Ultimate Shoulder Guide To Pain Relief in Athletes
Athletes don’t tend to get random shoulder pain – there’s usually repetitive overload, poor mechanics, or traumatic injury contributing to painful arc syndrome (limited range of motion), rotator cuff tendinopathy/maybe tears, shoulder instability or injury to the labrum.
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Below we’ll review the most common causes of shoulder pain in athletes. Plus, when to see a doctor, appropriate imaging, rehab options, and when to consider injections or surgery.
COMMON ATHLETE SHOULDER INJURIES
Types of Athletic Shoulder Pain
Throwing sports, swimming, volleyball, etc. cause you to repetitively place massive loads through your shoulders in extreme ranges of motion.
Symptoms of Overuse Shoulder Pain
- Dull pain that builds over time
- Decreased ability to throw hard or far
- Pain at night
These types of injuries can include anything from tendinopathy of the rotator cuff or labrum to “internal impingement” or even small partial tears. These overuse injuries can advance over time without proper management and end up limiting your abilities.
Traumatic Dislocations/Instability
Collisions, falls, or the act of throwing can cause your shoulder to translate or rotate too far and become unstable. Contact sports and falls are the most common causes of acute instability.
Symptoms of Traumatic Instability
- Sharp pain when trauma occurs
- Possible deformity or obvious change in contour of shoulder
- Feeling like your shoulder is going to “pop out”
Non-operative management with physical therapy is the first-line treatment for traumatic instability. Surgery is required when there are recurrent episodes of instability.
AC Joint Separations
Taking a direct fall on top of your shoulder will often injure the AC joint.
Symptoms of AC Joint Pain
- Pain at the top of your shoulder
- Local swelling or bump
- Pain with bringing your shoulder across your body
Mild to moderate AC joint separations respond to conservative therapy. Surgical treatment is sometimes necessary for high-grade separations.
HOW DO DOCTOR’S DIAGNOSE SHOULDER PAIN?
History & Physical Exam
Finding a proper diagnosis starts with obtaining a good history and performing a focused physical examination. Your doctor will want to assess your posture, range of motion, strength, and scapular movement. Specific tests can be performed to help identify pathology.
- Shoulder impingement signs (Hawkins, Neer)
- Strength of your rotator cuff (Jobe test)
- Labral tears (O’Brien test)
Physical exam findings, including evaluation of your motion quality and mechanics, can often identify the cause of your shoulder pain before any imaging studies are ordered.
Imaging Studies
- X-rays are good place to start to rule out fractures/bone abnormalities.
- An ultrasound can show tearing in your shoulder tendons.
- MRI’s are the best imaging study to evaluate your soft tissues including rotator cuff tendons and labrum.
Imaging may not be needed immediately, but should be considered if your pain persists despite initial treatment or if there is suspicion of structural damage based on history and physical examination.
CONSERVATIVE TREATMENT OPTIONS FOR ATHLETIC SHOULDER CONDITIONS
Athletic shoulder injuries are often able to be treated WITHOUT surgery if they are recognized early and managed appropriately. Here are your best non-operative treatment options.
Physical Therapy & Scapular Rehabilitation
The mainstay of NON-operative management should ALWAYS include physical therapy. Physical therapy will allow you to strengthen your rotator cuff muscles and scapular stabilizers (see picture below).
These muscles include but are not limited to your serratus anterior and lower traps. You should also expect to slowly progress load through your shoulder and resume sport-specific activity over the course of several weeks.
Activity Modification & Pain Management
In most cases of shoulder pain, you need to stop whatever is causing your pain! Decreasing your throwing volume, adjusting your training load, or replacing high-impact conditioning exercises may be all you need to do.
Activities that cause your pain should be avoided until you have progressed through therapy. Non-steroidal anti-inflammatory medications (NSAIDs) and sometimes injections can be used to help manage your pain, but should not replace completing your rehabilitation.
ADVANCED TREATMENT OPTIONS FOR SHOULDER PAIN IN ATHLETES
Some athletes continue to experience pain despite 3-6 months of proper physical therapy, while others have such severe injury that surgery is required to begin their rehabilitation. Here are your options if conservative treatment fails.
Injection Therapy
- Cortisone Injections can help alleviate pain and inflammation but provide only temporary relief.
- Platelet Rich Plasma (PRP) Injections are a popular new treatment with little evidence to support its use.
Shoulder Surgery
- Arthroscopic Rotator cuff repair
- Labral repair/reconstruction
- Surgical debridement of damaged tissue
Typically athletes return to sport within a few weeks of minor procedures such as debridement. Larger procedures such as rotator cuff repairs can take several months before you are able to return to sports with post-op rehabilitation.
REHAB ILATION FROM SHOULDER SURGERY
The process of rehabilitation does not end once you are able to throw or lift without pain. It’s important to progress THROUGH physical therapy before returning to sport.
Progressive Loading
You should start with control of pain and inflammation along with regaining your range of motion. From there you will progress to strengthening, first isometrically and then eccentrically.
Finally, you will progress to functional and sport-specific exercises. Each stage of rehab should be completed without provocation of your symptoms.
Movement Mechanics
Poor mechanics are often the cause of your injury. You should be sure to address movement patterns such as throwing technique, swim stroke, or even improper squat/lifting mechanics.
Correcting scapular motion is critical to ensure that larger muscles besides your shoulder are assisting with athletic movements. Proper mechanics will ensure forces are distributed through your body and not just your shoulder.
MAIN POINTS TO REVIEW
Between overuse, instability, and discrete traumatic injuries, there are many potential causes for shoulder pain in athletes.
The majority of shoulder injuries improve with relative rest, rehab, and return to sport progression that focuses on restoring strength, mobility, and movement quality.
If your pain is severe, does not improve with several weeks of rehabilitation, or you have significant instability you may need imaging and potentially surgery.
Recurrence of shoulder injuries can often be prevented with proper scapular strengthening, awareness of workload, and correction of movement mechanics. Use your recovery as an opportunity to come back stronger!
If you would like one-on-one help with recovering from a shoulder injury, schedule a FREE discover call with one of our coaches HERE.
Frequently Asked Questions
Q: How do I know if I have a serious injury to my shoulder?
A: If your pain lasts longer than a few weeks, hurts when you perform certain activities or movements, causes weakness, or limits your range of motion it’s time to see your doctor. Acute shoulder instability/deformity, severe pain, or inability to use your arm are clear signs that you need to be evaluated immediately.
Q: Can I keep working out if I have shoulder pain?
A: You may be able to modify your training to avoid movement that cause pain, but you should NOT continue full training without modification. Continuing to exercise through shoulder pain will only make your injury worse.
Q: How long does it take to recover from shoulder pain?
A: This depends on the diagnosis, but most mild overuse injuries can be resolved within 2-6 weeks with proper rehabilitation. More complex conditions like shoulder labrum tears or rotator cuff injuries take longer, especially if surgery is necessary. Recovery from surgery can take upwards of several months.