Shoulder Pain with Exercise

Question:

I have a 41-year-old Caucasian male client whom I’ve been training for the past three months. Our sessions comprise purely strength training with free weights as his primary goal is upper body hypertrophy. I obviously include core conditioning work into his routine as well. Since I have begun training my client, he has experienced pain in his right shoulder. It appears to be the medial deltoid when he attempts to abduct his shoulder during exercises such as dumbbell flye and lateral raise. He tells me it feels as if there is a little ball where his shoulder (deltoid) meets his bicep. It doesn’t cause extreme pain; it’s more of an uncomfortable, limiting feeling – he complains of "tightness." He seems to think that it could be caused by repetitive use of the mouse while he sits at the computer all day (RSI). Do you have any suggestions as to what this could be?

Answer:

You pose an interesting question. A few possible issues come to mind. First, does his posture place him in a kyphotic position with rounded shoulders and reduced sub-acromial space? This could cause an increased risk of impingement upon the supraspinatus. Does the discomfort persist with any rotational movements, especially external rotation? Also, is it present with abduction and external rotation? This can be a positive sign of that condition.

Another possible issue could be a problem with bursa under the deltoid. Tightness of the deltoid can compress the bursa or supraspinatus tightness can change the angular alignment of the humerus and be pressing against the bursa. If there is any inflammation, that could cause the little ball you describe.

If those issues are non-existent, consider looking at the mechanics of the shoulder girdle to assess motion of the scapula. Does the scapula abduct as the humerus moves through abduction? Often, especially with well developed individuals or those that are in a kyphotic position for long periods of time (i.e., sitting at a desk), the scapula becomes somewhat immobile and the deltoid must overpower the humerus into abduction when such movements are performed. The true cause of this scenario is the scapula does not move efficiently and causes the humeral head not to articulate properly in the glenoid, and the deltoid may overwork and jam the head against the bursa or the supraspinatus tendon to be impinged. Secondly, if the scapula does not move properly, the trapezius may be recruited too early and further elevate the shoulder girdle and create improper mechanics of the joint.

My suggestion is to assess the bilateral motion of both scapulae and see if there is a difference in the mobility of the scapula and humeral motion. To do this, I would get your client into a standing posture and allow the hips to work in the frontal plane. The key relationship there is when the same side hip adducts; this will enhance the same side scapula to abduct and the opposite scapula to adduct. This will provide more mobility to the humerus and often relieve the deltoid from overpowering the humerus. After that mobility movement pattern, if frontal plane movements are performed, I would suggest doing these with the thumb leading the motion (in other words, with the hand supinated). This will allow clearance of the greater tuberosity as it moves under the acromion. If motion is still causing a discomfort, try working the shoulder through the sagittal or transverse plane. I would still keep the client working in a standing, integrated approach. Be sure the hips have good mobility (i.e., good range of motion in hip extension), which will enhance shoulder flexion in the sagittal plane and the opposite hip/opposite shoulder external rotation and internal rotation in the transverse plane. This will ensure tri-plane scapular mobility. Tri-plane shoulder press, especially rotational shoulder press, may be an alternative exercise to work the deltoid yet staying away from movement that may irritate the affected area.

If the discomfort persists, refer to an orthopedic physician as there may be more serious issues involved.