Shoulder Pain at the Top of Your Backswing

The short answer

Pain at the top of the backswing is usually the lead shoulder being pushed into a position the joint cannot reach cleanly. The shoulder blade stops gliding, the rotator cuff tendons get compressed under the bony arch above them, and you feel it as a pinch at the top rather than a general ache.

Where the pinch comes from

Your lead shoulder, the left one for a right handed golfer, goes across your body at the top of the swing. That movement needs the shoulder blade to rotate upwards and slide around the ribcage. If the blade does not move, the arm bone runs out of room and the supraspinatus tendon gets squeezed. That is shoulder impingement, and it is one of the most common things I see in golfers at Quinta do Lago and Vale do Lobo.

The giveaway is where it hurts. Impingement tends to be sharp, in a specific arc of movement, and worse at the top of the backswing or when you reach into the back seat of the car. A general ache across the whole shoulder after a long round is usually muscular fatigue instead.

What is actually restricting it

• Pec minor. A small muscle under the chest that pulls the shoulder blade forward and down. When it is short, the blade cannot rotate up, and the arm has nowhere to go.
• Lat and teres major. These limit how far the arm can go overhead and across. Tight lats are common in anyone who has done gym work alongside golf.
• Posterior cuff and capsule. The back of the shoulder tightens with repeated rotation and pushes the joint forward in its socket.
• Thoracic spine again. A stiff mid back makes the shoulder work harder for the same amount of turn. The same restriction that gives golfers lower back pain often shows up here.

Why it gets worse through a golf trip

Four rounds in six days is a lot of volume for a shoulder that is already short of room. Tissue that would recover between weekly rounds at home does not get the chance. Visitors playing the Algarve courses in a concentrated week are the group most likely to arrive mid trip with a shoulder that has gone from niggle to sharp.

If that is you, it is worth treating during the trip rather than waiting until you are home. A session that restores the rotation you have lost will usually let you finish the week.

How I treat it

Assessment first: how far the arm goes overhead, how far it goes across, what the shoulder blade does while it happens, and which movements reproduce the pinch. Then treatment aimed at whatever is holding it.

In practice that is usually ART through pec minor, lat, teres major and the posterior cuff, trigger point work where the tissue is referring pain, and soft tissue work through the thoracic spine to give the shoulder a better base to work from. I trained in remedial massage in Sydney and I am certified in ART for the upper limb, which is the protocol that fits this problem most closely.

Range of movement usually improves inside one session. Whether that holds depends on how long it has been going on and whether anything changes about how much you are playing.

What not to do

Do not keep playing through a sharp pinch for weeks hoping it settles. Impingement that is left alone long enough can move on to tendon damage, and that takes considerably longer to resolve. Do not stretch into the painful arc either. Pushing a compressed tendon further into compression makes it angrier.

Booking

I see golfers at the clinic in Almancil, and I travel to Vale do Lobo, Quinta do Lago and Vilamoura if you are mid trip and would rather not drive. Clinic from €37, mobile €140 per hour. WhatsApp 925 382 490.