Why can't i lift my arm up without pain?
If you’re feeling pain when lifting the arm, you’re most likely experiencing one or more of the following presentations.
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Soft tissue imbalance
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Trigger Points and myofascial restrictions in soft tissue surrounding the shoulder and scapulo-thoracic joints: Trigger points in muscles like the deltoids, trapezius, or pectorals can refer pain to the shoulder and restrict movement. These myofascial trigger points often develop due to overuse, poor posture, or injury.
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Rotator Cuff Injury (or restrictions/trigger points in rotator cuff muscle group)
The rotator cuff is a group of muscles and tendons that stabilize your shoulder joint. Tears, strains, or inflammation in these tissues often cause pain when lifting your arm, especially overhead. This is one of the most common causes of shoulder pain.
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Frozen Shoulder (Adhesive Capsulitis)
This condition involves stiffness and pain in the shoulder joint, gradually worsening over time. It typically develops in three stages: freezing (painful), frozen (stiff), and thawing (improving mobility). Pain when lifting your arm is a classic symptom.
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Shoulder Impingement
This occurs when the soft tissue surrounding the shoulder joint become compressed or pinched during shoulder movements. The pain typically worsens when lifting your arm to the side or overhead.
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Shoulder Bursitis
Inflammation of the bursa (fluid-filled sac that cushions your joints) can cause pain with overhead movements. This often develops alongside other shoulder conditions.
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Biceps Tendinitis
Inflammation of the tendon connecting the biceps muscle to the shoulder can cause pain in the front of the shoulder that worsens when lifting or reaching.
I’ve written previous posts about most of these presentations so I wanted to focus on the first of the previous points in this particular blog post, “soft tissue imbalances”, which are the most frequent cause for pain when lifting the arm that we come across in clinic.
What are soft tissue imbalances?
Soft tissue imbalances occur when there’s a disruption in the neutral tensional-compressional forces, length, or function of the soft tissue (muscles, tendons, fascia, and ligaments) surrounding a joint.
In the context of pain when lifting the arm or shoulder pain this often manifests as some muscles becoming overly tight and/or shortened and/or weak while others become inflamed and/or lengthened and/or weak.
Bear in mind that a shortened muscle can still and often is weak!
These imbalances cause abnormal movement patterns and increase the stress on these structures that ultimately lead to pain when attempting certain movements like lifting the arm or rotating the shoulder. Soft tissue imbalances also cause an increased amount of pressure on the joints, potentially developing into more serious presentations if left untreated and increasing degeneration speed within the joint.
Tensional compressional forces and the Myofascial system
When talking about balance in the tensional-compressional forces we’re talking about the tensegrity element of the Myofascial system.
The myofascial system refers to the interconnected network of fascia—a single piece of spider web-like fabric, a type of connective tissue—and muscles throughout the body. This network operates based on the principle of tensegrity, which comes from “tensional integrity.”
Tensegrity is a structural principle where the integrity of a structure comes from a balance between tensional and compressional forces.
In our body:
- Tensional forces are primarily created by muscles, tendons, and fascia that pull and create tension.
- Compressional forces are primarily handled by bones that push and resist compression.
When your body is in balance, these forces work harmoniously to maintain optimal posture and functional movement.
However, when imbalances occur the system is exposed to pain and injury:
- Areas of excessive tension develop in some tissues
- Areas of insufficient support develop in others
- Joint spaces may become compressed
- Overall movement patterns become dysfunctional
Why the shoulder?
Why does the shoulder seem to be so vulnerable to pain and injury in relation to other joints?
Well… the shoulder is an amazing joint! It’s incredibly mobile, it can move in all directions and allow for extreme angles, this comes at a cost and also means that it’s not the most stable joint in our body!
The shoulder is complex. It’s harmony requires not only of the shoulder joint (gleno-humeral joint) but also the scapulothoracic joint and 2 other! Let’s take a look at them.
- Glenohumeral joint: What most people refer to as the “shoulder joint.” A ball-and-socket joint where the head of the humerus (upper arm bone) articulates with the glenoid cavity of the scapula (shoulder blade). This joint has incredible mobility, moving in all planes and angles, which is a challenge from a stability point of view!
- Scapulothoracic joint: This isn’t a true anatomical joint but a functional one! It refers to the interaction between the shoulder blade and the thoracic wall (ribs and associated soft tissue – muscles and fascia). The stability of this joint depends purely in the balance of the soft tissue structures involved in it. This joint is very very often not working well.
- Acromioclavicular joint: The joint between the acromion process of the scapula and the clavicle (collarbone).
- Sternoclavicular joint: The joint between the clavicle and the sternum (breastbone).
For the shoulder to function optimally, all these joints and all structures involved must work together in balance. Imagine more than 17 muscles that need to work in harmony. With so many structures involved, it’s easy for an imbalance to develop.
These imbalances don’t just cause pain—they create a cycle where the pain leads to compensatory movements, which further reinforce the imbalances.
The body as one
The body’s musculoskeletal system works as a whole interconnected system. This means that an imbalance in the shoulder joint and or any of the other 3 joints mentioned above relates with the rest of the body, especially the joints above and below the shoulder (neck and thoracic spine-lumbar spine) but also the whole body.
The whole body must be assessed and addressed accordingly.
So… How to address pain when lifting the arm?
Addressing soft tissue imbalances typically involves:
- Myofascial release: To address trigger points and fascial restrictions contributing to the imbalance and or the pain.
- Joint Decompression/mobilisation.
- Strengthening.
- Movement re-education: To restore proper movement patterns and proprioception
Functional Strength Training that respects the Myofascial system
Functional strength training is particularly effective for addressing soft tissue imbalances in the body because it focuses on training movement patterns where various muscle groups are involved simultaneously rather than isolated muscle groups, which better represents real life movement patterns.
Functional training respects the structural principle of tensegrity, helps rebalance and strengthen this system.
With a focus on building a solid spiral-like foundation, functional training prioritises the stabilising muscles that are often neglected in the traditional approach to strengthening, before moving into more complex movement patterns.
Training functionally reduces the negative impact of daily activities and work in our body.
For those experiencing pain when lifting the arm, a progressive functional training program should begin with establishing proper scapular control (which is where most people lack control), before advancing to more complex movements.
This foundation ensures that strength can be built in a balanced manner that supports and improves the health of the joint rather than compressing it or increasing the risk of injury and wear and tear.
Myofascial Release therapy
Myofascial Release therapy is a specialised form of hands-on therapy that focuses on releasing the body’s myofascial system – the interconnected network of muscles and fascia. Any element of this spider web-like network affects and is affected by the whole system. This means that restrictions can cause symptoms far from their location, in a domino-like effect.
In our Brighton and Hove based clinic we like to look at the myofascial system from two main angles.
Myofascial Release and pressure changes
The Myofascial tissue responds to pressure changes; mechanotransduction allows for these pressure changes to travel through the myofascial tissue at crazy speed.
Myofascial Release therapy uses therefore a whole-body approach where not only the symptomatic area is assessed and treated but the entire body as well.
Mechanotransduction also explain why myofascial release techniques can have such immediate and widespread effects throughout the whole body, even when treatment is applied to a reduced area.
Myofascial Release and the nervous system
The fascial tissue has more sensory nerve endings than the skin itself and 10 times more sensory receptors than red muscle. These sensory receptors play crucial roles in both proprioception (body positioning awareness) and interoception (internal body sensing).
The connection between the fascial system and the nervous system is particularly significant because:
- Sensory receptors in the fascia feed into the somatosensory cortex, helping with body positioning awareness
- A large number of receptors connect to the insular cortex, which is involved in emotional processing – establishing a direct link between fascia and emotions
- The fascial tissue responds to chemical changes in the body, making it highly reactive to stress and emotional states
This intricate connection between fascia and the nervous system suggests that fascial restrictions and inflammation might be affected by the nervous system and vice-versa rather than purely mechanical factors.
This understanding has important implications for treatment approaches, and it explains how we can address both physical symptoms and emotional well-being through myofascial release therapy.
Conclusion
We’ve covered the main causes linked with arm pain when lifting, focusing on soft tissue imbalances.
We explored how soft tissue imbalances can lead to pain and dysfunction, and highlighted the importance of addressing these issues with:
• Myofascial release therapy to address restrictions and restore proper tissue function
• Functional strength training that respects the body’s natural way to move and Movement re-education
Remember that the body works as an interconnected system, and successful treatment must consider not just the arm or shoulder in isolation, but the entire body and nervous system.
This whole-body approach offers the best chance for long-term results.
References
Fairweather, R. and Mari, M.S. (2015). Massage fusion: the Jing method for the treatment of chronic pain. Edinburgh: Handspring Publishing.
Travell, J.G. (1999). Myofascial pain and dysfunction / 1, Upper half of Body. Baltimore: Williams & Wilkins.
Barnes, M.F., 1997. The basic science of myofascial release: morphologic change in connective tissue. Journal of bodywork and movement therapies, 1(4), pp.231-238.
About the author
Rocio Santiago
MA in Nursing, Dip. Soft Tissue Therapy
Ro initially began her career as a nurse. Following this and after a difficult time in her life that resulted in a career change, Ro went on to train at one of the leading soft tissue therapy schools in Europe, completing a 3 year degree level course and specialising in effective soft tissue manipulation for the treatment of musculoskeletal pain.
The treatment method Ro uses consists of a combined approach using different specialised techniques, myofascial release and trigger point work among others, with the intention and focus on providing effective results in the least possible amount of time.
Combining her training, science background and life experience, her treatment method is based in science and built using a whole body approach, where mind and body are addressed as one.
Ro has been seeing clients as a soft tissue therapist for 8 years, successfully treating a wide range of conditions.