A painful shoulder in sports is one of the most common complaints. Athletes, especially young overhead athletes, suffer from shoulder pain at higher numbers than non-athletes. Shoulder pain doesn’t discriminate. Painful shoulders affect all genders, ages, and sports. If you suffer from shoulder pain, your actions in and out of your sport may be contributing to the ache. Here are the 12 unusual causes for your painful shoulder [if you have an impinement, learn more about them here].
Understanding Your Painful Shoulder
To determine the causes of your shoulder pain, you need to understand the pain and your shoulders.
Difference Between Pain and Soreness
If you experience painful shoulder movements, think about what you are feeling and when you feel it. Do you have a painful shoulder, or are you experiencing muscle soreness?
Symptoms of Soreness
Muscle soreness is different than pain. Soreness is describe more like discomfort, but it goes away within 24 to 48 hours. Soreness occurs only in the muscles, not the bones and joints. Signs of soreness are:
- Occurs after physical activity
- Tired muscles
- Dull discomfort
- Muscle tightness
- Burning sensation in the muscles
- Discomfort feels worse when attempting to move after an at-rest position
If you experience muscle soreness, it is temporary and rarely debilitating. Muscle soreness gets better with time, movement, and self-myofascial release.
Symptoms of Pain
If you experience a painful shoulder, it may indicative of an injury. Athletes and non-athletes experience different pain thresholds, which can make it difficult to diagnose pain among diverse populations and patients. What is the same, however, is the result of exceeding an individual pain threshold.
The pain threshold in athletes is generally higher than non-athletes or non-active people. The more athletes workout and train, the higher their threshold because they have gradually pushed their bodies beyond their initial pain threshold. They don’t, or shouldn’t, push when pain is significant.
Symptoms and signs of pain are:
- Stabbing and sharp pain
- Pain is shooting or electrifying
- Pain occurs while doing an activity, when resting, or when performing a certain movement
- Pain does not subside after 24 hours
- Causes shortness of breath
- Can pinpoint a specific area
- Keeps you up at night
- Leads to disability or time off from practice, training, or performing
If you experience any of the above symptoms of pain, there are quite a few reasons why.
12 Origins of Your Painful Shoulder
A few factors are going to influence the causes of your shoulder pain:
- Previous injury
- Physical activity level
- Extracurricular activities
- Type of sport and position played
- Frequency of use
There are so many factors that go into shoulder pain, just as there are causes for the painful shoulder. Here are a few unusual causes of your painful shoulder.
Overuse is one of the biggest contributors to shoulder pain. Overuse is pushing your shoulder to the limit without giving it time to rest, and then doing it all over again. Repetition and no rest leads to overuse injuries in a painful shoulder.
You are at risk for an overuse shoulder injury if:
- You complete many overhead motions.
- Your form is off when throwing, swimming, or performing any other overhead movement.
- You do unnecessary shoulder exercises that strain the shoulder instead of strengthening the shoulder.
- You force yourself to keep training and to complete the same movements, even when you feel pain and inflammation, you experience limited immobility, or when the muscles are weak.
- You throw suddenly and explosively, which causes stress or tearing.
How to prevent overuse:
- Enjoy rest days
- Avoid unnecessary shoulder stretching
- Improve bio-mechanics and form
- Strengthen the shoulders
- Seek help from a physical therapist
The most recognizable symptoms of shoulder instability is pulling a shoulder “out of socket.” This occurs when the muscles, ligaments, and tendons around the shoulder are not stable or strong enough to support the shoulder and its movements. Shoulder instability can be caused by direct sudden blows, injury, or overuse. When the shoulder wears out, instability occurs.
How you sit and stand can affect your shoulders. Before we sat at desks all day, we moved. Now we sit in cars to drive to work and walk only on our feet to get around. Our ancestors we were reaching, swinging, running, and building. This allowed bodies to move more, and it made the shoulders stronger.
Now, we sit, and we do so without an awareness of the position of our bodies. Slouching causes the tops of our heads to pull forward, which stresses the vertebrae in the lower neck. The muscles in our backs overcompensate for the stress and pulling forward of our upper bodies. Finally, to complete the slouch, we round our shoulders and upper back. This exacerbates back and neck pain. Rounding the shoulders also causes pain, limited mobility, imbalances, and poor form in the shoulders.
Read more about improving posture.
4. Frozen shoulder
Frozen shoulder, or adhesive capsulitis, is stiffness and pain in the shoulder. When someone experiences frozen shoulder they may report one or more of the following symptoms:
- Pain when moving the shoulder
- Weakness and instability of the shoulder
- Limited range of motion and flexibility
- Stiff shoulders
- Shoulder pain at night
I admit: I am not a fan of stretching. There is no proof that stretching improves performance, aids in recovery, or prevents injury. In fact, stretching before physical activity can actually cause injury, or at least improve the odds of injury, and impede physical performance. Overhead athletes are at an increased risk for injury if they stretch wrong.
Instead of static stretching, athletes and non-athletes should consider alternative methods to warm-up and ease muscle tension. Dynamic warm-ups and dynamic stretching:
- prepares the body for movement
- increases range of motion
- warms up the body to protect the muscles and joints
If you stretch to relieve tension or to soothe sore muscles, self-myofascial release is a better option. SMR is safer for a number of reasons because:
- targets your problem areas
- increases the temperature of the muscle
- it feels good
6. Nerve problems
Pinched nerves are common when someone suffers from a painful shoulder. You can usually identify a pinched nerve by the zinging, burning pain it causes. You can feel a pinched nerve when you perform a specific action such as lifting, pulling, turning, and extending the shoulder.
7. Tendon issues
You could have a painful shoulder because of tendon tears, irritation, inflammation, and degeneration. Tendon pain often presents itself as either acute pain or chronic pain.
Acute pain means that the pain is mild and is short-term, not longer than 3 to 6 months. Once the underlying cause for the acute pain is addressed, acute pain with subside. Failure to treat or address acute tendon pain can lead to chronic tendon pain and injury. Chronic pain is pain that won’t go away. It will stick around for months or years. People with chronic pain do not experience relief from over-the-counter medications and treatments.
Common shoulder tendon issues are:
- acute tendinitis
- chronic tendinitis
- tendon tears
A common overuse injury is bursitis. Bursitis is increased pressure on or inflammation of the bursa sac. The bursa sac is the area between bones, muscles, and tendons. Lubricating fluid that reduces friction, rubbing, and irritation so the muscles bones and tendons can move freely fill the bursa sac.
Bursitis affects the shoulder, but it can also cause pain and discomfort in other areas. The elbow, buttocks, ankles, hips, knee, and thigh are possible.
Symptoms of bursitis are:
- limited movement of the area
- pain and pressure
- tenderness when the shoulder is not moving
- swelling in the area
The CDC reports that arthritis is the number one cause for disability in the US. Arthritis is an ailment that many associate with aging. While that it true for the most part, athletes are at risk for arthritis too. Athletes can develop arthritis earlier on in life. Common causes of arthritis are overuse, old injuries, surgeries, and repeated blows.
The most common types of arthritis that affect the shoulder are:
- Post-traumatic Arthritis
- Avascular Necrosis
- Rheumatoid Arthritis
- Rotator Cuff Tear Arthropathy
10. Medical history
Your medical history can also cause painful shoulder. Previous injury, age, genetics, and your activity level can cause shoulder pain. If you have had previous surgeries, dislocations, fractures, or any other condition, you are at risk for shoulder pain.
Impingement is painful because it means that something is pinched or stuck. Impingement in the shoulder is also the result of overuse. What happens when a shoulder impingement occurs is the acromion is putting pressure on the tendons in the rotator cuff. When the shoulder lifts, the pinch causes pain.The higher the arms lifts away from the body, the more intense the pain and pinching.
A recent research review, found that exercise and manual therapy are the most effective forms of treatment for shoulder impingement. Corticosteroid injection was found to be effective in some cases, but should be the second line of defense behind exercise and manual therapy (Pieters 2019).
Finally, a fracture can cause a significant amount of pain to a person. Fractures are the result of a direct blow to or a fall on the shoulder. It is difficult to fracture the shoulder because of the anatomy of the shoulder. It is not impossible.
Signs of a shoulder fracture are:
- Obvious bone protrusion
- No shoulder movement
- pain and swelling
- Pain to the touch
- grinding in the shoulder when moving it
- immediate bruising of an area
- Significant shoulder rotation
Conclusion: Advice from Dr. John
If you experience any of the signs of painful shoulder, it is time to get help. Most of the signs and symptoms of a painful shoulder can be prevented and alleviated. Physical therapy and non-invasive treatments are a must first. Ease your shoulder pain with strength training, physical therapy, and mobility at COR in Santa Clara.
- Pieters L, Lewis J, Kuppens K, et al. An update of systematic reviews examining the effectiveness of conservative physiotherapy interventions for subacromial shoulder pain. Journal of orthopaedic & sports physical therapy. 2019;1-33:1-33. doi:10.2519/jospt.2020.8498