Zachary Rethorn.
Frozen shoulder (or adhesive capsulitis) occurs when the connective tissue surrounding the shoulder joint thickens and stiffens, restricting movement of the shoulder. It’s unrelated to arthritis, and is characterised by three stages: freezing, frozen, and thawing. It’s usually during the first two stages that the pain is at its worst. “It starts out with a lot of pain and progresses from pain to a great deal of stiffness,” Kaufman says.
While there’s no definite cause of frozen shoulder, some people are at a greater risk, including those who are 40 and up, people without previous shoulder problems, and people with diabetes, heart disease, or thyroid problems. Treatments will vary depending on where the impairments are, Kaufman says, and they take a lot of time. “Unfortunately, a lot of people don’t start feeling better until at least a year after they’re diagnosed with it.”
What if your shoulder pain isn't coming from your shoulder at all?
Think of referred pain as a glitch in the nervous system, where pain from one problem area in the body is sent along the nerve pathway to another part. A classic example is the first symptom of a heart attack can be pain in the teeth or jaw. Both gallbladder disease and herniated discs in the neck can cause referred pain in the upper back, near the shoulder, Dr Tanaka says.
This kind of pain isn’t worsened when you move the shoulder; instead, it’s more of a persistent pain that won’t go away even when you’re resting. Dr Tanaka advises people who experience this kind of pain should see a doctor right away.