Pain is a symptom. Symptoms are the feedback that the body generates when it faces problems with its delicate internal balance (homeostasis). Without symptoms like pain, thirst, nausea and fevers, it would be very difficult for us to maintain a healthy body in the same way that it would be hard to drive a car safely with no dashboard display.
What Causes Shoulder Pain?
The majority of shoulder pains are caused by mechanical lifestyle factors like sedentary work, chronic postural strain, muscle atrophy, stress and old injuries. Occasionally shoulder pain can have more serious causes; but thankfully these are rare and easy to rule out with straight forward tests like blood tests and x rays.
Shoulder pain is extremely common, in fact it may be the most common issues that turns up in pain management clinics. Despite this the causes of shoulder pain are quite predictable. Shoulder pain usually isn’t as debilitating as back pain (usually) because the tissues of the shoulder bear far less weight than tissues in the lower back, and so are exposed to less strain. Shoulder pain is also somewhat of a broad term. The shoulder encompasses a broad area from the upper arm into the upper back, and there are many tissue structures that can be involved. All of these tissues are however impacted in similar ways by the causes of shoulder pain.
Happily there are some very common and predictable underlying causes of shoulder pain. This makes even bad cases very manageable in the longer term. If you can truly identify the underlying cause of a pain, you can usually fix it.
So what are the real causes of shoulder pain? In no particular order, because it varies from person to person, the real causes of shoulder pain are as follows.
Chronic Postural Strain
We used to have to move in order to feed ourselves and survive. Now the majority of us are forced to sit endlessly in order to feed ourselves and survive. In addition to that, much of our leisure and free time involves sitting and screens. Our body’s are simply not evolved or adapted for hundreds of hours of sitting each month.
All of our tissues are designed to adapt to what is asked of them for better or worse. So over time, the excessive sitting we do relative to our evolutionary blueprint causes real changes to occur in our body’s skeleton and soft tissues. Muscles and connective tissues either shorten or tighten, joints lose their natural mobility and fluidity, and every our skeletal structure undergoes changes in shape and alignment. When all these combine we call it ‘bad posture’ and you don’t need a degree in biomechanics to spot it.
Over time the tissue responses to persistent postural stress lead to forms of repetitive strain. These then eventually lead to the tissue integrity being undermined. If you know someone who has had shoulder dislocations or rotator cuff tears; the overwhelming probability is that a weakness had built up over time in their shoulder. So not only shoulder pain but most shoulder ‘injuries’ have some connection to the tissue stress caused but poor posture.
Chronic Muscle Atrophy
Once again, we used to move to survive, nowadays we sit all day to survive. And loss muscle strength is inevitably one of the key impacts this has on the body. Specifically however, the muscles of the upper back and the back of the shoulder girdle do not not get used. Where virtually everyone who lives in an urban setting has some degree of muscle atrophy.
The muscles in the upper back and back of the shoulder are not full activated until we do pulling or climbing movements. And modern life does not ask us to do a meaningful amount of these from day to day. Notable exceptions would be surfers, rowers climbers and people who’s job involves ‘dragging’ large objects around. Most of us however don’t often have occasion to ‘pull’ under strain very often.
In contrast the muscles at the front off of the body are almost constantly activated as we are doing tasks in front of our body’s almost constantly. This is why every body builder on the planet finds that it is the ‘rear belt’ at the back of the shoulder is the hardest muscle to build up.
Loss of muscle mass means loss of support, loss of resilience and loss of resistance to injury in the tissues of the entire shoulder girdle.
Chronic Stress & Emotional Trauma
The tendency to lift the shoulders up and the tendency to hunch forward slightly in people who are anxious and depressed is probably the single easiest way to observe how our dominant mood affects the alignment and function of the body. There are an infinity of other ways this happens, but the shoulder one is easiest to spot. This is because the neck and shoulders are extremely prone to stored up emotional strain.
When we are in a persistently stressful life situation it creates subtle but chronic muscle tension in the neck and shoulders. Also, if we have unresolved trauma it can have a similar effect even if life is good now. Some of us tend to hold stress in other parts of the body too, but almost all of us hold some in the shoulder and neck region. Over time this extra ‘load’ on our soft tissues can cause them to suffer wear and tear, which eventually becomes painful.
The tendency that chronic stress and unresolved emotional trauma have is to cause pain by irritating other pre-exisiting issues like posture and old injuries. Stress and trauma have a way of letting us know where the weaknesss are in our body’s. For somer they impact the gut or the skin, for others it could be the lower back, and for others they expose weaknesses in the shoulder.
When we injure our shoulders or upper backs there are often residual changes that occur which we fail top target with effective longer term rehab. Because we are not really a rehab culture and we lead such sedentary lives there is a tendency for these ‘post-injury-tissue-changes’ to become chronic.
When we injured ourselves in the big outdoors we would mostly have had to keep going. Only the most severe of injuries stop a hunter from hunting. This would not have been fun for our ancestors, but it would have meant that they retained far more muscle mass after injury than we tend to. It would also have meant that their scar tissue formation would have been nice and pliable. For modern humans a lack of movement often means we end up with residual long term problems after shoulder injuries.
A shocking number of shoulder pain sufferers have some residual weakness or scar tissue that is causing their pain and injuries. And eventually it becomes nearly impossible in many cases to discern between the the injury and the harm caused by postural pain etc. Yet if you have residual, re-occuring or relapsing shoulder pain after an injury you can bet good money on there being scar tissue and weakness left in the wake of the injury.
Wrapping Up The Causes Of Shoulder Pain
This blog discussed the various causes of shoulder pain, which is a very common issue in pain management clinics. The shoulder encompasses a broad area from the upper arm into the upper back, and there are many tissue structures that can be involved. The underlying causes of shoulder pain include chronic postural strain caused by excessive sitting, chronic muscle atrophy caused by a lack of physical movement, chronic stress and emotional trauma causing chronic muscle tension in the neck and shoulders, and old injuries. It is essential to identify the underlying cause of the pain to manage it effectively in the long term.
The good news about shoulder pain is that it is very treatable in the vast majority of cases. For most of us choosing to live with shoulder pain would be a bit like choosing to live with toothache. Not fun and not necessary. That is, as long as you have the right tools and the right help.
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John is one of those rare gentlemen who has continued to play competitive soccer well into his late 50s. He is in really good shape, which you need to be to play football at that age—good shape except for his left leg. His left leg is not in good condition at all. In fact, once you get to know his left leg a bit better, it becomes apparent that it’s miraculous that he’s able to run at all, Let alone the type of running required to play competitive soccer against younger men.