Ever experienced a clicking in your shoulder while exercising? Maybe when doing a shoulder press, push up or moving through plank variations? If the answer is yes, chances are you can still perform the movement correctly, but are left puzzled by the clicking sensation.
You’re not alone! This is actually a really common issue and - provided there is no injury to the shoulder - it can easily be fixed. In today’s blog, we will explain how to strengthen key parts of the shoulder and recommend the best exercises to strengthen the joint using a holistic and integrated approach.
First, let’s delve into the shoulder joint and understand how it works, why it might click and how to stabilise it by building muscular control.
Shoulder pain, injuries and stiffness are unfortunately very common. The reported annual incidence of shoulder pain in primary care is 14.7 per 1000 patients and recurrence rates are as high as 25% (1). The most common causes of shoulder pain in primary care are rotator cuff disorders, acromioclavicular joint (ACJ) disease and glenohumeral joint (GHJ) disorders (1).
If you’re experiencing some form of shoulder pain, be smart and address it now! Don't let it get worse, as shoulder pain can be seriously painful and can get in the way of everyday life, eventually leading to pain during daily activities such as typing, carrying the shopping and even sleeping! (2).
Whether you are already experiencing pain or simply want to protect your shoulders from any future risk of injury, the key is to strengthen all muscles around the shoulder equally, stabilise the joint and reduce any muscular imbalances (2).
Common causes of mild pain and discomfort in the shoulder joint are incorrect posture, repetitive strain, overloading the joint (for example by repeatedly performing exercises that are too advanced and with poor form) and muscular imbalances around the joint. All of these, if not addressed, can lead to more serious muscle strains and tears (3).
What does the shoulder joint look like inside?
From the outside, the shoulder looks like a pretty simple joint, right? It allows us to lift our arms up, rotate them and shrug up. In reality, it is one of the most complex joints in the entire body.
So, what makes up the shoulder joint?
The head, or ball, of the humerus bone (upper arm) sits inside a small socket on the scapula (aka, the shoulder blade bone). This shallow socket is known as the glenoid cavity, which is why the shoulder joint is also referred to as the glenohumeral joint.
The glenoid cavity is lined along the outside circumference by the glenoid labrum, a rim of cartilaginous fibre that lines the joint and is the attachment site for the ligaments (6).
The rotator cuff is a series of muscles and tendons that work together to keep the humerus head inside the glenoid cavity. Together, the glenoid labrum and four rotator cuff muscles stabilise the shoulder joint (4).
So, whilst the shoulder joint is extremely functional and allows a huge range of mobility from your arms, it is also a very delicate part of the body and as such is prone to injury. The shoulder relies heavily on a number of muscles to stabilize its movements (4). An imbalance in the muscles surrounding the shoulder can result in incorrect movement patterns, that over time create aches and pains - and clicking!
Which are the shoulder muscles?
The musculature of the shoulder ranges from large prime mover muscles to small stabiliser and fixator muscles. These are the deltoids, latissimus dorsi (lats), upper and lower trapezius (traps), serratus anterior, biceps brachii, triceps brachii, pectoralis minor, rhomboids and the rotator cuff (made up of four parts: the supraspinatus, infraspinatus, teres minor and subscapularis) (5).
In total, 17 muscles attach to the scapula (shoulder blade). If any one of these muscles is weak, it can affect optimal shoulder mechanics, making the area vulnerable to injury, especially during heavy overhead lifting. The heavier the weight, the more stable your shoulders need to be. An effective and long-term workout plan will target all areas of the shoulder to strengthen, protect and stabilise the joint.
Why do my shoulders click?
The clicking sound you hear, also known as crepitus, can be caused by a number of different factors. It doesn’t always cause pain, and in fact your tendons and bones can occasionally make a cracking sound even when they’re working perfectly well together. But if your joint cracking is accompanied by pain, it could signal an injury or other condition.
Common causes of shoulders clicking:
- Muscle tendons moving across the bony structures of the shoulder. Muscles tendons are strong and stringy and movement can cause a clicking, popping, or cracking noise as they pass over a bony prominence.
- Impingement – this occurs when your rotator cuff (the four muscles that hold your ball-and-socket shoulder joint together) is pinched within the tight space it attaches to. If it becomes inflamed chronic pain may result. A study found that weight lifters who performed upright rows and lateral raises with their elbows above their shoulders were more likely to have impingement than those who stuck to proper form by keeping the movement to shoulder height (2).
- Injury to a muscle – a recent onset of unusual clicking, popping, or cracking accompained by pain could be a symptom of muscle injury. The injury will have lead to a change in the space available to muscle tendons and their ability to track along the shoulder joint. The sudden onset of these sounds could indicate that further damage is happening - in this case an assessment from a qualified physiotherapist is definitely recommended!
- Scapulothoracic bursitis, or snapping scapula syndrome, is caused by an inflammation of the bursa. These are fluid-filled sacs that protect your joints and help the surfaces of the bone and socket to move in harmony. Inflammation means that you need to rest the area, recover and see a qualified physiotherapist (3).
- Malunion (growth) of fractures of the scapula or ribs – following a fracture of the shoulder or ribs, the bones may have healed with some new ridges that are prone to rubbing, catching and making noise as the muscles move over them. This is not usually of concern unless it is causing pain (3).
- Labral tears – the labrum can become torn due to overuse, age, or injury, which can in turn cause a partial or total dislocation. This is something a qualified physiotherapist and other healthcare professionals would need to examine and diagnose (3).
- Osteocondroma – a benign growth in your shoulder, scapula, or rib cage can cause your shoulder to crack at times when you raise your arm. These kinds of growths are the most common benign bone growths. Sometimes people with these growths have no other symptoms (7).
- Cavitation – sometimes, working out or simply raising your shoulders quickly can release gas from your joints, like what happens when you crack your knuckles. In these cases, there’s no underlying condition or pain that’s connected to your shoulder cracking. This kind of sound is related to air bubbles in your joints (7).
- Osteoarthritis – as you age, the spongy cartilage that keeps your bones from rubbing against each other can start to break down. A snapping or cracking sound in your shoulder could mean that your bones are making contact with each other as a result of this breakdown in cartilage. The sound of grating or cracking can be an early symptom of arthritis. This is something that needs to be seen my a qualified physiotherapist, as their advice can help reduce further damage and manage the condition (7).
How to treat clicking and mild shoulder pain
For acute or chronic pain, it is important to see a healthcare professional. However, for mild symptoms and for overall better shoulder health and posture the below strategies can help:
- Posture corrections: sitting up straight when at a desk for long hours can be enough to relieve shoulder pain for some people. Remember that physiotherapists are experts at realigning movement and making changes to your posture to allow your muscles and bones work more efficiently, which is why seeing a professional can help to understand your personal situation better (3).
- Foam rolling at the gym or at home can encourage faster healing by stimulating the soft tissue, increasing blood flow to the area and releasing some tightness. Some studies suggest that this type of manual therapy can help reduce pain (7).
- Stretching and strengthening exercises – see below for specific exercises to improve shoulder movement patterns and correct any muscle imbalances
- Activity modifications – before performing an exercise, you must make sure that you know what the proper technique is! Repeating movements with incorrect form will hugely raise your risk of injury (3).
- Avoid cutting off blood flow to the injured or sore shoulder, for instance by sleeping with your arm up and your head resting on it. This can cut off blood flow to your injury, which slows down the repairing process. A better sleeping position is lying on the unaffected side, with your arms out in front of you or hugging a pillow. If you’re pain-free, sleep in that same position but alternate sides nightly (2).
Here are 5 stretches and 5 exercises to help improve shoulder pain and clicking!
5 Mobility Drills and Stretches to Help Reduce Shoulder Pain
Click on the name of each exercise to see a video.
- Kinstretch CARs – shoulder protraction, elevation, retraction and depression for health shoulder movement and full range of motion.
- Stirring the Pot – mobility drill for shoulders to achieve isolated full range of motion.
- Helicopters or Snow Angels – strengthens shoulders, in particular traps and lower back.
- Swimmers stretch – stretches pec minor, shoulders and back.
- Door stretch – hold one hand above your head in a surrendering pose at a 90-degree angle against a doorway. Push against the frame of the doorway as if you’re trying to walk through it and hold this pose for 30 seconds. Once you’ve completed this stretch, raise your hands higher against the doorframe, so your elbows are parallel with your chin. Hold the stretch again in this position.
5 Strength Exercises to Improve Shoulder Movement and Reduce Existing Pain
- External and internal rotations – external rotation targets your teres minor, infraspinatus and posterior deltoid, whilst internal rotations targets your pecs, lateral deltoids, subscapularis and teres major. These two movements work the small muscles at the back of your shoulders that help to stabilize your shoulder joint, balance out the generally strong deltoids and reduce the risk of impingement.
- Prone Is, Ys and Ts – these exercises target the lower and middle traps. Lower traps are important for shoulder stability and overhead arm movement and help to bring the shoulder blades back and down (key to ensuring proper posture by preventing forwarded, rounded shoulders). Unfortunately, they are often weak! This weakness can lead to impingement and pain in the shoulder with overhead movement. Middle traps are one of the muscles responsible for scapular retraction (bringing your shoulder blades back behind you) and help rotate the shoulder blade during overhead arm movement.
- Prone Ys. Lay on your stomach at a 45-degree angle over an exercise ball, arms by your sides. Lift both arms up overhead as though you’re forming the letter “Y”. Try not to lift from anywhere else in your body, and keep your shoulder blades pinned down and back.
- Prone Ts. Lay on your stomach at a 45-degree angle over an exercise ball. With both arms out to the side, forming the letter “T,” bring your arms straight back behind you, lifting from between the shoulder blades, being sure not to hunch your shoulders up towards your ears.
- Lower traps activation and strengthening. This will help improve shoulder stability and reduce any imbalance between upper and lower traps. A large imbalance between upper and lower traps has been linked to shoulder pain, and lower traps tend to be weaker in lifters with shoulder pain.
- For lower traps activation, try to consciously pull your shoulder blades back and down towards one another. Do this before each rep on lat pulldowns and pull up variations to improve your form, perform the correct movement pattern and protect your shoulders. Click here for an example.
- Seated Rows V-Bar.
- TRX Low Row.
- Side Lying Abduction – this exercise targets the supraspinatus and deltoid muscles, both of which are important for shoulder elevation. Start by lying on your side with your arm straight down your side and your thumb pointing upwards. Gently lift the arm up in the coronal plane (a straight line from your hip up to vertical) until you’ve got a 90-degree angle from your torso to your arm. Gently lower back to the starting position, staying in control of the movement. Start using bodyweight only, gradually add 1 or 2kg weight plates or dumbbells as you get stronger.
- Plank with protractions and modified plank protractions- this exercise strengthens the serratus anterior, one of the larger shoulder muscles. Its role is to stabilise the shoulder blade on the thorax (ribs) and is critical for pain-free upward arm rotation. Begin in a high plank position, facing the floor with your core drawn in, hands and toes in contact with the floor. Spread your fingers for maximum contact and support from the floor. Keep your spine neutral and eyes down as you protract the shoulders (push up through your shoulder blades), letting the shoulder blades move away from each other as though you’re trying to push the floor away. Hold this position for 30 to 90 seconds. If needed, there are many ways to modify a plank. Try resting on your forearms if you have wrist pain, or starting with a modified plank at a 45-degree angle using a stable surface. You can also do this exercise in a kneeling plank position
What exercises should I avoid if I have shoulder pain?
- Shoulder press.
- Overhead press.
- Behind the neck pulldown.
- Moves done with arms in the “high-five” position.
- Excessive push ups – e.g. multiple reps, multiple times a week.
- Any exercise or activity that seems to make it worse!
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- BMC Musculoskelet Disord, 2011, “A prospective study of shoulder pain in primary care: Prevalence of imaged pathology and response to guided diagnostic blocks”, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC31278....
- Schuler, L, 2016, "How to End Shoulder Pain From Lifting" Men's Health, https://www.menshealth.com/fitness/a19526779/shore....
- Bernard, K., 2017, “Is This Serious? Why Do My Shoulders Click?”, https://www.pthealth.ca/blog/is-this-serious-why-d....
- WebMD, 2018, "What Is My Rotator Cuff, and Why Does It Hurt?", https://www.webmd.com/pain-management/what-is-my-r....
- Innerbody, 2018, “Muscles of the Shoulder”, http://www.innerbody.com/image/musc10.html
- Fealy, S., 2010, "Shoulder Labrum Tears: An Overview", https://www.hss.edu/conditions_shoulder-labrum-tea....
- Minnis, G., 2018, "Why Do My Shoulders Click, Pop, Grind, and Crack?", Healthline, https://www.healthline.com/health/cracking-shoulde....
- Tavel, R. 2018, "Lifting Heavy? Bulletproof Your Shoulders with These 5 Moves First", Men's Health, https://www.menshealth.com/fitness/a23567971/shoul....
- Physiopedia, 2018, "Scapula", https://www.physio-pedia.com/Scapula
- NHS, Shoulder Pain: https://www.nhs.uk/conditions/shoulder-pain/
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