I woke up one day with a ‘pinching’ shoulder. Now what?

Have you ever woken up bleary-eyed, lifted your arms to stretch and felt an almighty pinching pain in the front of your shoulder?

Maybe you felt it when doing your overhead press at the gym?

Or even grabbing a mug from a high shelf of your cupboard?

‘But I didn’t even do anything to injure it!’ you say. 

You’re not alone.

Pinching pain at the front of the shoulder, known as Shoulder Impingement Syndrome, makes up around 50% of all shoulder complaints.

So what is happening when you’re feeling  the shoulder ‘pinch’?

The shoulder is a complicated joint. As it allows for so much movement, the ligaments and the muscles form a spiral pattern around the joint. Whenever you move your shoulder, this spiral of muscles and ligaments twists and slides the shoulder joint around. As a result, it makes sense that things can easily go wrong.

Now, if we think of the shoulder joint and it’s ligaments as the inside spiral, and the muscles around the shoulder as the outside spiral, you can have an issue with either one, or both spirals.

Figure 1. The ‘External Spiral’                   Figure 2. The ‘Internal Spiral’

Most often, when there has been no ‘incident’ or injury that you can remember, part of the ‘spiral’ isn’t working smoothly. This means your arm bone may slide forward or upwards in the shoulder socket, creating contact between the bones, or putting a squeeze on the tendons and bursae – all of which can cause some pain when you lift your arm, even if you have no pain at rest.

What can be done about pinching shoulder pain?

Your physiotherapist’s priority, after making sure there’s no other more serious issues going on, is to work out which spiral is affected.

If the inside spiral is affected

• This refers to an issue within the structure of the shoulder joint. This can be related to injuries to the bone, capsule, ligaments or labrum. As a result, these structures can be compressed together causing pain.

How we treat it:

• Sometimes, an exercise program for the outside spiral will be enough to manage the issues of the inside spiral. Sometimes, we will use some treatment techniques to get the joint moving correctly. Sometimes, you may need a surgeon’s opinion, and we will refer you on.

If the outside spiral is affected

• The shoulder muscles pull on the shoulder joint in different directions. If there is tightness or weakness of a muscle group, or over-developed muscle group, the shoulder joint will be pulled in a direction different to normal. This means that as you move your arm, it will be pulled into a non-ideal position. This can cause structures in the shoulder to be pressed together, again causing pain.

How we treat it:

• An exercise program which increases length of the muscles where they are restricted, and strengthens the muscles where they are weak is used.

Common issues we see with the outside spiral:

• Largely overdeveloped upper traps compared to lower traps
• Largely over-developed external rotators compared to internal rotators
• Weakness of the external rotators when the arm is lifted.
• Tightness of the internal rotators of the shoulder (particularly pecs and lats)
• Stiffness of the upper back
• Rotator cuff tears (meaning other muscles will pull the shoulder in non-ideal direction).
• Poor awareness of where the shoulder is in space (proprioception)

How do I know which treatment I need?

For a treatment that is specific to your shoulder, you will need to see a physiotherapist. Some people with shoulder impingement pain may be a painter, others may be a swimmer. Therefore, we unfortunately can’t apply one treatment to everyone.

Your physiotherapist will be able to diagnose your injury and detect the areas you need to work on to improve the mechanics of the shoulder. They will also be able to detect what other factors are involved. For example, did you know your stress levels can impact how much shoulder pain you have?

The shoulder is a complicated joint. Avoid getting your head in a spin (or spiral!) and see your physiotherapist to get your shoulders feeling healthy ASAP.