With Dr. Stephen Leffler

Based upon the questions that I am e-mailed and which show up frequently on the conferences, shoulder pain is a problem for many bowhunters. This is not really that surprising if you look at the anatomy of your shoulder and what shooting a bow demands of these joints. Your shoulder is an ingeniously designed joint which was made for flexibility and motion. The ball of your humerus (arm bone) sits loosely in the glenoid fossa which is a shallow dish on your scapula. The bones are held in place by a network of muscles and tendons.

This gives your shoulder great flexibility and range of motion but makes it highly susceptible to overuse injuries and muscle tears. The muscles of the shoulder joint are comprised of your rotator cuff muscles which are actually a group of four small muscles and your deltoid or shoulder muscle. The biceps, triceps, and pectoralis muscles attach to your shoulder and can also be injured or cause pain.

Shooting a bow is a tough job for your shoulders. Your string shoulder is pulling and rotating your shoulder outward while your bow shoulder is pushing and resisting collapse inward. These are obviously opposite activities and subject each shoulder to different types of stress and injuries. In my experience most bowhunters have shoulder problems with their string or "pulling shoulder". This makes sense when you consider that the rotator cuff muscles are the major "pullers". These muscles are pretty small and are easily strained or torn if not properly conditioned. These muscles also get weaker and more susceptible to injury as we age. In fact, the vast majority of rotator cuff injuries occur in people over 40.

Drawing a bow puts tremendous strain on these muscles. If you start slowly and gradually increase your shooting, then the muscles will become conditioned and you should have few problems. If your shoulder starts to hurt then cut your practice back slightly and drop your bow weight if possible. Usually mild pain that only occurs with activity but still allows you to shoot is caused by inflammation of the muscles and tendons. The pain is caused by tiny tears in the muscle or tendon with microscopic bleeding and a subsequent inflammatory response. If you ignore the pain the tiny tears can become more serious and eventually lead to a complete disruption of the muscle or tendon. This can happen gradually or from a sudden injury such as a fall with your arm overhead. At this stage you will no longer be able to perform the motion, not because of pain, but because the muscular attachment is disrupted. Another possible source of shoulder pain is the various bursae which cushion and protect the joint. Bursa are small fluid filled "pillows" which are located between bones in your shoulder to provide cushioning and to keep the bones from rubbing together. These bursa can also become inflamed from overuse or poor form and lead to bursitis. This is an inflammatory process which should respond well to rest and anti-inflammatory medications.

A shoulder strengthening and conditioning program is a great way to prevent many chronic shoulder problems as well as rehabilitate prevoiusly injured bowhunters. As noted above, gradually increasing your bow practice and starting with a lower draw weight will get you off to a good start. Shoulder stretches should be a part of every archer's warm up routine. It is even more important for those of you over 40. These stretches help keep the muscles flexible and limber. They will improve blood flow to the muscles which can help resolve inflammation. They are a great way to rehabilitate a shoulder which already hurts and an even better way to prevent injury.

The first stretch works on the front part of your rotator cuff which is the subscapularis muscle. Hold your arms at 90 degrees from your body and flex your elbows to 90 degrees. Now gently try to touch your shoulder blades together. You should feel a stretch in the muscles of the front of your shoulder. Now straighten out your elbows and repeat the stretch. You should hold each position for five seconds and then release.


Repeat five times and then move onto the second stretch. This stretch targets the all important posterior muscles of the rotator cuff which are the bowstring pullers and are the most commonly injured. Place your right arm across your chest and rest your hand on your left shoulder. Place your left hand on your right elbow and gently push the elbow toward your chest. Hold this position for 20 seconds then relax. Repeat this stretch five times and then switch arms.


The final stretch is for the supraspinatus muscle which is the top muscle in the rotator cuff and helps you bring your arm overhead. Put your right hand behind your back and grab your right wrist with your left hand. Pull your right wrist to the left. Gently pull for 20 seconds then relax. Repeat five times then switch arms. You should feel the stretch on the top of your shoulder.

These stretching exercises will go a long way toward keeping your muscles flexible to prevent or rehabilitate injuries. A strengthening program for the shoulder muscles is also of great benefit. Routine exercises such as shoulder presses, bench presses and pull ups are all excellent and should be a part of any complete conditioning program. Unfortunately these exercises don't really target the rotator cuff. In fact if not performed with very strict form these exercises are well known to cause cuff injuries. A very simple way to even out the development of your shoulders is to start and finish every practice session by switching arms and drawing your bow with your opposite hand. Hold at full draw for five seconds and let down. This obviously works better with traditional bows. If you shoot a compound then those rubber band devices that are advertised can be used. Build up to ten repetitions. This helps even out the development of the pusher and puller muscles of the shoulder.

We will now look at specific exercises which target the rotator cuff. The first exercise begins with you lying on your back with your shoulders and elbows at 90 degrees. Holding a 5 pound dumbbell in one hand keep your upper arm and elbow on the floor and rotate your shoulder to bring your hand perpendicular to the floor. Lower your arm back to the floor and repeat. Perform 10 repetitions with each arm. Three sets with each arm should be done.


The next exercise is done by lying on your left side and resting your right arm on your right side with your elbow at 90 degrees. Using a five pound dumbbell keep your upper arm against your side and rotate your shoulder to bring your hand perpendicular to the floor. Slowly lower your hand back down. Perform 10 repetitions and then switch sides. Three sets should be performed with each arm.

The final exercise is done by holding a five pound dumbbell in each hand. Starting with your arms at your side and your elbows bent, slowly bring your arms up to 90 degrees so that your elbows, shoulders and hands are all at the same level. Slowly bring your arms back to the starting position and repeat ten times. Three sets of ten repitions will provide excellent conditioning.


If you begin having pain in your shoulder with shooting then try to reduce bow weight and your amount of practice. Do the above stretches and conditioning exercises and use anti inflammatory medications such as Advil. Mild injuries should do very well with conservative treatment. If the pain worsens or becomes more chronic then you should seek medical care. A good place to start is with your family physician. You will need a careful evaluation of your shoulder to locate areas of inflammation or complete tears. Some family docs are much better at this than others. If your physician seems to understand your problem and has made a careful diagnosis and treatment plan then you are all set. If he or she isn't helping you then specialty consult may be needed. A physician who specializes in shoulder injuries such as an Orthopedic surgeon or sports medicine physician will be able to fully evaluate your shoulder and understand the mechanics of bow shooting and how this places stress on your shoulder. These specialists also are used to dealing with athletes and will understand the "necessity" of drawing a bow in November. They will be experts in quickly rehabilitating your shoulder and getting you back to shooting in the shortest amount of time. If conservative treatment fails or is not working fast enough (elk season starts in a week and you can't get to half draw) then steroid injections may be necessary. These can very quickly resolve inflammation which can have you shooting in no time. Unfortunately they do nothing to correct the underlying problem which caused the inflammation in the first place and the pain will likely recur unless you make changes in your form or conditioning. Also, the steroids are not really good for your tendons and repeated injections actually weaken the tendon. Most physicians feel that 5-6 injections are the maximum for any single joint and I think that is on the high side. So steroids can work temporary miracles but should not be seen as a permanent solution to your shoulder pain.

Your physician may diagnose a complete tear of the rotator cuff. In this situation you will be unable to do certain motions with your shoulder such as lift your arm overhead. When the cuff is completely disrupted no amount of medication or steroid injections will fix the problem. In active people (like bowhunters) surgery is required to reattach the cuff and return your shoulder to normal function. This will obviously put you out of commission for 6-8 weeks but is the only good option with a serious cuff tear.

In this article we have tried to look at what causes bowhunters' shoulders to hurt and a reasonable stretching and conditioning program. Good practice habits and conditioning should help prevent problems. If it is too late and your shoulder is already hurting then medical evaluation and careful diagnosis can get you back to shooting as quickly as possible.