Why Am I Having Sharp Shoulder Pain?

One very common pain complaint I hear from people who lift weights is shoulder pain, particularly with pressing and abduction movements. It shows up out of nowhere, and some movements hurt more than others.

Say, for example, you've been lifting weights for a few years without incident or injury. Over the past few weeks, however, you have started noticing a sharp pain in your shoulder every time you bench press, or when you perform push-ups. It gets really bad when you do shoulder presses or lateral raises. You don't remember getting hurt, and can't pinpoint when exactly it started happening.

You wonder, "Am I just sore, or is it something serious? Should I ignore it and keep working out, or go see a doctor about it?"

Not knowing the cause of pain or what to do about it is very frustrating.

While injuries and the causes of pain can vary from person to person, and I would perform an evaluation on an individual in order to determine the cause and treatment plan for each individual, I can speak generally about some of the reasons why people have pain in the shoulder.

First we need to understand the anatomy of the shoulder, which is a ball and socket joint. The “ball” is the humeral head and the “socket” is the glenoid fossa of the scapula. The shoulder, or glenohumeral joint, is made up of three bones: the humerus, the scapula (shoulder blade), and the clavicle (collarbone). The diagram on the left shows the shoulder joint, looking at it from the front.

The rotator cuff is a group of muscles that stabilize the ball in the socket. These muscles are the supraspinatus, infraspinatus, teres minor, and subscapularis. The rotator cuff serves several functions including stabilization of the glenohumeral joint, control of humeral head translation (up/down/forward and backward movements), abduction, and internal and external rotation of the shoulder. As shown in the diagram on the right, the rotator cuff tendons pass under the acromion process of the scapula to attach to the humerus. This subacromial space also contains a bursa, a fluid-filled sac that cushions the tendons from the under-surface of the acromion.

In a pain-free shoulder, the tendons pass under the acromion, and the bursa is compressed and regains its shape with no problem during shoulder movements. But, sometimes the bursa and/or the tendons get inflamed, causing pain. This is commonly referred to as shoulder impingement.

Impingement is a very general term for shoulder pain. Impingement can happen at the top and front of the shoulder (subacromial impingement) or at the top and back of the shoulder with pain when reaching up and back (internal impingement). The pain you are describing sounds similar to subacromial impingement.

Athletes with subacromial impingement often complain of pain in the front and top of the shoulder, made worse with reaching overhead or raising the arm away from the body.

Primary impingement occurs when the problem stems from the joint itself (some people have a hooked acromion process that puts pressure on the tendons).

Secondary impingement can be related to posture, muscle imbalances, and training that cause the humeral head to shift in the socket, putting pressure on the tendons. If the rotator cuff tendons are not holding the ball in the socket properly (due to weakness and/or motor control issues), the ball can ride up too high due to the pull of the deltoid muscle. This will impinge the rotator cuff between the acromion and the humeral head.

In some people, weakness or lack of motor control of the rotator cuff can lead to an anterior (forward) shift of the humeral head. This can lead to overuse and irritation of the long head of the biceps tendon, and pain in the front of the shoulder.

Several factors can contribute to shoulder impingement such as:

• Lack of thoracic spine extension, which puts the scapula in a less than ideal position for overhead activities
• Shoulder instability
• Bony anomalies of the acromion or AC joint
• Tightness of the pectoral muscles leading to an anterior tilt of the scapula
• Improper or excessive training
• Muscle imbalances

If you are having sharp pain, my best advice is to see a physical therapist who can perform a thorough evaluation, using a variety of clinical tests, to determine the cause of your shoulder pain.

We can refer you to a physician if we think you need x-rays, an MRI, or a diagnostic ultrasound. Physical therapy treatment can include manual therapy to mobilize the joint, exercises to strengthen weak muscles, and re-education of muscle control and timing. With proper treatment, you should be able to return to lifting weights without pain. You can find a physical therapist near you here.

At Girls Gone Strong, we strongly recommend including injury prevention strategies in your training program to address mobility, stability, and overall movement.