Anterior (front) shoulder pain is one of the most common complaints we get from all overhead athletes especially baseball players. This pain is often palpable at the origin of the bicep tendon. Although every case can have countless pathologies (such as labral tears, impingement, poor movement mechanics) causing the pain at the bicep tendon region, about 90% of the time we find that this pain is referred pain.

Referred pain is pain felt in a part of the body other than its actual source. Through my studies of Chinese Medicine, I can validate that many times the science and theory behind referred pain make little sense. Fortunately, pain that would be considered “bicipital tendonitis” is often very clear cut referred from the rotator cuff— most specifically the infraspinatus. The “X”s in the image below shows how the infraspinatus connects to the humerus (arm bone). Altered length, strength, movement mechanics, tissue quality or timing of the infraspinatus will throw off the mechanics of overhead movements.

To determine if this a true referred pain issue, we find the painful motion (usually reaching overhead) and have the athlete give us a number 1-10 (10 being terrible pain). After establishing a baseline for pain, we find tender points in the infraspinatus, apply firm pressure and retest the motion. This is uncomfortable for the athlete in the spot being pressed but often brings a 6-8/10 pain down to a 0-1. If that is the case, we have found the problem.

Fixing the soft tissue quality is usually done by aggressive treatment. This can be active release, cupping, Graston’s, or Gua Sha. Cupping has been the tool that gets the quickest and longest lasting results (see below). I believe this is the case because almost all therapeutic techniques are compressive in nature. Cupping offer a decompressive component often causing discoloration. Most athletes walk away pain-free in 1-2 treatments even if they have been suffering symptoms for years.

Soft tissue treatments often don’t need to be aggressive, but sometimes they do. Here is an example of an aggressive treatment. Repost @bartsmarkucki: Rehabbing the back today with @drheenan ! Been training hard getting ready for #arnoldclassic2016 this Saturday for past couple months. My first meet back since surgery in August. Excited to see what happens feeling strong and ready! #cupping #therapy #rehab #back #muscles #buildabear #on #my #ass #olympiclifter #weightlifter #gym #postworkout #massage #muscles #olympicweightlifting #crossfit #rejuvination #arnoldclassic2016 #usaweightlifting #fitlife #fitness #healing #bodybuilding #shoulders #arnolds #booty #picoftheday

If you do not have access to a manual therapist, a lacrosse ball jammed into the infraspinatus often does the trick.