Go see a doctor if you’ve had a traumatic event like a fall and to rule out more serious forms of shoulder pain like tumors, cardiac conditions, and disease.
This post will discuss shoulder impingement, rotator cuff tears, and surgery alternatives to return to pain-free living.
Rotator Cuff Tear
The rotator cuff is 4 muscles that work to keep the upper arm bone in the center of the shallow shoulder joint. It's not some crazy complex contraption that only doctors can understand. It's 4 muscles.
A rotator cuff tear is when one or more of these muscles rips either partially or fully off the bone. This can happen due to a sudden fall or trauma, or it can happen gradually over time due to poor shoulder mechanics.
To repair a torn rotator cuff, you can perform exercise or get surgery. If you're unable to lift your arm and lack strength, surgery might be a faster path to recovery. However, if you're able to lift your arm, then proper exercise and habit change is likely a faster path to pain-free living. The majority of shoulder cuff tears do not require surgery.
Shoulder Impingement
Shoulder impingement is the most common cause for a rotator cuff tear. Although you might associate the onset of pain with a trauma, like a fall, it's more likely that your shoulders were already weak and imbalanced, and the final trauma was the straw that broke the camel's back.
When you lack space in the shoulder joint, either due to poor posture or muscle imbalance, the muscle tendons get pinched, resulting in breakdown and pain. Shoulder impingement is very common, with about 500,000 rotator cuff surgeries per year in the United States alone!
The most common shoulder impingement occurs when the supraspinatus rotator cuff muscle is pinched by the acromion bone causing pain at the top of the shoulder.
Shoulder Surgery
Learning what the surgeon plans to do can change your opinion to get shoulder surgery in the first place! Once you have surgery, you can't reverse it. Before getting surgery, you should know EXACTLY what they plan to do.
Is it an open repair surgery or all-arthoscopic surgery?
Are they going to shave down bone?
Cut muscle?
Drill holes in the bone?
Staple or suture muscle back to the bone?
Surgery for chronic shoulder impingement pain has been shown to be no more effective than placebo surgery or exercise after 2 years [Source] and 5 years follow-up [Source].
Not all shoulder surgeries are equal. Surgery is recommended if you have zero strength in the arm and a fully detached rotator cuff muscle, as having the surgery can speed up recovery. Otherwise, proper posture and exercise will likely lead to a faster recovery.
Shoulder surgery requires on average 11 months of recovery!
"After rotator cuff repair surgery, it takes about 6 weeks for the tendon to heal initially; 3 months to form a relatively strong attachment to the bone and about 6 to 9 months before the shoulder feels normal. The average time to return to unrestricted activity is 11 months." - Shoulder Pain? The Solution & Prevention, pg. 45, Dr. John Kirsch
Not only that, but shoulder surgery comes with possible complications:
Nerve injury.
Infection.
Deltoid detachment.
Stiffness.
Tendon re-tear. There is a chance for re-tear following all types of repairs.
The often overlooked factor with shoulder surgery is that the shoulder is not a load-bearing joint like the hip or knee. If you have knee replacement surgery, it commonly heals without issue because every time you stand you use your knee, thus increasing circulation and healing.
The shoulder is different. Since it doesn't bear load when performing daily activities, you must put forth extra effort to strengthen the muscles and increase circulation and healing. Rehabilitation complexities cause shoulder surgery to have a slower recovery than knee surgery.
Surgery might seem like an immediate fix, but you have to manage your post surgery shoulders just as you have to if you don’t get surgery, otherwise the pattern will repeat.
Instead of spending months recovering from a surgery, what if there were a better, less expensive, less painful, faster, and more empowering way to return to pain-free living and activity?
Shoulder Surgery Alternatives
"When I realized that 95% of the surgery that is done on the shoulder is unnecessary, I then felt it was really a moral obligation to get this book into print." - Dr. John Kirsch
If you're considering shoulder surgery, IMMEDIATELY purchase this book to learn from Dr. John Kirsch, a 36-year practicing orthopedic surgeon.
Shoulder impingement and rotator cuff tears are a result of poor posture (kyphosis) and muscle imbalance (upper crossed syndrome).
Extended time sitting at a computer with poor posture will lead to rounded shoulders and a forward head, and commonly involves tightness in the upper trapezius and pectoral muscles, leading to weakness in the deep neck flexors and rhomboids
If you have shoulder pain and associate yourself with the computer worker, you'd want to focus on improving posture, stretching the front of the body, and strengthening the back of the body.
Pain-free movement will speed up the healing process, but you must avoid triggering the pain, because each time you feel significant pain it's like you're scratching the already damaged area.
Step One: Stretch the Front
It's important to stretch the front of the body, but this includes both upper AND lower body because your entire body is connected through your fascia, the connective tissue surrounding muscles, and so if any part of your body is out of line, even far away from your shoulder, it can cause shoulder pain.
For example, a tight hip flexor or posture imbalance at your hips can create uneven tension on the shoulder joints, leading to chronic pain. This means we can't only isolate the shoulder joints, we must look at the body overall as one unit to identify causes of chronic pain.
The following mobility routine will help any computer worker improve mobility on the front of their body.
Shoulder Pain Mobility Routine | Perform this routine daily | |
|---|---|---|
1 | Stretch & Foam Roll to open up the front of your body. Lie on your back over a foam roller or exercise ball. Allow your arms to move overhead and externally rotate as long as it's pain-free. Then lie on your stomach to stretch & foam roll the abdomen. The following video introduces you to myofascial release and trigger point testing:
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2 | Spend time throughout the day lying on your stomach. Babies require "tummy time" and adults do too! If you're watching tv, spend some time on your stomach instead of always lying on your back. If it's painful, place a pillow under your hips and squeeze your hips to into the ground to reduce stress on the low back. |   |
3 | Hang from a bar at a pain-free level. This might mean the bar is at hip or shoulder height, or it might mean your hands are overhead and your feet are on the ground. Start with the pain-free level for you and perform 1 minute per day of hanging until you're able to fully support your bodyweight from a bar for 1 minute without letting your feet touch the ground. Hanging from a bar overhead is the easiest and simplest way to strengthen the shoulder joint and increase the space in the shoulder joint. When hanging, the humerus (upper arm bone) leans on the acromion bending this structure, providing more room beneath the acromion so your supraspinatus muscle is not longer pinched when raising the arm. Sedentary living with poor posture causes the coracoacromial ligament to tighten, thus reducing shoulder joint space. Hanging reverses this tightening and provides more space to the shoulder joint. |   |
4 | Improve head & neck posture by performing neck extension throughout the day.  Always attempt to keep the nose below the ears during daily living to practice good posture.  |   |
5 | The last stretch to mobilize the body is the couch stretch, designed to open the hip flexors that get tight from excessive sitting. Tight hips can cause your shoulder pain, so open the hips by performing the couch stretch for 2 minutes per side per day. |  |
Once you've opened up the front of your body, we need to strengthen the back. Here is a daily workout routine to strengthen the middle of the back and improve shoulder pain from rotator cuff impingement.
Shoulder Pain Strengthening Routine | Perform this routine daily | |
1 | Prone A-raise 3 sets of 12x5sec hold This will work the muscles of the middle of your back, mostly your lower trapezius muscles. Prone T- raise 3 sets of 12x5sec hold This will work the muscles between your shoulder blades, mostly your rhomboid muscles. This video demonstrates the different prone raising exercises for the mid back and back of the shoulder: |   |
2 |   | |
3 | TRX Row 3 sets of 12 reps It's critical that you perform this exercise correctly by using primarily your mid back muscles to row instead of your biceps. Learn how to row correctly and perform it regularly, and your shoulders will be stronger than ever. |  |
This is a daily routine. This is not easy and progress likely isn’t immediate, but if you apply these exercises and habit changes your shoulder pain would be gone or greatly diminished in less than a month.
Stubborn Shoulder Pain Not Going Away
Once you’ve started training the right way, inflammation can cause pain to persist, so be patient and continue your exercises.
To permanently fix your shoulders, you must address the cause. Find ways to maintain good posture throughout the day and take frequent breaks from computer work. Record yourself when performing exercises to review your lifting technique, or seek a qualified trainer.
Physical therapy and personal training is not all the same. Although many of the same exercises are used, execution is everything! The tiniest change of movement or intention can make the exercise therapeutic or painful. Find the highest quality therapist or trainer - you get what you pay for!
While the above solutions will help most people, some shoulder pain can come from neural issues, eye differences, organ referral, scars, stress, or hip or ankle dysfunction.
To permanently fix your shoulders, you must study yourself to identify and address the cause. Make a list of activities or postures that worsen your pain and those that improve your symptoms.
The more you take ownership for your injury, the more powerful you become. At the end of the day, you’re the only person who can fix your shoulder pain. The Biology of Belief by Dr. Bruce Lipton is a great book if you’d like to read more about how perfect your body is and how in control you are.
If you have questions, comment below or send me a message.
For a custom program that meets your specific needs, schedule a consultation or purchase fitness programming for one-on-one guidance from Tom.
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