Pain in Your Shoulder - It Won't Just Go Away Magically
Pickleball has provided an opportunity for people who played sports in their younger years to get back out there and enjoy the thrill of competition, while playing a sport that is social, fun, addictive and accessible! I’ve seen patients in the clinic who come to me with complaints of shoulder pain, often describing it as a subtle pain that started a few weeks back, but they don’t remember doing anything that would have caused an injury. They forget to mention that they’ve been playing pickleball six times a week for two to three hours each day!
The most common category of shoulder pain is called shoulder impingement. Impingement can be primary or secondary. A primary impingement is when there are anatomical structures in the shoulder causing pinching of tendons, bursae, and narrowing of the subaccromial space. Conditions like osteoarthritis, bone spurs, and certain types of acromion can cause primary impingement.
A dynamically unstable shoulder causes secondary impingement. This means that a combination of excess motion and decreased strength and stability around the shoulder is present, which in turn can lead to structures being compressed.
The shoulder joint is one of the most unstable joints in our bodies. In order to understand how impingement pathology can lead to more serious problems, it’s important to get a visual of the shoulder anatomy. With this article is a simplified picture of a right shoulder.
As you can see, there are a lot of structures under the acromion, including the bursa, and one of the rotator cuff muscles (Supraspinatus). In 80 percent of rotator cuff tears, the Supraspinatus is the muscle involved, and the reason is that it’s lodged in the tight space under the acromion.
A combination of both primary and secondary impingement is not uncommon, especially in people over the age of 60. Symptoms of impingement usually include pain with movement, especially at shoulder height, pain at nighttime and with lying on the affected side, reaching for the seatbelt, and pain with reaching behind your back or hitting overheads.
It’s important to stop performing painful activities when you have these symptoms, and consult a healthcare professional such as a physical therapist. Impingement can be corrected through an individualized rehabilitation program, but it won’t go away on its own. It’s crucial to shut down painful activities and start the healing process in order to prevent aggravation and possible tearing of the rotator cuff down the line. Fixing the mechanics and increasing the stability of the shoulder are key to avoiding further complications.
Most people train their upper bodies focusing on the main pushing and pulling exercises such as push-ups, pull-ups, bicep curls, tricep presses, etc. These exercises are not inherently bad, but they’re not enough in order to maintain a healthy and stable shoulder. Rarely do I see athletes incorporate rotational movements of the shoulders in their workouts. It’s no surprise that over time, this becomes a problem as there is an imbalance between the demands placed on the rotator cuff structures by the sport (for example hitting an overhead), and the strength and stability of the rotator cuff musculature.
The rotator cuff is comprised of four different muscles: the Supraspinatus, Infraspinatus, Teres Minor, and Subscapularis, and are sometimes referred to as the “S.I.T.S.” muscles. These muscles surround the shoulder joint and provide stability of the humeral head inside the socket as our arm moves through the range of motion. Unlike the hip joint, which is a stable deep “ball-in-socket” type of joint made to bear a lot of weight, the shoulder socket is a very shallow joint that relies on ligaments and muscles for its stability. This means the rotator cuff musculature plays a vital role in stabilizing the shoulder during dynamic movements.
This is why it’s imperative to incorporate rotational movements in a strengthening routine, and to develop appropriate strength in the rotator cuff in order to avoid chronic shoulder pain and injury. If you would like to see some examples of rotational strengthening, visit and go to the Strengthening tab to see a video demonstration of beneficial exercises. Always consult a professional, and preferably a qualified physical therapist, if you are unsure about how to strengthen your shoulder.
Playing pickleball with pain in your shoulder is not normal, and should be addressed. There are many techniques and treatments available these days to alleviate shoulder pain and get you back to playing without pain, and with improved strength and stability. Please don’t ignore the problem thinking it will get better with time. This method has been tested and doesn’t work. Be proactive and take control of your health—it’ll pay in the long run! If you have any questions, contact The Pickleball Doctor at firstname.lastname@example.org.