The shoulder is the most mobile joint of the body, capable of a vast range of movements extending outwards, downwards, above our heads, behind our backs and so on.
With great flexibility comes a great responsibility for the joint to remain stable. While our shoulders do a generally good job of it, shoulder pain and other issues are exceedingly common.
"Shoulder problems are very common," Dr Arun Ramappa, professor of orthopaedic surgery at Harvard Medical School, tells Harvard Health.
The shoulder joint is impressive but irritatingly unstable. Its range of movement leaves it vulnerable to injury, and pain can develop in both the short and long term.
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The most common causes of shoulder pain
Trauma and injury
Trauma and injury to the shoulder are some of the most common causes of shoulder pain.
Dislocation of the shoulder is the most common joint dislocation, accounting for over half of all joint dislocations. Some sources suggest that roughly 1.7% of the total population will suffer a shoulder dislocation at some point in their lives.
More than half of shoulder dislocations occur between the ages of 15 and 29 owing to a combination of increased physical activity and greater joint mobility.
The risk is highest for young men, but there is a slight increase in risk for women above the age of 50 also. However, shoulder dislocation can still occur at any time.
Shoulder dislocation causes the rotator cuff ligaments to stretch and tear and may cause injury to the labrum, a piece of cartilage that sits towards the base of the shoulder, and the cartilage capsule that protects the top of the joint.
Injuries to the labrum and rotator cuff can cause instability which leads to repeat dislocations and chronic pain.
Another shoulder trauma is brachial plexus injury, which is common in contact sports, also known as a ‘stinger’ injury in rugby.
Brachial plexus injuries occur when the nerves across the shoulder and neck are pulled from the tissue or, in extreme cases, totally ripped from the spinal cord.
Whilst this sounds catastrophic, most brachial plexus injuries heal totally with minimal intervention.
- Shoulder trauma and injury are some of the most common joint injuries.
- Most shoulder dislocations occur in younger people, but they can occur at any age.
- Once a shoulder dislocates, it’s common to experience ongoing instability in the joint.
- Brachial plexus injuries to the upper shoulder and neck are another type of shoulder injury that involves injury to the nerves.
- Shoulder dislocations are not especially dangerous so long as the joint is relocated quite quickly, ideally within half an hour to an hour. This prevents further swelling and inflammation. Those who experience repeat dislocations often find a way of relocating the joint themselves.
Arthritis and other inflammatory conditions
Like any joint in the body, the shoulder is prone to wear-and-tear leading to osteoarthritis. Rheumatoid arthritis can also affect the shoulder joint.
Inflammation in the joint can cause pain, stiffness and impaired mobility. This is one of the more common causes of shoulder pain in older individuals. However, shoulder arthritis is probably less common than arthritis in other joints like the knees, hips, back, fingers and neck.
Another inflammatory condition that can affect the shoulder is bursitis, an inflammation of the fluid-filled sacs that cushion the joints.
- Both osteoarthritis and rheumatoid arthritis can cause shoulder pain.
- Arthritis causes the various structures in the shoulder to wear and become inflamed.
- Bursitis is another inflammatory condition that causes the fluid-filled sacs around the shoulder to become inflamed.
- Shoulder arthritis can come and go or may become a more chronic issue; it’s also related to frozen shoulder.
We spoke to Scott Poundall from Excel Therapy, who told Health Times: "Inflammatory conditions such as arthritis or bursitis typically occur due to a lack of space in the shoulder joint which causes friction. Gentle movements and exercise can be an effective way of reducing inflammation and this is why it typically gets given to a lot of patients.”
Frozen shoulder is more common in the over-50s and is characterised by immobilising pain in the shoulder.
Frozen shoulder is generally caused by rapid onset of localised inflammation around the shoulder joint. It may be caused by a flare-up of arthritis and is probably more likely to occur in those who have experienced shoulder injuries before.
- Frozen shoulder is still not fully understood, but it usually involves localised inflammation around the shoulder joint.
- A painful condition, frozen shoulder can be stubborn and may even take years to subside completely.
- Frozen shoulder is more common in those with joint wear-and-tear, a history of inflammatory disease or those who have experienced shoulder trauma or injuries.
Heart attacks and shoulder pain
It’s important to remember that pain radiating throughout the chest and shoulder, particularly the left shoulder, can be a sign of a heart attack.
Often, the pain radiates up to the chin and down the arm too. For men, the pain is usually described as crushing and may be accompanied by shortness of breath, clammy skin and lightheadedness. For women, heart attack pain and symptoms are often more subtle.
Other causes of shoulder pain
Shoulder pain isn’t always caused by the joint itself. Muscle tightness or sprain in the back, neck, chest or shoulders can cause shoulder pain.
Shoulder pain may result from poor posture, repetitive strain, muscle sprains and sore muscles from overwork or over-extension.
Exercises for neck and shoulder pain
Exercise and physiotherapy can drastically improve shoulder pain.
If you’ve experienced a shoulder injury or frozen shoulder, then your doctor should refer you for physiotherapy. This will start with an assessment of your shoulder stability, movement and strength. Your physio will take you through some exercises that can gradually rebuild strength and agility. It's crucial to start slowly and build up movement at a steady pace to avoid reinjury.
If you’re experiencing shoulder pain due to muscle tightness, soreness or other non-traumatic injuries, you can guide yourself through your own shoulder exercise regime. However, always speak to a doctor if you think you need the green light to exercise your shoulder without professional assistance.
For shoulder and neck pain, the neck release is an excellent exercise that can also help with pain resulting from bad posture. It involves releasing the head so your chin sits on your upper back and gently swaying the neck from side to side, tilting it towards the shoulders.
- Standing or sitting, let the head drop to the chest
- Gently sway your head from side to side
- Repeat on both sides
Another light exercise that is great for shoulder and neck pain. Grip the back of your seat with your hand and pull your torso around to look behind you. Keep the hips facing forward.
- Seated, grip the back of your chair
- Pull your torso and back around to look behind you
- Keep the hips facing forward
Across the chest stretch
One of the best shoulder blade exercises for rebuilding dexterity in the front and back of the joint. This gentle stretch aids with flexibility. It involves pulling your arm gently across your chest. This is a typically safe position for those with unstable shoulder joints.
- Standing, bring your arm across your chest
- Pull your arm towards your chest gently with your other arm so you can feel your shoulder muscles stretch
- Repeat with both arms
Exercises for sore shoulders
Arm circles and swings
NHS Inform recommends these types of light exercises for those who are not yet ready for strength training. They involve hanging your arm off a table and swinging it back, forth and around in small circles.
- Lean over a desk or table, bending your back towards 90 degrees
- Let your arm relax
- Gently move your arm back and forth
- Move your arm round in circles
Clasped arm raise
The clasped arm raise is excellent for rehabilitating injured shoulders as it keeps shoulders together in a typically stable position. Clasp your hands in front of your body and gently lift them up and down to exercise the shoulders. You can add a light weight, like a water bottle, if you're confident with the position.
- Standing up, place your hands in front of your body and clasp them together
- Gently move your arms up and down
- Don’t pull your arms beyond the back of your head
Resistance bands offer a relatively safe and straightforward way to work out the shoulders, back and chest muscles. Read our guide on using resistance bands here for a detailed breakdown of the many types of exercises you can do with resistance bands.
For the shoulders, try a 'resistance band pull apart', where you hold the band shoulder-width apart and gradually pull outwards. Go slow; you shouldn't use resistance bands aggressively.
- Hold the resistance band in your hands in front of your body
- Gently pull the band apart
- Start lower before raising your hands towards shoulder height
- Don’t exceed shoulder width at first
Strength training for shoulder pain
Strength training builds muscle around the shoulders, tightening the joint and improving stability. It’s crucial not to jump the gun when it comes to strength training, particularly if you've suffered a shoulder injury.
If you experience shoulder pain during pushing exercises or any other weight-bearing exercises, it's essential to stop and assess yourself and seek advice if needed. Always consult your doctor or physiotherapist if you’re unsure.
Read our guide on strength training for the over-50s here; it contains some excellent exercises that can get you started.
Don’t underestimate the importance of other types of exercise. All exercises go some way to improving circulation, flexibility, strength, mobility and fitness. Check out the Staying Active area of the site for exercise ideas, fitness regimes and helpful tips and tricks that can help you beat shoulder pain.