Dr. James Larson is an orthopedic surgeon, trained and specializing in sports medicine and arthroscopic surgery. He started the LSO website to educate the functional fitness community of coaches and athletes. His mission is to help people understand their bodies and the sport of fitness so that they can stay healthy and prevent injuries.
Shoulder Pain from Working Out
The most common problem I see in the office is shoulder pain. People worry that the new fad of high-intensity workouts will cause shoulder injuries. Heavy workouts won’t injure your shoulder if you do them right. And learning to lift with proper form can actually protect your shoulder. Most people don’t workout regularly. But shoulder rotator cuff tears are still one of the most common injuries requiring surgery. In fact, studies show that nearly 70% of people have some sort of rotator cuff tear by the time they are 70 years old. On the flip side, lifting with the same poor posture that we develop sitting at a desk will lead to injured shoulders in short order. Sometimes your shoulder pain is just muscle soreness from exercise. But sometimes it can be worse. How can you tell if your pain is an injury or just soreness?
What’s Causing Your Shoulder Pain?
When I talk to patients, there are two things I put the most importance on. The first is whether the pain started suddenly or gradually. The second is whether it is a generalized ache or a sharp pain with certain motions or activities. Why are these factors important? Well, sudden pain that starts after a specific injury is likely to be actual damage. Sharp pains at certain positions or with certain activities can indicate that you are feeling a specific point of damage. But pain with a gradual onset is much less likely to be a major injury. A generalized ache frequently indicates tendinitis or similar problems. It frequently can be treated with correction of posture, lifting form, or physical therapy.
What are the most common shoulder injuries?
The most common causes of shoulder pains in lifters and fitness athletes include:
- Labrum Tears
- Distal Clavicle Osteolysis
Strains and DOMS
Mild pains in the shoulder are typically simple muscle strains or something known as Delayed Onset Muscle Soreness (DOMS for short). (You can read more about that here.) DOMS usually occur the day after your workout, when you’ve slept the night and had time to stiffen up. Repetitive shoulder exercise with a hunched posture strains the joint. Over time this becomes a persistent pain when you try to press or push. Coaches need to make sure their athletes keep an open chest during WODs. Keeping the shoulders down and back prevents stress, and that keeps your shoulders feeling better. If the pain gets better after you warm up for a bit, you probably don’t need to worry.
Keeping your shoulder blades depressed and retracted also prevents impingement. Shoulder impingement occurs when your rotator cuff gets compressed against the acromion, which is the bone above the cuff. The rotator cuff is a set of four small muscles deep around the shoulder. The most commonly injured one is the supraspinatus. Working out with the shoulders squeezed forward and shrugged puts you in a position of impingement. When the shoulders are pulled backward and your traps are relaxed, you pull the acromion away from the cuff. That frees your shoulder to move without impingement. Proper shoulder positioning during a WOD makes you practice healthy shoulder motion in the rest of your life also. Correct shoulder motion keeps your cuff happy and prevents rotator cuff tears in the future. But lifting with the shoulders pushed forward leads the other direction. That’s how you end up in my office getting your cuff fixed in your forties.
A sudden force applied to the shoulder when your arm is overhead or extended behind you are common ways to tear the labrum or rotator cuff. In HIIT workouts, this happens most commonly during pull-ups or overhead lifts like the snatch or overhead squat. Using a weight that you can properly control and adjusting a workout when you start to lose control are very important ways to avoid these injuries. Core control and central power generation help prevent these injuries as well. An example of this includes, controlled kipping, especially in the descent phase. This is one reason why we don’t recommend butterfly pull-ups for beginners or people with limited range of motion.
Should I see a doctor about my shoulder?
This post isn’t intended to give specific medical advice. It’s impossible to address every individual injury on this blog post. In general, if you experienced a specific injury and the pain hasn’t improved after a few days, then, yes, a trip to the doctor is probably a good idea. If your problem is nagging and chronic, try making corrections to your lifting technique or simply giving your shoulder a rest. Have you tried these and it hasn’t helped? Now would probably also be time to visit a physician for an exam.
If you’re currently working out and don’t have shoulder pain, try adding these simple exercises to help prevent future problems!
I hope this post answers some basic questions you may have! We will continue to release posts to discuss many of the above topics in more detail. If you more questions or didn’t see specifics you were looking for, please let us know in the comments section. We will be sure to put it high on our priority list!