Why shoulders hurt and how to get them well

Maybe your shoulder pain started after you slipped on a wet floor and caught yourself with your arm. Lifting your child into the car or playing catch hurts. Perhaps the pain came on gradually but you can’t pinpoint what triggered it. Whatever the case, pain now accompanies your simple daily tasks such as getting dressed, brushing your hair, or even soaping up in the shower. Beyond the daily necessities of life, this pain infringes on your daily workout, your tennis with friends, and even fun hobbies like gardening. Its natural to wonder if you can get relief from shoulder pain without surgery or steroids. Luckily there are many steps you can take before considering these options.

I’m not getting the answers I need! How can I fix shoulder pain without surgery?

If you’re like many people, you went to your MD who, after taking an x-ray and finding no specific cause for your pain, recommended icing, anti inflammatories, and physical therapy. After six weeks of diligently following your recommended program, you experienced little or no progress. When you complained to your doctor about your lack of results, he offered you a cortisone shot or exploratory surgery as your only other options.

Does this sound familiar? If so, you are not alone, and you likely feel more than a little discouraged. After all, you followed the advice of all your go-to experts and you still feel the pain. You are wary of cortisone and wonder if this is really your final option or not.

If you feel stuck, with no clear direction, the first step is to learn as much as possible about your specific shoulder condition. The more you know, the faster you can sort out your options. This will help you find a competent practitioner to guide you in finding effective shoulder pain treatments.

Overview

Let’s first take a look at shoulder pain from a bird’s eye view. According to The University of Rochester Medical Center, the most common shoulder injuries are^[1] (1) Trina Bellendir and Joseph Thomas MD. Common Injuries of the Shoulder, University of Rochester Medical Center Rochester [website]. 2019, https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=1&contentid=832. (accessed December 20, 2019)

1. Shoulder instability

2. Rotator cuff tears

3. Frozen shoulder

4. Overuse/Strains

5. Arthritis

If you’ve experienced one or more of these shoulder conditions, you are not alone. Shoulder injuries are very common. A 2006-2008 study conducted by the Journal of Athletic Training estimated that there are 232,258 shoulder injuries each year from high school sports activities alone. ^[2](2) John E Bonza,Sarah K Fields,Ellen E Yard, and R Dawn Comstock. Shoulder Injuries Among United States High School Athletes During the 2005–2006 and 2006–2007 School Years, National Library of Medicine – National Institutes of Health [website]. January 2009, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629044/ (accessed December 20, 2019) 

Just imagine what the number would be if it included all age groups!
This study also doesn’t account for all the injuries that come from non-sports related injuries—for example, reaching for a purse or bag in the back seat when you’re in the front seat or the dislocation of your shoulder in a car accident.

Many factors can cause and perpetuate shoulder issues, including:

1. Neurological inhibition from the part of your brain that controls movement^[3](3) Young A. Current Issues in Arthrogenous Inhibition, National Library of Medicine – National Institutes of Health [website]. November 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1005198/ (Accessed December 20, 2019)

2. The muscles, tendons, and ligaments inundated by “gnarly spots,” also known as trigger points ^[4] (4) Carel BronArthur de Gast Jan Dommerholt, Boudewijn Stegenga,Michel Wensing,and Rob AB Oostendorp. Treatment of Myofascial Trigger Points in Patients with Chronic Shoulder Pain: A Randomized, Controlled Trial, National Library of Medicine – National Institutes of Health [website]. January 2011, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3039607/(Accessed December 20, 2019)

3. Infections in the joint from surgery or injections ^[5] (5) Laurie A. Hiemstra, MD, Peter B. MacDonald, MD, Warren Froese, MD. Subacromial Infection Following Corticosteroid Injection, Journal of Shoulder and Elbow Surgery [website]. January 2003, https://www.jshoulderelbow.org/article/S1058-2746(03)00003-X/abstract(Accessed December 20, 2019)

4. Diabetes, heart disease, rheumatoid arthritis, autoimmune disease, or any other underlying conditions that include low to high-grade systemic inflammation ^[6] (6) Sara Calabro, Reviewed by Pat F. Bass, MD. Autoimmune Disorders of the Joints, Muscles, and Nerves, Everyday Health [website]. December 2, 2019, https://www.everydayhealth.com/autoimmune-disorders/autoimmune-disorders-of-the-joints-muscles-and-nerves.aspx(accessed December 21, 2019)

5. Viral load from conditions such as Lyme’s disease ^[7] (7) Lei Huang, Rong Ou,Guilherme Rabelo de Souza,Thiago M. Cunha,Henrique Lemos,Eslam Mohamed,Lingqian Li,Gabriela Pacholczyk,Janice Randall,David H. Munn,and Andrew L. Mellor, Benhur Lee, Editor. Virus Infections Incite Pain Hypersensitivity by Inducing Indoleamine 2,3 Dioxygenase, National Library of Medicine – National Institutes of Health [website]. 11 May 2016. https://www.ncbi.nlm.nih.gov/pubmed/?term=Rabelo%20de%20Souza%20G%5BAuthor%5D&cauthor=true&cauthor_uid=27168185 (accessed December 14, 2019)

6. Vitamin deficiency, especially vitamin D3 ^[8] (8) Kathryn R. Martin and David M. Reid. Is There A Role For Vitamin D In The Treatment Of Chronic Pain? National Library of Medicine – National Institutes of Health [website]. 9 May 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466150/ (accessed December 14, 2019)

7. Scar formation, also known as adhesions, after surgery, such as shoulder surgery, breast implants, radiation treatments, and mastectomies ^[9] (9) Reviewed by Lisa Bernstein, MD. Adhesions, General and After Surgery. WebMD. [website]. https://www.webmd.com/a-to-z-guides/adhesion-general-post-surgery#1 (accessed December 16, 2019)

8. A breakdown of your body’s basic housekeeping functions like sleep (insomnia), digestion, and elimination ^[10] (10) Finan PH, Goodin BR and Smith MT. The Association of Sleep and Pain: An Update and a Path Forward, National Library of Medicine – National Institutes of Health [website]. 1 December 2014, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4046588/ (accessed December 12, 2019).

9. Chronic stress conditions, such as anxiety, depression, and PTSD ^[11] (11) David Spero. How Trauma Can Lead to Chronic Pain and What to Do About It, Pain-Free Living Your Guild to Living a Healthier Life [website]. 19 July 2017. https://www.painfreelivinglife.com/tools-chronic-pain/emotional-health/trauma-can-lead-chronic-pain (accessed December 14, 2019)

10. Periods of immobility can cause the joint to freeze and can happen from something as simple as not dynamically using your shoulders ^[12] (12) Rajeev K Sharma. Lazy bones? Beware of Frozen Shoulder Condition, Decan Herald [website]. June 8, 2013, https://www.deccanherald.com/content/337265/lazy-bones-beware-frozen-shoulder.html (assessed December 21, 2019)

11. Adhesions in the shoulder joint and muscles from repetitive stress

12. Structural damage such as brakes, sprains, strains, tears, and ruptures to the muscles, bones, nerves, bursa, tendons, or ligaments

As you can see from this list, the definitive origin of your shoulder issue may not be evident if caused by multiple causative factors. Perhaps you fell and hurt your shoulder, but the reason it won’t heal may be due to a hidden factor such as diabetes. If you are looking for solutions on how to get relief from shoulder pain without surgery or steroids it’s important to look at the big picture.

To make it easier for you, I will explore these and other causes and perpetrators in more detail in my upcoming articles on shoulder pain.

Why humans are prone to shoulder pain

Evolution also has a hand in why our shoulders are vulnerable to injuries. Mammals who walk on all fours don’t have the same shoulder problems we do. Their shoulders are less injury-prone because their front limbs are more stable than ours. Stability, in this case, comes from the fact that their front legs have a limited range of motion. Even if a dog or horse temporarily stands on their hind legs, like at the circus, they can’t reach behind their backs or raise their arms straight up as humans can.

As we gradually evolved into two-legged, upright creatures, our genes had to make some tough design trade-offs. We sacrificed stability for our ability to move in many directions. To allow for this, our shoulder joint sockets became very shallow and, therefore, very prone to dislocations.

Additionally, shoulder movement is driven by seventeen muscles, three true joints, and one floating joint. The ways they work together is complex and easily thrown out of whack. We also don’t use our shoulders as much as we used to. Inactivity and the lack of variety in our daily movements can leave the shoulder joints more vulnerable to injury from very minor accidents.

In my upcoming articles, I’ll explore solutions for the most common shoulder injuries. I’ll show you the many alternative treatments and how to get relief from shoulder pain without surgery or steroids. I’ll also offer hands-on, self-help tips to help you normalize your life. These guides can enable you to get safe, faster results and can act as a great supplement to your work with an MD, physical therapist, or other reputable practitioners.

I will be posting regularly and look forward to your comments and feedback.

If you would like to know more about a specific pain issue, please send me a request through email, social media, or as a comment after one of my articles.