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Pain: Is it Always in the Shoulder?

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Shoulder pain is both common and frustrating, as there are many things that could be contributing to discomfort in that area. To have a better idea of what may be causing your pain, let’s get a little background on how the shoulder works.

Getting to Know Your Shoulder

pain: is it always in the shoulder?The shoulder is a wonderful joint that allows you to reach your hand in a nearly infinite number of points in space. The long upper arm bone, known as the humerus, has a spherical head that is anchored to a small and shallow surface on the scapula. Think of this as a golf ball sitting on a tee. This orientation allows you to move your hand across your body and behind your back, as well as enables you to reach away from your body and behind your head.

Because the bony area in the shoulder is so minimal, the shoulder joint is held in check by a labrum and bundles of ligaments and muscle. For reference, the labrum is a rim of cartilage that adds a small amount of surface area and stability to the joint. Think of this like a bumper guard in a parking lot, it functions as a small blocker to remind drivers to only go so far. The ligaments and muscle in the shoulder joint, on the other hand, are referred to as the rotator cuff. These muscles include the supraspinatus, infraspinatus, subscapularis and teres minor. This intertwined network of muscle and ligaments create an important function to be both flexible and strong, known as dynamic stability1.

The rotator cuff works together to hold the humeral head in the joint as it moves in space. An example of this would be the hinges of a door keeping the door in frame as you open and close it, but instead of rotating around one axis, the shoulder rotates around three at the same time! This is quite amazing so as you can imagine it requires quite a bit of fine tuning.

With all that mobility, things are bound to go awry in the shoulder and the surrounding area. Such issues might include – but are not limited to – shoulder dislocations, labral tears, rotator cuff tendinitis or tear, shoulder fracture, ligament tears, and simple aches and pains. Now certainly, the labrum and/or rotator cuff can be torn traumatically, but how about those times when the shoulder hurts for no specific reason or progresses in pain and dysfunction over time? We are all at risk for shoulder pain at some time or another. In fact, 12-18 year-olds have a 12-57 percent chance of experiencing shoulder pain, while 45-64 year-olds have a 21-55 percent chance2.

What Else Plays a Role in Shoulder Mobility?

The scapula, clavicle, thoracic spine, ribs, cervical spine, and to a lesser extent the elbow all play a role in the movement quality of the shoulder. That does not even account for the 20 or so primary muscles that act on the shoulder girdle. The amount of movement is impressive and complex at the same time3.   What this means is that the shoulder cannot survive alone on exercises and stretches performed at the rotator cuff. Moreover, lifting your arm overhead while working, cleaning or playing sports – and without full mobility of the upper thoracic spine and/or rotation of the scapula – puts the shoulder at potential for breakdown.

For example, dysfunction of the thoracic spine when reaching overhead complicates the shoulder’s ability to reach the end range. What’s more, stiffness of the upper thorax could restrict shoulder overhead reaching4. As you intend to use your shoulder for the various tasks of work, sport, and daily activities, the shoulder will likely push further against its restraints and create damage.

Let’s go back to the bumper analogy: if enough vehicles hit against the bumper, it will potentially become easier for the vehicle to create more damage. Imagine this in the shoulder joint when the humeral head beats up on its restraining tissue. The rotator cuff can become more irritated over time and may not be capable of stabilizing the humeral head as it was designed to do. If exercise at the gym has not helped and rest only helps for the short-term, what should you do?

Take the Next Step

This is when you may need to get a screening from an Athletico Physical Therapist. Athletico has many highly trained manual therapists skilled in differential diagnosis, rehab principles, and hands on treatment that can help to return muscle power5. The manual therapists at Athletico will get to the culprit of your condition to resolve not only your correct affliction, but also reduce the likelihood of it returning. Furthermore, if it appears you need consultation from a medical provider for additional testing, Athletico’s therapists are trained to point you in the right direction and get you the care you need.

Schedule your complimentary injury screen at an Athletico near you!

Click to Schedule a Complimentary Injury Screen

The Athletico blog is an educational resource written by Athletico employees. Athletico bloggers are licensed professionals who abide by the code of ethics outlined by their respective professional associations. The content published in blog posts represents the opinion of the individual author based on their expertise and experience. The content provided in this blog is for informational purposes only, does not constitute medical advice and should not be relied on for making personal health decisions.

1A. K. Saha (1971) Dynamic Stability of the Glenohumeral Joint, Acta

Orthopaedica Scandinavica, 42:6, 491-505.

2Mario Pribicevic (2012). The Epidemiology of Shoulder Pain: A Narrative Review of the Literature, Pain in Perspective, Dr. Subhamay Ghosh (Ed.), InTech, DOI: 10.5772/52931. Available from:

3Russ Paine, and Michael Voight (2013). The Role of the Scapula, International Journal of Sports Physical Therapy, Oct: 8(5): 617-629.

4Michael P. Bullock, Nadine E. Foster, Chris C. Wright (2005).  Shoulder Impingement: The Effect of Sitting Posture on Shoulder Pain and Range of Motion, Manual Therapy: 10(1): 28-37.

5Ethan J Liebler, Lisa Tufan-Coors, Peter Douris, Howard W Makofsky, Raymond McKenna, Christopher Michels and Shawlyn Rattray (2001).  The Effect of Thoracic Spine Mobilization on Lower Trapezius Strength Testing, Journal of Manual and Manipulative Therapy:  9(4): 207-212.

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