The anterior shoulder is a mess of different muscles, tendons, ligaments, and bones. It proved to be impossible to purchase the rights to a clear and understandable image, so I thank The Radiology Assistant for allowing the use of their image through the Creative Commons license.
Anterior shoulder pain is extremely common in athletes and sports people and, if you look at the image below, you can probably work out why...
There's too much stuff crammed into that tiny 1-inch space!!
The biceps tendons (labelled short head and long head), supraspinatus tendon, and subscapularis tendons all attach to the shoulder in the same 1cm² area!
Short of surgically correcting this design-flaw, how can we prevent anterior shoulder pain? The answer is actually quite simple, and follows two basic principles:
Principle 1 - Minimise inflammation of the anterior shoulder.
Inflammation is the natural, and perfectly safe result when a muscle (or other tissue) is worked hard. It increases the blood volume of the tissue to allow for rapid healing, which causes the muscle/tendon/ligament to increase its size.
When a single structure in the shoulder is inflamed it causes no trouble, but if two, three, four, or more structures are inflamed, then the different tendons and ligaments begin pressing on each other and causing a lot of pain.
The goal is, then, to work each muscle of the shoulder separately. This includes the pecs which aren't in the picture, but attach just below the lesser tubercle on the humerus. If you're at the gym, have one pecs/triceps day, and one biceps/lats & rhomboids day, rather than a chest day and a back day.
Principle 2 - Open the front of the shoulder joint
Like I've already mentioned, the issue with the anterior shoulder is space - there's not enough of it. There's even less of it if you're slouching forwards. If you want to maximise the space in the anterior shoulder, posture is important and that means biomechanics.
The muscles which are going to open up the joint are the back muscles - rhomboids, latissimus dorsi, and trapezius. No matter what your sport is, head to the gym once per week to hit these muscles. It will increase the joint space dramatically!
If you want more information on anterior shoulder pain, email me directly via the contact page. If you want specific information about your own injury or if you're after treatment for an injury, contact one of my clinics directly to make an appointment. Details of those clinics can be found here.
Dr Mitch Clark