Have you ever considered which of the joints in your body is the most important?
It’s a difficult question… but if I had to answer, the humble shoulder would be right up there. Why’s that? Well consider what life would be like if you couldn’t move your arms at all and they were simply stuck by your sides. Being able to move our hands to manipulate objects, bring food to our mouth, or to communicate are very important abilities for humans.
Where does most of that movement come from? The shoulder!
The shoulder is one of the most mobile joints in our body. We can reach right up over our head, behind our back and out in front. When we don’t have any shoulder problems, it can be easy to take for granted just how much we use them. Unfortunately, many people over 50 experience shoulder problems that limit their ability to do daily tasks, the things they love and exercise.
Now there are many different causes of shoulder pain like rotator cuff problems, osteoarthritis, frozen shoulder and biceps tendinopathy, to name a few. It is beyond the scope of this article to take a deep dive into each condition, but rather, it will give insights and address misconceptions for those suffering from the symptoms of these various issues. Most of the tips provided in this article are applicable to anyone with shoulder pain, regardless of the specific diagnosis.
The causes of shoulder pain
Two of the most common structural contributors to shoulder pain are rotator cuff changes and shoulder osteoarthritis, so it is worth briefly discussing these.
Rotator Cuff Related Pain
The rotator cuff is a group of 4 muscles that attach the humeral head (the top of your upper arm) to the scapula (your shoulder blade). Their role is to rotate the arm, and to help keep the humeral head in the middle of the shoulder socket during movements like reaching in front or overhead. One of the key issues affecting older adults is rotator cuff tears. These can be the result of a specific acute injury like a fall, or they can be the result of long term changes in the tissue, without any one specific cause. Rotator cuff tears can result in pain in the shoulder and down the arm, weakness in the shoulder muscles and restricted movement, especially over head and behind the back.
HOWEVER, it’s not as simple as tear = pain. In fact, many people with rotator cuff tears don’t even know they have one! One study looking at 664 patients with an average age of 69, found that 22% of the population had a full thickness rotator cuff tear. One third of these were symptomatic, but the other two thirds had zero symptoms! The study also showed that the older you got, the more likely you were to have a rotator cuff tear, but the LESS likely you were to have symptoms associated with it! (Minagawa et al. 2013)
This is great news for people who have had their shoulder pain attributed to a tear - it means that even if the muscles stays torn, you can improve or eliminate your symptoms!
Interesting… but let’s now talk about the other common cause of shoulder pain.
The glenohumeral joint is the ball (humeral head) and socket (glenoid) joint of your shoulder. Like other joints of the body, it can be affected by osteoarthritis. Commonly thought of as a ‘wear and tear’ or ‘degenerative’ condition, osteoarthritis can be more accurately thought of as an ‘overdoing’ of the healing and repair process in the joint as a whole, rather than simply wearing down of the cartilage. Like rotator cuff issues, shoulder osteoarthritis can result in pain and reduced movement. Once again, it makes sense to assume that the features of osteoarthritis like cartilage thinning, osteophyte formation and subchondral sclerosis would cause pain… and once again, that is an incorrect assumption!
A study by Gill and colleagues (2014) compared the x-rays of a group of people with shoulder pain to those without shoulder pain. They found no difference between the groups in terms of the arthritic shoulder changes. So, whilst osteoarthritis can be a contributor to shoulder pain, it’s not clear cut.
If tissue changes aren’t always the problem...
What factors determine why some people get pain with these conditions, and others do not?
It’s a difficult question to answer. What we do know is that pain is an incredibly complex phenomenon with lots of different inputs. It’s not as simple as pain = damage (as we have seen). For a full explanation of pain and how it works, have a read of this article.
Whilst there are lots of different factors affecting whether your shoulder becomes painful, it can be useful to conceptualise the problem as an imbalance between what the shoulder can tolerate and what is asked to do. The solution therefore, is to increase the shoulder’s load tolerance.
The Case for Exercise
Exercise is the closest we’ve come to a magic pill for health. The list of benefits is nearly endless, and thankfully, that list includes shoulder health. Exercise has multiple benefits for the shoulder:
Beyond these specific changes, being active has many more general health benefits that can reduce risk and impact of shoulder pain.
Hopefully, I’ve convinced you of the benefits, but if you need more persuasion check out the video we made about the benefits of exercise.What sort of exercise?
We always recommend aiming for the minimum physical activity guidelines such as those set in Australia.
(Australian Government Department of Health 2021)
When it comes to shoulder health however, many of the aforementioned benefits such as increasing strength, load tolerance and confidence in the shoulder can be brought about by a good resistance training program.
Strength based exercise or resistance training is any form of exercise where you are moving against a resistance. This could be lifting weights, lifting your bodyweight or using resistance bands. Similar to aerobic exercise, we want to start low and build up slowly over time. A good resistance training program will involve exercises that challenge all the major muscle groups and gradually progresses in the loads used for each exercise.
There are many exercises that can challenge the shoulders. However, we prefer to focus on big, multi joint movements that have carry over to daily tasks. Two challenging shoulder exercises we virtually always employ in our workouts are overhead pressing and push up variations. Overhead pressing replicates tasks like lifting things into overhead cupboards, whilst pushing up is a great way of replicating the action of getting up from the floor. In nearly all cases, these movements can be modified to make them more tolerable for people with shoulder pain. Here are the steps we often take to make a movement more tolerable:
To see some of these tips in action - check out this video all about troubleshooting the overhead press!
If you’re not familiar with resistance training you can check out our free workout! If you would like longer term guidance with a program involving resistance training as well as aerobic exercise, I highly recommend our 8 Week Fit and Strong Program.Frequently Asked Questions