You have probably experienced shoulder pain at some point in your life. For most of us, the pain was short-lived and resolved by itself without complications. Not all of us are this lucky though. You might be living with chronic shoulder pain for a while now. Today, we give you five reasons why your shoulder hurts (based on the latest research as we know it).

#1 Poor Shoulder Strength

Surprisingly, not all movements are created equal. A 2014 study published in British Journal of Sports Medicine found an association between weakness in external rotation of the shoulder and an increased risk of injury. Interesting to note: there was no relationship found between internal rotation strength and injury.

Previously, other studies have also published similar findings, including a lower external rotation to internal rotation strength ratio to be associated with an increased chance of injury.

What does this mean for you? While strength is important, all not strengthening exercises will make a difference. Not getting results from your current recovery program? This might be why.

Remember, rehabilitation is not personal training and definitely not a strength and conditioning program. It is a proactive approach to managing pain and injuries – in a specific and controlled way – so that you can go back to doing what you love.

Does your current healthcare provider know this?

#2 Poor motor control

We previously blogged that motor coordination errors are possible reasons to why people tear their ACL. Likewise, it is possible that your shoulder injury (or pain) is not the direct result of a structural fault.

We talked a lot about scapular dyskinesis (or scapular dyskinesia). Essentially, this is a broad term to describe movement or coordination faults in how the scapular moves in relation to the humerus (bone of the arm) or rib cage when you are moving your arm. In short: poor movement pattern. It is a common finding in people with shoulder pain from conditions such as rotator cuff tear, subacrominal pain syndrome, to glenoid labral tears or instability.

However, having poor movement doesn’t necessary translate to injuries! Other studies have demonstrated that scapular dyskinesis is a common finding in people who are symptom-free.

So, what does this mean?

Truth is we don’t know! While science has been excellent at giving us data, we don’t always know how to interpret this information – does poor shoulder movements cause injury or does a shoulder injury cause poor movement?

Does poor shoulder movements even matter since a significant amount of people with poor movements do not experience any symptoms?

Will they eventually experience pain given enough time?

We don’t know, yet.

#3 Range of motion deficit

First things first, you don’t need to have perfectly symmetrical range of motion side to side. It is normal for overhead athletes to have MORE external rotation in their dominant shoulder. This is a (benign) adaption to the repetitive action of throwing and is often thought to have preventative effects against injuries!

However, external rotation aside, total range of motion and internal rotation range of motion differences have been linked to an increase in injuries. Studies have found that a difference in total range of motion of >5° between sides and a difference in >20° in internal rotation to be significant risk factors for injuries.

It should be noted that these figures are the relative range of motion rather than absolute range of motion. As far as we know, it is unlikely for absolute range of motion to be associated with shoulder injuries. As such, perfectly symmetrical shoulder movements is overrated and – perhaps – oversold by healthcare providers.

#4 Chronic high workload

Enough said. Training too much can cause injuries. A 2017 study looking at baseball players found training >16 hours a week is associated with an increased of injury.

16 hours is a lot though. Do you train 16 hours a week?

If you do, maybe it’s time to go easy on the body?

#5 Sudden increase in workload

A sudden increase in training load is also associated with increased risk of injury. Another 2017 study looking at shoulder injuries in overhead athletes found that players who increased their workload by >60% in one week compared to the average of the last four weeks sufferers more injuries compared to those who increased (or decreased) their workload by 20%.

We all know slow and steady wins the race. We have also been advised over and over again to take it slow. But how slow?

20% slow.

Increasing your shoulder training by 20% (compared to the average of the last FOUR weeks) seems to be reasonable and supported by evidence to be the best way moving forward.

Remember, don’t rush it! (We can’t emphasise this enough.)

Okay, can you help with my shoulder pain?

Most likely, yes.

It is true that we don’t know for sure what causes shoulder pain and we also don’t know how to prevent it. On the bright side, we do know a few things about how to make your shoulder pain better. That, however, is a another post for another time. Stay tune!

Discover the difference the right care can make! Choose wisely and choose an evidence-based practitioner. Find out more about making an appointment here.