Throwing a football, landing a serve, picking up a toddler, reaching for a shelf—these are all activities that rely on a well-functioning shoulder joint. Atlas carried the world on his shoulders—and so do many of us! The shoulder is a unique joint, designed for a wide range of motion, but with great mobility comes less stability. Athletes aren’t the only ones at risk for shoulder pain— overexertion, repetitive stress from work duties, and improper exercise form can also be risk factors, so it’s important to treat this important joint with care.[i]
Anatomy of the Shoulder
The shoulder is essentially a ball-and-socket joint supported by muscles, ligaments and tendons. The upper arm bone (humerus) fits into the shoulder blade (scapula) relatively loosely, balancing on two smaller joints in the region, allowing the shoulder to twist up, down and around with a high degree of flexibility. Because the shoulder is so malleable, however, injuries can easily occur in this area. Four important muscles are responsible for keeping the shoulder joint sturdy and strong; these are called the rotator cuff muscles. Cartilage underneath the shoulder blade and a small sac of fluid called a bursa also help cushion the bones as they move. Injuries occur when any of these supporting organs become damaged. [ii]
Common Shoulder Injuries[iii]
- Frozen Shoulder (adhesive capsulitis) – The tissues around the shoulder joint stiffen and form scars, causing pain, rigidity and limited range of motion. The condition usually occurs after surgery, overuse or a disease such as diabetes or stroke.
- Rotator Cuff Tear – A very serious injury for tennis players and pitchers, this occurs when one or more of the rotator cuff muscles partially or fully rip or are pulled away from the bone. Usually due to severe stress in the area over time (like lifting heavy weights or throwing fastballs) or an abrupt injury (like falling on the shoulder), a rotator cuff tear usually has the following symptoms: pain, weakness and tenderness, difficulty moving the shoulder or lifting above the head, snapping or creaking sounds, and inability to sleep on the shoulder.
- Shoulder Impingement – Often caused by repetitive overhead motions, like painting, swimming and tennis, shoulder impingement occurs when the shoulder blade presses in on the rotator cuff muscles as the arm lifts up. Symptoms include pain, weakness and difficulty lifting overhead. If left untreated, this condition could lead to tendonitis or bursitis.
- Shoulder Tendonitis – Tendonitis is inflammation in the tendons, and can occur in the tendons supporting the rotator cuff muscles. Tendons are designed to bend and stretch, but overuse can cause tearing or swelling.
- Shoulder Bursitis – A bursa in the shoulder can become inflamed when the joint is overused, injured or under too much pressure for a long period of time.
- Arthritis – Osteoarthritis and rheumatoid arthritis can both affect the shoulder joint, typically resulting in inflammation and pain.
- Labral Tear – The labrum is the cartilage in between the upper arm bone and the shoulder blade, and can be torn due to overuse or an accident.
Shoulder Injury Treatment
Luckily, except for the most severe injuries, most shoulder problems will heal on their own with consistent and conscious care to reduce swelling and encourage muscle repair. Treatment for shoulder injuries is generally the same: Rest the joint, avoid aggravating activities, take anti-inflammatory medications, ice regularly, add gentle heat, and engage in gentle range-of-motion stretching. It’s important to let the shoulder fully heal before returning to strenuous activities; physical therapy led by a trained professional, targeting certain areas and muscles, also helps ensure proper recovery.[iv] If you are experiencing shoulder pain, consult a doctor or trained professional for diagnosis and treatment.
Healthy Shoulder Maintenance
In general, exercise and stretching are the best ways to maintain healthy shoulders and prevent injury. Injuries occur when the shoulder joint, which is inherently loose, becomes overextended and the muscles are not strong enough to prevent rupture. Therefore, building strength in the rotator cuff muscles, through appropriate weight training and targeted stretching, makes you less susceptible to rips, tears and inflammation. For someone who puts a lot of stress on the shoulders, like a painter or tennis player, strengthening and stretching can help prevent and treat injury from repetitive motion.[v]
It’s important to build stability in this relatively weak joint, especially for athletes, people with sedentary lifestyles or people with other health problems. If you’re going to begin an exercise program, be sure to build strength gradually and not overextend or overexert. And remember to stretch! There are plenty of easy, gentle stretching exercises you can do at home to prevent and treat shoulder injuries. See a physical therapist for instruction, and make these a part of your regular routine.
Unfortunately we cannot show off our subscapularis muscle of the rotator cuff complex. If we could, people would be more apt to conditioning these small and adaptable muscles more regularly. One of the main causes of injury to the shoulder is the big, superficial mover muscles (the ones we can see) can overpower the smaller, deep stabilizer muscles (sounds a lot like the spine…and the hips…and the…). So the best approach is to make sure these hidden, quiet muscles get some attention during the heavy work, game play or gym workouts of the superficial mover muscles. Again, “stability supports movement complexity.”