Shoulder Pain in Pole: What Research on Overhead Athletes Can Teach Us

Pole athletes are overhead athletes, so while there may not be an abundance of literature specifically on pole athletes, we can gain insights from research on other overhead athletes such as baseball pitchers, swimmers, gymnasts, volleyball players, and aerialists. All of these athletes repeatedly place large amounts of force through their shoulders in elevated and often extreme ranges of motion.

Pole athletes specifically hang from our shoulders, rotate through them under the load of our entire bodyweight (often combined with momentum and high-velocity movement), absorb momentum through them, and produce force from positions that many people never train at all.

Yet despite these demands, a lot of shoulder training in pole still revolves around two extremes: resting the joint and waiting for the pain to go away, or using very light therabands for generic rotator cuff exercises. Unsurprisingly, neither of these approaches prepares the shoulder to tolerate the demands of high-level pole movement long-term.

A lot of shoulder pain in pole does not come from one acute injury. More often, it develops gradually over time. The shoulder starts feeling irritated during certain skills, then progressively becomes more sensitive, inconsistent, stiff, unstable, or painful as training continues. This pattern is extremely common in overhead athletes as a whole, and the research surrounding overhead sports gives us useful insight into why this happens and what may actually help.

Pole Requires More Than Skill

Pole training is highly specific. It improves coordination, movement efficiency, timing, grip, and technical execution. But like I mentioned in my previous blog post, skill development is only one piece of athletic development.

The shoulder joint is every pole athlete’s lifeblood. There’s not much you can do in pole without the shoulder, so it needs the physical capacity to tolerate repeated loading, force production at long muscle lengths, rapid transitions between positions, high-force pulling and pushing, momentum and force absorption, and large ranges of motion under load.

These qualities do not always improve simply from doing more pole. In fact, many pole athletes, myself included in the past, unknowingly use passive flexibility to accomplish skills, relying on gravity or the pole to get their shoulder into the desired position. But do this for too long, and your shoulder will start signaling for help through pain and irritation.

What Research on Overhead Athletes Shows

It’s important to recognize that shoulder pain and injury are multifactorial. In most cases, there is not one single movement, tissue, exercise, or mistake that “caused” the problem. Pain experiences are often influenced by many interacting variables such as training volume and intensity, recovery, sleep and nutrition, previous injury history, life stress, tissue capacity, movement variability, strength, mobility, and overall workload management.

Because of this, it is often impossible to identify one exact cause of shoulder pain in overhead athletes. However, while we cannot always determine the precise cause, research can still help us identify common patterns and potential risk factors associated with increased injury occurrence. More importantly, it gives us direction for what physical qualities we may want to improve to better prepare the shoulder for the demands of overhead sport.

Mobility Deficits

One of the most studied findings is glenohumeral internal rotation deficit (GIRD), which refers to reduced shoulder internal rotation range of motion. In baseball pitchers and swimmers, reduced internal rotation (IR) has been associated with increased injury risk and shoulder pain.

This is particularly interesting when we consider positions commonly used in pole, such as twisted grip. Many pole athletes spend significant time training overhead positions that require large amounts of shoulder internal rotation, often under substantial load. Yet despite how demanding these positions are, internal rotation capacity is rarely trained directly with the same attention athletes give to flexibility-based skills.

This is one reason I place such a strong emphasis on internal rotation mobility and strength within my own training and coaching.

While we cannot say that internal rotation deficits directly cause shoulder pain in pole athletes, research on overhead athletes does suggest that limitations in these ranges may influence how stress is distributed through the shoulder over time. Given how frequently pole athletes load internal rotation-heavy positions like twisted grip, improving strength and control in these ranges may be an important part of long-term shoulder resilience and performance.

This highlights something many athletes misunderstand: range of motion matters, but not simply for the sake of being flexible.

The real question is: can you actively control and produce force in the ranges your sport requires? These are two very different things.

Strength Matters Too

Research also suggests that strength deficits may play a role in non-traumatic shoulder pain in overhead athletes.

Several studies found that symptomatic shoulders often demonstrate lower isometric strength compared to the non-symptomatic side. Another prospective study found that lower external rotation strength was associated with future shoulder pain in overhead athletes months later.

This is especially interesting because many overhead sports require force production in stretched or disadvantaged positions repeatedly. If the shoulder lacks the ability to generate force in these positions, something else often compensates, typically passive tissues, tendons, joint structures, and neighboring muscles and joints. Over time, this can lead to irritation and overload down the kinetic chain.

Why Stretching Alone Often Falls Short

This is where a lot of pole athletes get stuck, and I hear it all the time: “My shoulder hurts; I just need to stretch more.”

When the shoulder starts feeling stiff or irritated, the default response is often stretching, massage/manual therapy, or rest. To be fair, some of these approaches can temporarily reduce discomfort or improve range of motion, but temporary increases in flexibility are not the same thing as improved load tolerance.

If a shoulder gains range of motion but still cannot produce or tolerate force there, the underlying issue may not actually change. The athlete simply returns to the same training demands with the same capacity limitations. This is one reason many people feel temporarily better, then flare up again as soon as training intensity increases.

One of the more interesting findings in the literature is that resistance training appears to improve range of motion just as effectively as stretching over time. Mobility is not solely about relaxing tissues or increasing passive flexibility. It is also influenced by strength, control, tolerance, and the nervous system’s confidence in a position.

In other words, sometimes the body is tight but does not need more stretching. Sometimes it needs more strength and control in the range it already has. This is especially relevant in pole, where flexibility without control can actually become a problem.

Why End-Range Strength Matters for Pole Athletes

This is where end-range training becomes important and is the thing I never shut up about.

Research has shown that muscular and tendon adaptations are specific to the positions and joint angles being trained. If strength work never challenges end ranges, then those ranges may remain comparatively weak and underprepared despite being heavily demanded during sport.

Some evidence also suggests that isometric training may improve strength, pain, tendon stiffness, function, and tolerance to load, particularly when performed at longer muscle lengths (aka in a stretch/end-range).

This does not mean isometrics are magic, nor does it mean every shoulder problem is solved with end-range exercises. However, it does support the idea that shoulders often benefit from learning how to produce and tolerate force in the exact positions they struggle with.

This matters enormously for pole athletes because many high-level skills place the shoulder in positions that are stretched, loaded, unstable, rapidly changing, and mechanically disadvantaged.

Yet I still see most shoulder training programs focus primarily on mid-range, slow, light, controlled exercises. Again, these exercises are not wrong. They might be a good starting point, but there is a 0% chance they will fully prepare the shoulder for the real demands of pole training.

As a unique community, we cannot rely on shoulder exercises made for people whose goals are simply lifting weights in the gym or moving through everyday life. We are asking our bodies to do far more than that, and need to prepare them accordingly.

My Biggest Point

When we connect these findings together, a clear theme starts to emerge. Pole athletes do not simply need passive flexibility. They need range of motion, strength, control, and tissue tolerance within those ranges.

This is why I believe end-range strength training is such a valuable tool for pole athletes. Rather than treating mobility and strength as completely separate qualities, end-range resistance training allows us to develop both simultaneously.

Pole athletes are constantly required to produce force in stretched positions, stabilize overhead, tolerate load at long muscle lengths, and transition between positions under tension. Simply accessing a position does not necessarily mean the shoulder has the strength or capacity to tolerate force there repeatedly. The body still needs to be able to actively control those ranges under load.

That is why so much of my own training and coaching focuses on developing end-range strength, loaded mobility, and active control through positions commonly used in pole. The goal is not just to improve flexibility for the sake of flexibility, but to build shoulders that can confidently handle the demands of high-level movement.

What This Looks Like in Practice

In practice, this means building shoulder training around positions that actually show up in pole rather than only working in mid-range or low-load environments.

For me and the athletes I work with, that often looks like holding isometric positions at end ranges where the shoulder is most challenged, then gradually progressing the amount of force the shoulder can tolerate there.

It includes controlled loading into positions where the shoulder is stretched, not just moving through them passively, and then learning to produce force without immediately leaving those ranges.

It also means practicing force absorption, where the shoulder has to accept load rather than only produce it, and exposure to faster, more dynamic movement so control isn’t limited to slow or predictable conditions.

Over time, these inputs are progressed so the shoulder doesn’t just “access” positions, but can stay stable, strong, and responsive in them under real training demands.

Because ultimately, the goal is not simply to become more flexible or temporarily reduce discomfort, but to build a shoulder that can actively control and tolerate the positions pole requires so you can move confidently and keep flying long-term with fewer interruptions from shoulder pain.

Key research referenced in this article:

Afonso, José, Rodrigo Ramirez-Campillo, João Moscão, et al. “Strength Training versus Stretching for Improving Range of Motion: A Systematic Review and Meta-Analysis.” Healthcare 9, no. 4 (2021): 427. https://doi.org/10.3390/healthcare9040427.

Augusto, Denise Dal’Ava, Rodrigo Scattone Silva, João Felipe de Medeiros Filho, Lori Ann Michener, and Catarina de Oliveira Sousa. “Rotator Cuff Isometric Exercises in Combination with Scapular Muscle Strengthening and Stretching in Individuals with Rotator Cuff Tendinopathy: A Multiple-Subject Case Report.” Journal of Bodywork and Movement Therapies 37 (January 2024): 164–69. https://doi.org/10.1016/j.jbmt.2023.11.032.

Chun Lung So, Billy, Stan Cheuk Ting Lau, Wan Yu Kwok, Daniel Hon Ting Tse, and Siu Shing Man. “Investigating The Association Between Supraspinatus Tendon Abnormality, Shoulder Pain and Isokinetic Strength in Elite Swimmers: A Cross-Sectional Study.” Journal of Sports Science & Medicine 22, no. 1 (2023): 17–27. 162251468. https://doi.org/10.52082/jssm.2023.17.

Intelangelo, Leonardo, Ignacio Lassaga, Elias Gonzalo, et al. “Is Strength the Main Risk Factor of Overuse Shoulder Injuries? A Cohort Study of 296 Amateur Overhead Athletes.” Sports Health 17, no. 5 (2025): 1028–35. https://doi.org/10.1177/19417381241298287.

Itoigawa, Yoshiaki, Akihisa Koga, Daichi Morikawa, et al. “Posterior Shoulder Stiffness Was Associated with Shoulder Pain during Throwing in College Baseball Players: Assessment of Shear Wave Elastography.” European Journal of Orthopaedic Surgery & Traumatology: Orthopedie Traumatologie 33, no. 4 (2023): 1237–44. https://doi.org/10.1007/s00590-022-03286-z.

Kubo, K., K. Ohgo, R. Takeishi, et al. “Effects of Isometric Training at Different Knee Angles on the Muscle–Tendon Complex in Vivo.” Scandinavian Journal of Medicine & Science in Sports (Wiley-Blackwell) 16, no. 3 (2006): 159–67. 20583344. https://doi.org/10.1111/j.1600-0838.2005.00450.x.

Lanza, Marcel B., Thomas G. Balshaw, and Jonathan P. Folland. “Is the Joint-Angle Specificity of Isometric Resistance Training Real? And If so, Does It Have a Neural Basis?” European Journal of Applied Physiology 119, nos. 11–12 (2019): 2465–76. https://doi.org/10.1007/s00421-019-04229-z.

Lau, Rachel, and Swarup Mukherjee. “Prevalence of Shoulder and Elbow Overuse Injuries Among Competitive Overhead Youth Athletes in Singapore.” Orthopaedic Journal of Sports Medicine 11, no. 3 (2023): 23259671231156199. https://doi.org/10.1177/23259671231156199.

Mattar, Luke T., Adam J. Popchak, William J. Anderst, Volker Musahl, James J. Irrgang, and Richard E. Debski. “Associations between Range of Motion, Strength, Tear Size, Patient-Reported Outcomes, and Glenohumeral Kinematics in Individuals with Symptomatic Isolated Supraspinatus Tears.” Journal of Shoulder and Elbow Surgery 31, no. 6 (2022): 1261–71. https://doi.org/10.1016/j.jse.2021.12.032.

Paraskevopoulos, Eleftherios, Anna Christakou, Andrew Smythe, et al. “Addressing Rotator Cuff-Related Shoulder Pain: Findings from a Greek Regional Observational Study Utilizing a Clinical Case Scenario.” Clinics & Practice 15, no. 2 (2025): 30. 183341857. https://doi.org/10.3390/clinpract15020030.

Rio, Ebonie, Mathijs van Ark, Sean Docking, et al. “Isometric Contractions Are More Analgesic Than Isotonic Contractions for Patellar Tendon Pain: An In-Season Randomized Clinical Trial.” Clinical Journal of Sport Medicine: Official Journal of the Canadian Academy of Sport Medicine 27, no. 3 (2017): 253–59. https://doi.org/10.1097/JSM.0000000000000364.

Secchi, Leonardo Luiz Barretti, Paula Rezende Camargo, Laís Emanuelle Meira Alves, and Luciana De Michelis Mendonça. “Shoulder Pain Occurrence in Asymptomatic Overhead Athletes: A Prospective Cohort Study with a 6-Month Follow-Up.” Physical Therapy in Sport 73 (May 2025): 156–64. https://doi.org/10.1016/j.ptsp.2025.04.003.

Standoli, Jacopo Preziosi, Vittorio Candela, Marco Bonifazi, and Stefano Gumina. Glenohumeral Internal Rotation Deficit in Young Asymptomatic Elite Swimmers. Journal of Athletic Training. July 1, 2024. https://doi.org/10.4085/1062-6050-0263.23.

Swanson, Brian T., Marissa Hagenbruch, Bernardine Lapaan, and Kirill Skipalskiy. “Combined Effects of Glenohumeral Mobilization, Stretching, and Thoracic Manipulation on Shoulder Internal Rotation Range of Motion.” International Journal of Sports Physical Therapy 19, no. 4 (2024): 394–409. 176522682. https://doi.org/10.26603/001c.95040.

Wilk, Kevin E., Leonard C. Macrina, Glenn S. Fleisig, et al. “Correlation of Glenohumeral Internal Rotation Deficit and Total Rotational Motion to Shoulder Injuries in Professional Baseball Pitchers.” The American Journal of Sports Medicine 39, no. 2 (2011): 329–35. https://doi.org/10.1177/0363546510384223.