Mythbusting: Shoulder Pain Causes
Have you been told that your shoulder pain is caused by “impingement” happening between the tendons and bones? How about your posture being the underlying cause? I’m sure you’ve been told it’s because your scapula isn’t moving correctly. Maybe you’ve even heard each of these three “diagnoses” from different providers.
The thing is, over the last few years more and more research has shown that the above factors have little-to-no correlation with the onset of shoulder pain. Our bodies are resilient, and the more that we learn about the shoulder girdle in particular, the more we are beginning to understand that simple things like our anatomical makeup and posture are rarely, if ever, going to lead to our own demise from a pain and injury standpoint (genetic and neurological disorders aside). This is good news, because the common drivers of shoulder pain are much more modifiable and within our control than anatomical makeup and posture. My aim in this blog is to break down the common misconceptions surrounding shoulder pain and shed light on where it might actually be coming from.
Shoulder Impingement
To this day, “shoulder impingement” is probably the most common shoulder diagnosis given by healthcare providers. Common symptoms that fit this diagnosis include pinching shoulder pain in the front and/or top of the shoulder with: reaching overhead, reaching across one’s body, and lifting above shoulder height. The rationale behind the cause of this diagnosis is that the rotator cuff and biceps tendons are getting pinched, or “impinged”, between the bones below and above, leading to tendon irritation and fraying. It was, and still often is, thought that this happens when the overhanging bone above the tendon called the acromion is too large or overhanging, leading to the tendon having less space to move without friction. It has also been thought to occur when the shoulders are too rounded and thus place the acromion in a lower position.
Thankfully for us, it has recently been discovered that EVERYONE technically experiences this tendon “impingement” with the aforementioned movements and it is not pathological as was once thought. Our tendons, especially in the shoulder, are lubricated and oriented in such a way that they are able to withstand these types of friction without issue. Shoulder pain does often occur in these positions where impingement occurs, but it is only after the tendon has already been irritated through other means (which I will discuss below), rather than a direct result of the impingement itself.
Posture
Another common narrative is that poor posture often leads to shoulder pain and impingement. The thought is that if the shoulders are excessively rounded, the acromion bone above the rotator cuff tendons sits forward and lower down, causing it to make contact with the below tendons with movement. Fortunately, many studies have recently found that there is no correlation between posture and shoulder pain onset. Even if it were to lead to an increase in contact between tendon and bone, this is a normal thing for the human body to experience and likely not something that causes pain or damage to the tendon, for reasons we discussed above.
Scapular Winging
Similar to the rounded-shoulders posture, scapular winging or “dyskinesis” has been heavily incriminated by the healthcare field, as it is thought to be associated with faulty mechanics and muscle imbalances in the shoulder. Lack of activity in certain muscles leading to the overuse of certain muscles and tendons elsewhere, or so it’s been told. Outside of very rare nerve injuries, this one has also been put to pasture. Not only has it not been found to be correlated with pain, but research has also shown that providers’ ability to agree on whether or not this diagnosis is even present can be decided by a coin-flip. Variation in scapular position and movement is normal, just like variation in height and hair color.
The Bottom Line
The good news in all of this is that not only are the true common causes of shoulder pain more simple than was once thought; they are also more actionable and malleable. Rather than being caused by anatomical or postural attributes, which are extremely challenging if not impossible to change via exercise and movement alone, we are instead finding that shoulder pain is much more commonly caused by things like overloading, underpreparedness, and under recovery. This should come as a relief, as these are variables that are proactively and reactively modifiable.
Dealing with shoulder pain yourself? Click here to chat with one of our docs and get some answers!
Dr. Brooks Kenderdine
PT, DPT, CSCS, USAW-1
Co-owner | The PATH Rehab & Performance
