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an older woman wearing a white shirt grabs her shoulder in pain

Stress and Shoulder Pain: The Invisible Link That May Be Affecting Your Pain

By Advanced Pain Care

Stress and shoulder pain are more closely linked than you might think. Whether physical stress after a surgery or injury or mental stress–you may find your shoulder pain flares up in tandem with stress levels. 

As an orthopedist, I think of the shoulder as the glenohumeral joint, which is strictly the ball and socket joint. However, many of my patients are likely to think of a lot of the muscles around the area as a part of the shoulder, from the scapula or shoulder blade to the chest wall and the pecs, and down to the elbow. This is also true and makes a lot of sense because a lot of pain that we may think of as shoulder pain is actually felt in those surrounding areas or at the point where the shoulder and neck meet. 

There are a few general techniques for reducing stress-related shoulder pain, whatever the underlying cause. Stretching, yoga and other mindfulness practices, psychotherapy or physical therapy, heat and cryotherapy, and over-the-counter pain medication all can help to counteract stress-related shoulder pain. 

Physical Stress and Shoulder Pain

Stress after surgery or a physical injury can aggravate shoulder pain. For instance, after shoulder surgery, I usually put my patients in a sling to recover. Many of them develop a tendency to tense their shoulders up and tuck their elbows in what I call a “guarded position.” They aren’t relaxing their muscles, because they’re afraid that movement of the shoulder will cause pain during the healing process. However, the guarded position is stressful for the shoulder and the areas around it. These folks might start to experience neck pain and headaches, as well as periscapular pain around the shoulder. 

However, the guarded position isn’t unique to shoulder surgeries. I see it in many patients who are recovering from other surgeries or injuries. I’m a high school football team doctor and I frequently notice kids who may have a concussion and subsequent light sensitivity doing the same. The first step to combating physical stress-related shoulder pain is recognizing when you are slipping into these tense and guarded positions. 

Mental Stress and Shoulder Pain 

If you are anxious or stressed, you may start to get tense and fall into uncomfortable postures. Many of us don’t notice that we’re adopting these tensed positions or straining our muscles for long periods–until we start to feel the painful effects. When these muscles are overtaxed and overused, they start to ache and hurt. This is especially common in the neck, upper back, and shoulders. 

The pandemic has been stressful for everyone, from job uncertainty to illness, both physical and mental, to unstable childcare and everything in between. In addition, most of us are finding ourselves working from home more often than ever before. We might not be moving around as much or getting up from our desks the way that we used to at the office. This stationary work set-up can exacerbate shoulder pain as well. You may be hunching forward to read emails on your laptop, sitting for hours at a time, or slouching in an uncomfortable office chair. Instead of going on a walk during lunch, you might be eating at your home office desk. 

Stress and the pandemic can lead you to leave the house less and spend more time hanging around on the couch. There’s nothing wrong with well-earned relaxation, but make sure that you are making time to move your body. Mental stress, lack of movement, and a sedentary workday can be just the toxic combination to increase shoulder pain. 

What Are Your Shoulder Pain Management Options? 

The most important thing you can do to manage stress-related shoulder pain is to practice mindfulness and body awareness. When you are feeling stressed, there is a simple exercise you can do to pinpoint where your body is holding tension. Sit down and take a deep breath. Then, start at the top of your head, focusing on the physical feelings you are experiencing there and consciously relaxing that part of your body. Then, move onto your cheeks and jaw, your neck, then your shoulders, and so on, all the way down your body. You’ll be able to tell which areas of your body are the tensest and tightest. 

Yoga is also a great way to be mindful and aware of your body. Turn your phone on silent for 10 or 20 minutes, while you do a yoga routine off of Youtube. Focus on your breath, as well as the physical feeling of stretching out your muscles. For post-operative patients, I also recommend calling in some backup for help pointing out when you are tensing up or falling into that guarded position. Ask your family, spouse, or whoever else is around to keep an eye on you and let you know when you look tense. You might not realize that you are unconsciously adopting a guarded position, but your loved ones can remind you to un-tense and relax! 

The second most important technique for reducing stress-related shoulder pain is exercise and movement. I’m a firm believer that exercise helps us all feel our best. It increases blood flow, which reduces inflammation and pain. Exercise also increases the fluid in our joints, which reduces joint pain as the joint can receive more nutrients. Plus, it’s a proven stress reliever and great for mental health. Honestly, exercise has no downside! 

Some folks might have to get a little creative, depending on physical limitations, but there are options for everyone! You should exercise smarter, not harder if you have physical limitations. I recommend a stationary bike or recumbent bike, or a simple pair of pedals that you can use at your desk or while watching TV. Taking walks or running is also a great accessible option if you aren’t near a gym or don’t have the extra money to spare for the time being. 

I also always recommend stretching, as it is easy, free, and simple to fit in quickly to a busy day. Although most of us were taught simple stretches in gym class, those stretches tend to underutilize the back. Engaging the back muscles is great for managing shoulder pain. Try simply touching your shoulder blades together and drawing your shoulders back, and hold that position for a few seconds. You can also hold weights with your arms extended downwards and let the weight pull down on your traps. Finally, another great stretch is a reverse snow angel. Lay down on your stomach and lift your head, legs, and arms. You’ll find that your back muscles are engaged and working hard! 

If you are working from home or sitting at a desk for long periods anywhere, make sure that you get up every 20-30 minutes. You don’t have to do much, just try to stretch a little or get up and walk around for a few seconds. It will improve your posture and reset your focus, helping to cut down on mental and physical stress. 

Understanding Stress and Shoulder Pain

Of course, there are many other options for stress and shoulder pain, such as physical therapy or mental therapy and over-the-counter pain medication. However, mindfulness and exercise will always help in tandem with other treatment options and techniques. If your shoulder pain is severe or it isn’t getting better, it might be time to come into APC and get it checked out. We can conduct tests and take MRIs, and then work with you to develop a plan based on the information we find. Whether you need an interventional pain specialist, a rheumatologist, or a neurologist, we’re all within the same APC system and often under the same roof. 

Stress is often invisibly linked to pain, and shoulder pain is no different. When you understand what is causing your stress and how your body is holding onto tension, managing your shoulder pain will be much easier!