Disclaimer: Although I am a licensed physical therapist, I am NOT your physical therapist. Everything in this blog is for educational purposes only and not meant to replace any advice you have received from your Doctors.
Welcome to your "I tweaked my shoulder, now what?" 3 part series!
In today's PART 1 you will learn:
Is it my muscle, ligament or nerve that is injured?
Is the pain from my shoulder or neck?
Which one of my muscles could be the problem?
and stay tuned for PART 2 and PART 3: Step by step guide to manage the pain and how to safely progress back into exercise
Is it my muscle, ligament or nerve that is injured?
The first thing you want to determine is "is this a musculoskeletal injury?" (an injury related to muscles, ligaments or bones)
And the majority of the time you can answer this pretty easily... but here are some ways you can determine this ↓
Your injury is most likely musculoskeletal in nature if:
Your symptoms get worse with any kind of movement, but better with rest
You remember an acute injury (such as a fall) that initiated your pain
Any kind of movement or position changes your symptoms
Your pain may be related to a medical issue that requires attention from your primary medical doctor if:
Your symptoms are constant and unchanging. No position, movement or remedy changes your level of pain or discomfort (for better or worse)
Your shoulder pain gets worse after meals, especially after fatty foods, which could be a gallbladder issue
*Consult your medical doctor if your shoulder pain is similar to either of the above
Now ask yourself "what does my pain feel like?"
This will help determine if your injury is to a muscle or ligament versus a nerve.
If you can describe your pain as achy, dull or throbbing the injured tissue is most likely muscle or ligament. Now you might also feel a sudden sharp pain with a certain movement that quickly diminishes... this can also be due to a muscle or ligament strain of some sort.
If you describe your pain as a sharp shooting (almost electric) type pain when you move, you may have an injury to a nerve. If you get bouts of numbness or tingling down your arm a nerve is most likely involved
(and make sure you read the next section to determine if your injury is actually to your neck and not your shoulder)
Now no matter which one better describes your pain, I want you to take a deep breath and not panic! Realizing you might have an injury to a muscle, ligament or nerve sounds scary... but I promise you no immediate emergency action is required.
Injuries to muscle, ligaments or nerves can be of many different grades or severity. And your injury could just be a small strain! Try all the recommendations I will give you in the next two days and chances are YOU will be able to manage your shoulder tweak all on your own!
How can I tell if the pain is coming from my shoulder or neck?
The majority of your shoulder muscles also attach to your neck so often a neck injury can look like a shoulder injury. AND neck injuries can often cause referral pain down to your shoulder, also presenting as a shoulder injury.
Numbness, tingling, or shooting pain that goes all the way down to your hand is most likely coming from your neck, not your shoulder.
Here are a few ways to confirm...
1. Isolate the shoulder
Keep your head and neck stationary and move your shoulder all around (up, across, to the side, in a circle)
Can you re-create your pain or symptoms?
Keep your head and neck stationary and push your arm up against a wall to activate your shoulder muscles (in all directions: front, side, behind)
Can you re-create your pain or symptoms?
If yes, your pain is most likely coming from your shoulder
2. Isolate the neck
Keep your shoulder down by your side and move your head all around (up, down, side to side, rotate, in a circle)
Can you re-create your pain or symptoms?
Keep your shoulder down by your side and push your head up against your hand to activate your neck muscles (in all directions: on the side of your head, on your forehead, and back of head)
Can you re-create your pain or symptoms?
Place your hands on the top of your head and place a mild to moderate amount of pressure down onto your head
Does this cause pain or any symptoms down your shoulder or arm?
While standing, bend over into a forward fold. Clasps your hands behind your head and give a little pull on your head towards the ground
Does this give any relief to your pain or symptoms?
If yes, your pain is most likely coming from your neck
If you now suspect your pain is actually coming from your neck and not your shoulder...
Now, what if you could re-create your pain or symptoms by isolating both your shoulder and neck??
That is totally possible! Like I said earlier, the majority of the muscles that attach to your shoulder also attach to your neck. So if you had pain when moving your shoulder AND moving your neck your injury could be to a muscle that attaches to both areas. You will want to address the strength of both regions (never a bad idea anyway).
But did your pain feel worse or more intense with one versus the other (shoulder isolation versus neck isolation)? If so, you will want to focus your recovery efforts on that region first.
Which one of my muscles could be the problem?
Have you confirmed your pain is from a musculoskeletal related injury? ✅
Does your pain feel like it's a muscular pain versus a nerve pain? ✅
Are you fairly certain your pain is actually coming from your shoulder? ✅
Now let's investigate which muscle could be unhappy!
To start I want to say that knowing exactly which muscle could be injured is absolutely NOT necessary to fully recover! and not knowing does NOT prevent you from reaching your full potential by any means. A good recovery program will aim to strengthen all of your surrounding muscles in a balanced fashion no matter what.
But I want to fully support your curiosity about which muscle could be causing you pain, so here are some things to try...
1. Find some tender spots
Massage around to find areas that are tender. Do you find tenderness around the...
Front of your shoulder
Biceps
Pectoral muscles
Side of your shoulder
Deltoids
Top of your shoulder
Upper trapezius muscle
Supraspinatus muscle (a rotator cuff muscle)
Back of your shoulder
External rotators
Upper back region between your shoulder blade and spine
middle trap
Rhomboids
2. Can you isolate which muscle causes pain?
Try activating or using a certain muscle group... can you re-create your pain or symptoms? If yes, that muscle group is most likely the injured tissue
PUSHING MUSCLES
Does any sort of pushing motion cause pain? Could be a push up on the floor, against the wall, pushing open a door, punching in front of you or pushing up overhead.
This tests your biceps, pectoral muscles, deltoids (mostly the front of your body shoulder muscles)
PULLING MUSCLES
Does any sort of pulling motion cause pain? Could be a row, a chin up, pulling your seatbelt across your body, the motion of elbowing something behind you.
This tests your triceps, middle trap, rhomboids, lats (mostly the back of your body shoulder muscles)
ROTATING MUSCLES
Does any sort of rotation cause pain?
This tests your rotator cuff muscles
That was a lot of information for one day! But hopefully you feel like you understand your shoulder pain a bit better... and understanding is the first step towards recovery.
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PART 2 : Step by step guide to manage the pain
and
PART 3 : How to safely progress back to exercise