Why Does My Shoulder Hurt When Hitting Forehands?

If you’ve ever thought, “Why does my shoulder hurt when hitting forehands?” or “Why does my shoulder hurt when I hug my child?” or even, “Why does my shoulder hurt when I throw a ball?”, you most likely have a shoulder injury. Over 50 million people in the United States suffer from shoulder pain at some time in their lives. It’s one of the most common problems that people seek help for. There are over 30 different injuries that cause shoulder pain.

 

 

But these specific actions (hitting forehands, hugging your child, and throwing a ball) probably mean you have an injury to a specific muscle-tendon unit in your shoulder, called the subscapularis. Either the muscle or the tendon can be injured, but the good news is that a skilled massage therapist can help.

Where is the Subscapularis Muscle-Tendon Unit?

 

 

The subscapularis muscle sits on the underside of your shoulder blade, opposite the ribs. It’s one of the strongest shoulder muscles and the most often strained.

 

 

And because a tendon connects muscle to bone, the subscapularis tendon goes through your armpit and is attached at the front of your shoulder, at the top of your arm bone, the humerus.

 

A muscle has a lot of flexibility, and a tendon has a little flexibility. But where the tendon attaches to a bone, there is no flexibility. Therefore, most injuries to muscles and their connecting tendons happen where the tendon connects to the bone.

 

 

Do I Have a Rotator Cuff Injury?

 

 

A rotator cuff injury is a very broad term that doesn’t really tell you a lot. The rotator cuff actually consists of four different muscles, with their own tendons that attach to the bone at your shoulder. If someone says you have a rotator cuff injury, it usually means they don’t know what’s injured. It’s rare to have all four muscle-tendon units injured at the same time, so no, you most likely do not have an injury to your whole rotator cuff.

 

 

What’s Causing the Pain in My Shoulder?

 

 

The pain from most injuries is caused by poorly formed scar tissue. Whenever you get an injury, the body produces scar tissue. If that scar tissue is lined up properly, the injury heals correctly, and there is no more pain. If it heals poorly, we refer to it as adhesive scar tissue.

 

This type of scar tissue is very vulnerable to reinjury. So, every time you stress it, the scar tissue re-tears. That’s why it’s essential to see a skilled professional, who can treat you and recommend exercises so that the healing process occurs in good alignment.

 

 

How Will a Massage Therapist Find a Subscapularis Shoulder Injury?

 

 

The shoulder is one of those areas of the body that causes referred pain. This means the pain is located in one place, while the injury is in another place, sometimes 6 or 8 inches away from the injury site. This referred pain is why it’s so difficult for many therapists to figure out what’s going on.

 

 

A trained therapist will use a few simple tests to help identify if the subscapularis muscle and its tendon are strained. The main action of this muscle is to rotate the arm inward, so the therapist will have you bend your arm at a 90° angle with your fingers pointing straight ahead. Then, they will hold your wrist still and ask you to pull your lower arm toward your abdomen while they resist your movement. This action tests this muscle and its tendon.

 

When this test is painful or if the arm is abnormally weak, the therapist knows exactly what is injured because this test makes you use the primary motion that the subscapularis muscle controls.

 

Why Do You Get Weaker with a Shoulder Injury?

 

When you have a shoulder injury, you start to use the other arm or avoid doing things that stress the injured area, either intentionally or not. This causes you to become weaker and weaker over time, when doing certain movements.

 

I have treated many athletic clients during my career, including individuals who can lift 200 pounds. When I test them for injuries, they can’t believe that I can overpower them with a few fingers. They hardly have any strength in the injured area, but they just never noticed it.

 

 

How Do You Heal a Subscapularis Shoulder Injury?

 

If the injury is very mild, you can try a corresponding exercise to accelerate healing. If the injury is more serious or has been present for many months, then you generally can’t heal without treatment from a professional.

 

After a skilled therapist assesses the injured area, they can provide treatment. The goal of the treatment is to eliminate the adhesive scar tissue that is causing the pain. This is typically done through friction therapy, where the therapist gently moves their fingers to separate the scar tissue and encourage normal healing.

 

 

What Kind of Exercise Will Help a Subscapularis Shoulder Injury?

 

The goal of any rehabilitation exercise program is to rebuild strength so that the right and left sides of the body have equal strength. The best exercise program includes a warm-up, a targeted stretch, the corresponding exercise, a stretch repeat, and either ice or heat application.

 

This program is described on my Exercise Rehabilitation Videos page. For a subcapularis shoulder injury, first watch The Basics. This video will describe the exercise program to you.

 

Then, watch and exercise to the Forehand Shoulder (Subscapularis) Exercise Program.

 

A consistent routine generally helps a very mild injury, and a consistent routine with concurrent treatment will generally help more severe injuries.

 

If you’re in the Boston, MA area, I have been treating chronic pain for decades and am also available by appointment. If you’re not in the Boston area, I can still help by conducting a remote evaluation session, where I walk you through a series of assessment tests. You’ll need either your current massage therapist or someone I can direct to perform the assessment tests. You can also email me or call my office to see if this is a good fit for you or ask any questions you might have beforehand.

 

Start Here – The Basics: Muscle-Tendon Injury Exercise Program

Forehand Shoulder (Subscapularis) Exercise Program

 

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If you are experiencing calf pain and live in the Boston area, schedule an appointment or a complimentary 10-15 minute phone consultation.

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Ben E. Benjamin holds a Ph.D. in Sports Medicine and was the founder and President of the Muscular Therapy Institute in Cambridge, Massachusetts.  He is the author of dozens of articles on working with injuries and chronic pain as well as the widely used books in the field, Are You Tense? Exercise Without Injury and Listen To Your Pain: The Active Person’s Guide to Understanding, Identifying and Treating Pain and Injury. Dr. Benjamin has been in private practice for over 50 years and teaches therapists throughout the country.

 

 

 

Why Does My Shoulder Hurt When Hitting Forehands? FAQs

 

• Why does my shoulder hurt when hitting forehands?

If you have pain when hitting forehands, hugging your child, or throwing a ball, you probably have an injury to a specific muscle-tendon unit in your shoulder, called the subscapularis. Both the muscle or the tendon can be injured.

 

• Where is the subscapularis muscle-tendon unit?

The subscapularis muscle sits on the underside of your shoulder blade, opposite the ribs. And the subscapularis tendon goes through your armpit and is attached at the front of your shoulder, at the top of your arm bone, the humerus.

 

• Do I have a rotator cuff injury?

Probably not. A rotator cuff injury is a very broad term that doesn’t really tell you a lot. The rotator cuff actually consists of four different muscles, with their own tendons that attach to the bone at your shoulder. If someone says you have a rotator cuff injury, it usually means they don’t know what’s injured.

 

• What’s causing the pain in my shoulder?

The pain from most injuries is caused by poorly formed scar tissue. This type of scar tissue is very vulnerable to reinjury. So, every time you stress it, the scar tissue re-tears and causes more pain.

 

• How will a massage therapist find a subscapularis shoulder injury?

A skilled therapist will use assessment tests to find out what part of your body is really injured. For the subcapularis in particular, the therapist will have you bend your arm at a 90° angle with your fingers pointing straight ahead. Then, they will hold your wrist still and ask you to pull your lower arm toward your abdomen while they resist your movement.

 

• Why do you get weaker with a shoulder injury?

When you have a shoulder injury, you start to use the other arm or avoid doing things that stress the injured area, either intentionally or not. When you don’t use those muscles, they become weaker.

 

• How do you heal a subscapularis shoulder injury?

For mild injuries, a good rehabilitative exercise program usually works. For more severe injuries, a professional can help, with treatment like friction therapy.

 

• What kind of exercise will help a subscapularis shoulder injury?

A good rehabilitative exercise program includes a warm-up, a targeted stretch, the corresponding exercise, a stretch repeat, and either ice or heat application. First watch The Basics, then watch and exercise to the Forehand Shoulder (Subscapularis) Exercise Program.