Pain Series: The Shoulder Pain Protocol

How To Fix Shoulder Pain – In this Pain Series article we will give you an idea of what causes shoulder pain, and how to fix shoulder pain.

The Pain Series is a set of articles which correspond to The Ready State Pain Protocols. Each protocol is designed based on a systems approach to:

  1. Desensitize current pain
  2. Restore function
  3. Prevent future pain 

This article of the pain series discusses The Runner’s Knee Protocol and how to fix knee pain

Introduction – How to fix shoulder pain

Hey everyone, welcome to The Shoulder Pain Protocol article. In this article, I’m going to detail on how To fix shoulder pain and the basics of our Fix Yourself: Shoulder Pain Protocol course to give you an idea what causes shoulder pain, and what you can do about it. 

Now, likely you’re reading this article because you’re concerned with the last few degrees of range of motion limiting you from a world record bench press or you feel like your velocity as a major league pitcher has come down. Okay, we know that’s probably not it. Probably the reason is because your shoulder hurts. More importantly, your shoulder has gotten in the way of your life and begun to implicate itself in the way you interact with your environment and you want to know how to fix shoulder pain. 

First we focus on desensitizing the tissues. Reducing the pain felt is our primary focus, not only for the obvious effect of lowering discomfort, but also because as we Desensitize, the secondary goals become easier to manage. The second idea is that this is the perfect time to change or improve the way our shoulders function. This is the Restore section of the shoulder protocol. Pain and movement map on the same pathways. If we can restore your function, we can also change the way your brain perceives your position and your pain. Your shoulder is only healthy if it can come and go through all the major shoulder positions. Finally we Prevent. Your brain is the most complex structure in the universe, and it’s attached to a physiology that is designed to be pain free for 100 years. Prevention involves testing and retesting the shoulder in archetypal positions and using exercises that optimize position.

Before we dive in on how to fix shoulder pain, I want you to understand that your shoulders are designed to be worked hard and last a hundred years. Shoulder pain is not a freak accident and didn’t spontaneously occur. Movements that you’ve performed safely and without pain many times, can sometimes become sensitized and painful. It may be complicated, but the steps to solving this very annoying problem are quite manageable! Keep in mind that human beings are incredible healing machines and your ability to heal and improve the function of your body doesn’t have to have an expiration date. 

A Systems Approach for how to fix shoulder pain

When addressing problematic tissues, we use a systems approach. We want to appreciate the whole picture of our pain by viewing the following factors in conjunction with each other. 

Sliding Surfaces: Most of the time people assume pain has to do with muscles, but it could very well be the result of your connective tissues. We call these tissues sliding surfaces. Sliding surface mechanics are such that in a healthy physiology, your tissues can move and slide past and over each other with ease. 

Joint Capsule: The second aspect of our whole systems approach is to appreciate that pain could be coming from the joint capsule. That bag of tissue around the joint is a major component of function, and if the humerus is stiff, improving your normal range of motion may open up and reduce pain. 

Muscular Dynamic System: In less words, this refers to upstream and downstream musculature. Often in shoulder pain we blame the rotator cuff being weak, but it could be muscles upstream or downstream such as the trapezius, scapula, lats, etc. It may not be that your rotator cuff is weak. In fact, we tend to see that weakness is not the issue. 

Movement Quality: There is absolutely good technique, and worse technique, and there are choices we can make that promote better function. Believe it or not, the quality of your movement affects your pain. 

The Environmental System: Last but not least, we have your environmental system. These include the quality of your sleep, your nutrition, even your and your families beliefs regarding the resilience or fragility of your physiology. How can we improve the environment of healing you occupy? 

Now, we don’t have to necessarily address all of these systems. Instead we view this as a large amount of material we can move through to improve the pain problem. Usually once we address two or three of these factors, we see the improvement we’re looking for. It’s not an image of a mountain that needs to be completely climbed, but an abundance of options for improving our pain. This is a connected network, not a maze. 


Treatment Model

Our treatment model is organized around a few key concepts on how to fix shoulder pain.

How can we influence the environment around the site of our pain? Are there methods with which we can DESENSITIZE the pain signaling in the shoulder in a way that doesn’t slow or limit tissue healing? Can we remove congestion and swelling in the shoulder tissues that may be slowing healing time and contributing to your symptoms when you use your arm?

Can we RESTORE the normal function and movement to your shoulder? Rarely do we see mechanical based shoulder pain that isn’t also associated with some kind of tissue restriction in the shoulder joint. Improving global functional capacity of your arm may potentially unload an aspect of your sensitized shoulder.

Are there particular shapes and positions that support better functioning of your shoulders day-to-day that might unload your painful shoulder while it normalizes and heals? How can we PREVENT future injury by changing your movement patterns and better preparing your body for the rigors of dynamic movement?

Before we get into the techniques of how to fix shoulder pain, I want to discuss tools. While we have a number of options for rehab with minimal equipment, mobility tools give us access to the most effective techniques and a much larger repertoire of solutions. 

 

Mobility Tools: Rollers, Balls, Bands and More


Without mobility tools, we are restricted to a small number of solutions for pain. We can actively work on our position, alter our environment, and use dynamic stretching, but we are severely limited. Mobility tools allow us to address sliding surface mechanics, increase and improve blood flow to the tissues, desensitize rapidly, and change our brain’s perception of our pain. 

You don’t need all of these. In fact, you can get away with as little as a lacrosse ball and a gym membership, but more tools means more options and more options means less pain. All of which are great ways on how to fix shoulder pain.

As follows are my top recommendations and their uses for how to fix shoulder pain.

Balls: Lacrosse ball, The Ready State Supernova and The Supernovito

Balls are tied with foam rollers as our foundational mobility tools, and their incredible portability makes them awesome for on the go MOBs as well. Everyone should have a few lacrosse balls lying around, and I suggest adding in a larger ball like The Ready State Supernova when you can. For an upgrade to the lacrosse ball, we also have the “Supernovito,” a hard textured ball of the same design as the supernova, but the size of a lacrosse ball. 

We use balls for pinpoint pressure on tissues. Many of the tissue mashing techniques in this protocol utilize these tools for tissue mashing areas we can’t always easily address using foam rollers. The traps, for example, are difficult to tissue mash with a foam roller but we can get deep into these tissues with a small or large ball. 

As a bonus, another way we use balls is in what we call a peanut. Taping two lacrosse balls together, or using The Ready State Gemini creates a new device that can be used to great effect on the tissues around your spine such as the neck and scapula. 

Foam Rollers

After balls, foam rollers are our next tool. If you haven’t been living under a rock, you’ve probably seen these tools appear in every gym you can find. Most of the foam rollers at the gym are quite soft and flimsy, and while these can still be used, we prefer more versatile devices. Our foam roller has a harder, textured exterior more well suited to improving sliding surface mechanics. Another staple of my toolset is The Rumble Roller Gator. 

A textured roller like the aforementioned is crucial for tissue scrubbing techniques like the lat scrub. You can find The Ready State Rumble Roller here, our textured “leopard” roller here, and the rumble roller gator here.

Resistance Bands 

Our third tool is loop resistance bands. In case you haven’t been following us, I’m not a fan of “stretching.” Stretching a muscle in the traditional sense is like pulling on a rope. The rope gets longer, but also weaker as the fibers draw thin. 

At The Ready State, I promote an alternative known as PNF stretching which involves contracting your muscle and then relaxing into the stretch at intervals. For example, when touching your toes to stretch your hamstrings, you would flex your hamstrings and quads for 4 seconds, then relax and reach further into the stretch for 4 to 8 seconds. 

We also refer to this as Contract-Relax, which is a technique we employ in tissue mashing too. 

Where resistance bands come in is something we call banded distractions. By using a resistance band we can create an alternative vector for stretching. Looping a band around your shoulder joint, we can use a band to pull our shoulder joint directly back into optimal positioning, while our hands are free. This lets us address our positioning in a multitude of ranges, such as with the hand behind our back, arm overhead, etc. 

For some examples of banded distractions for internal shoulder rotation, check out our article The Most Important Shoulder Position You Are Not Keeping an Eye On.

VooDoo Floss or Blood Flow Restriction

VooDoo floss are basically rubber ACE bandages. We use them to create compression forces around a tissue, especially a joint. Wrapping VooDoo floss around a tissue is great for pushing blood through tissues which may receive inadequate bloodflow. My friend Tim Ferriss describes VooDoo floss as the fastest way to turn off painful tissues, and while pain and its causes can be complex, the rapidity of a positive response from using this tool can feel magical. 

For desensitization, VooDoo floss is one of the most high yield tools. With shoulders you may need a partner to help wrap the joint, but even if you have a hard time doing it on your own, flossing the elbow and even wrist can create positive changes in the shoulder. 

Our general rules with voodoo floss are to wrap the joint with enough tension in the band to create noticeable compression. Overlap the loops of the band ¼ to ½ inch and then fold the end of the band under your final loop. I’ll often aim to get this final wrap over the most sensitive part of my tissues. 

Now move your arm through ranges of motion where you find trouble or through as much range of motion as possible. I recommend flossing the tissues for no more than 2 minutes, and stopping if you feel any tingling. 

This may seem like a small amount of time under tension, and it is, but on removing the band we create a massive flushing effect. Bloodflow, lymphatic fluid, you name it. This is incredible for healing stiff or stagnant tissues. 

Percussion Devices (Hyperice, Theragun, etc.)

Percussion devices are a great tool for desensitization and sliding surface mechanics. These are great for fast relief on the go, as well as providing a different stimulus than other devices can provide. Most percussion guns have multiple heads of different shapes you can use to change the stimulus. One of my favorite tools is the flat head on a Hyperice. I use the edge of the head to scrape across stiff tissues, such as the front of the shoulders. 

You may favor other devices for deep work on how to fix shoulder pain, but don’t underestimate the utility of percussion. Percussion guns provide non-threatening stimulus, and can rapidly change the way your brain perceives a tissue. Remember, even after a tissue is mechanically safe and functional, the brain can still perceive a pain response. 

This is why we use tools to change our brain’s perception of a tissue area: Turn off the pain response.

Neuromuscular Electrical Stimulation (NMES) Therapy
How to fix shoulder pain with H-WAVE OTC

Finally, we have NMES therapy. NMES devices use electrical currents to provide relief for painful tissues. While this may not be practical for everyone, we use this tool all the time in our clinic and I would be remiss not to discuss it. These kinds of devices allow us to have lots and lots of non-fatiguing muscle contraction. This allows us to create a lot of motion without having to exercise the muscle. 

Basically, I’m getting movement in the tissues, but I can get upwards of 20 hours a day.

We favor the H-Wave OTC Muscle Rehabilitation Device for these purposes. 

Desensitization: Turning off the pain signal

As discussed, desensitization is about exactly what it sounds like: turning off the pain signals and creating fast relief from your pain. 

In The Shoulder Pain Protocol, I go over seven techniques for desensitizing your tissues using the tools mentioned in the last section. Here we’re going to focus on two for you to get started with, feel quick relief, and how to fix shoulder pain. 

Sleep & Walking

Pain often leads to a decrease in exercise and more-importantly, movement. One of the ways we promote healing is by getting as much non-exercise movement in as possible and then sleeping at least 8 hours a night. Aim to walk 8k to 10k steps per day while healing tissues. This will promote tissue decongestion, bloodflow, and sleep quality. Then sleep 8 hours a night, which may require being in bed for 9 hours. 

8k to 10k steps per day, 8 hours of sleep (which may require being in bed for 9)

Contract + Relax

Incorporating the contract/relax technique is a very simple way to get movement into the system, without motion. This is a powerful way to improve the function of the shoulder as well as improve the way the brain is perceiving threat in the structural tissues of the shoulder. 

This is our staple technique for both tissue mashing and stretching. Modify any mobility work you are currently doing by incorporating contract + relax now. 

Restore: Improve Tissue Function

Pain is often a result of functional limitations of a tissue system. Remember, our tissues are designed to last a hundred years, and this is especially true of the shoulders. We use our hands every day, all the time. They are a key component in what makes us human, and the shoulder is key for our ability to manipulate and interact with our environment. 

Once we feel relief from the pain signal, now it’s time to restore function to the shoulder joint. 

Healing Times, Isometrics, and Tempo

Healing your tissues involves having realistic expectations regarding the healing process. We see a minimum of 4 to 6 weeks to heal a tissue at the fastest. This means no matter who you are or what your genetics, you should expect to work on these tissues consistently for a month or more to create true healing. 

Often we can turn off the pain signal long before we make these permanent changes in the tissues. We actually think of the pain itself as the low-bar for improvement. We expect you to be pain free long before you clear this 4 to 6 week healing process. 

Daily Shoulder Spin-Up

The daily shoulder spin-up is a sequence I designed to take your shoulder through all the shoulder archetypes and the transitions between them. This both helps us identify positions of compromise as well as improve function. 

Prevent: Create Resilience Against Future Pain

Prevention is how we complete the conversation around pain. Once we’ve desensitized and restored our tissue function, we should have a healthy shoulder. However, we must recognize that pain didn’t happen overnight. We arrived at pain over time putting our tissues through suboptimal positions and unraveled our body’s natural resilience. It didn’t just happen. 

To prevent future pain, therefore, is to practice and promote good positions for our shoulders.

The Turkish Get-up

One of the most incredible prevention exercises for shoulder pain is the turkish get-up. This movement requires you to load the shoulder and transition through multiple shoulder archetypes. Perform this exercise as a regular component of your training and increase weight as you are able to. 

5-50lbs, 5 minutes per side

The Shoulder Pain Protocol

It was my aim to teach you about the origins of shoulder pain and show you a protocol for healing. If your shoulder hurts and you are seeking resolution, our full shoulder pain protocol takes everything in this article and expands on it 400%. 

I go in detail on how to use the tools listed for multiple techniques not listed here. We go in depth on the pathology of shoulder pain and expand on the healing process and how it happens. Finally, we provide guidance on your expectations and wrap everything up with after action reports. 

At The Ready State, it is our aim to return our bodies to their ancestral birthright as resilient, pain free machines. 

Shoulder pain is one of the most common ways we see this resilience break down, but it doesn’t need to be. It is perfectly possible to manage your shoulder pain, and ultimately, heal your tissues.

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