Wellness Corner: Shoulder pain—ergonomics or hormones?
Key Highlights
- Shoulder pain in midlife dental clinicians isn’t just ergonomic—perimenopause and menopause reduce tendon resilience and increase injury risk.
- Hormonal shoulder pain often presents as global stiffness, night pain, and gradual loss of motion, distinct from acute injury patterns.
- Early mobility, targeted strength training, ergonomic adjustments, and timely professional care can prevent progression to frozen shoulder.
Shoulder pain is common for clinicians and is usually considered the price of practicing dentistry: awkward postures, patient positioning, little musculoskeletal integrity, and long clinical days. And yes, those are major contributors, but for many clinicians, especially women in their 40s, 50s, and early 60s, there’s another factor that we overlook unless we consult our OB/GYN.
Hormonal changes in peri- and menopausal women can make the shoulder more vulnerable to pain and injury. This isn’t widely known in our profession, but it should be since women make up a large portion of the dental workforce, and most of us have decades of clinical workload behind us right through perimenopause and menopause without realizing how those changes affect our musculoskeletal system.
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When we experience pain, we often assume “I’m just getting older.” Perhaps we should look at how our physiology directly impacts the same rotator cuff and shoulder tendons we load during patient care.
Hormones, like estrogen, matter more than we realize. Estrogen plays a big role in keeping our tendons elastic, strong, and able to recover from repetitive strain.1 So when estrogen levels fluctuate or decrease, connective tissues naturally become less resilient, slower to heal, hyperreactive to inflammation or microtearing.2 A common and usually temporary side effect for women during this time is a condition called adhesive capsulitis or “frozen shoulder.”
Given that dental clinicians are already a high-risk group that struggles with practicing proper ergonomics, it becomes even more important to reduce the strain we place on our shoulders by being mindful to avoid the following:
- Arms abducted (chicken wing)
- Sustained muscle contraction
- Overhead reaching
- Awkward positioning
- Minimal breaks between tasks
When combining these physical demands with hormonal shifts that reduce tendon tolerance, the result is a perfect storm and why many women suddenly feel like their shoulder “went downhill overnight.” It didn’t; it just reached a threshold.3
Is it hormonal, injury, or both? Most commonly, the hormonal changes soften the terrain, while daily clinical load and loss of protective muscle create the injury. Here are some ways to understand the difference.
Injury symptoms:
- Pain during specific movements
- Sharp pain reaching into the back seat
- Weakness during resistance
- Painful arc when lifting the arm
Hormonal (or early frozen shoulder) symptoms:
- Global stiffness
- Difficulty externally rotating
- Pain at rest/night
- Gradual onset without a trigger
What you can do about it (action steps that work)
No. 1: Catch stiffness early
During perimenopause, stiffness is a signal—not a nuisance. Early mobility work—especially external rotation—keeps the capsule from tightening.
No. 2: Strengthen the rotator cuff intentionally
Rows, banded external rotation, and scapular retraction build tendon tolerance, which supports the entire shoulder girdle.
No. 3: Adjust ergonomics to match your life stage
Being mindful of neutral body position during practice, wearing deflective loupes that place the chin in neutral with the shoulders back, using a saddle stool to get closer to the patient so the shoulders don’t pull forward, and respecting the body’s need for break periods become nonnegotiables.
No. 4: Manage inflammation strategically
Cold therapy, appropriate anti-inflammatory use, and increased omega-3 intake all reduce tendon irritation.
No. 5: Seek help at the first sign of progressive stiffness
Early physical therapy improves outcomes and reduces the long-term risk of frozen shoulder. A consult can help determine if it’s an injury or hormonal, as well as provide options (like HRT) that can help promote connective tissue homeostasis.4
No. 6: Understand when a cortisone shot is the right tool
When inflammation is blocking progress, a cortisone shot can reduce pain enough to let PT be effective.
The bigger message
As an ergonomic and corrective exercise specialist, I can’t keep giving clinicians posture tips without acknowledging the hormonal changes affecting a huge portion of the dental workforce. Ergonomics matters—but so do hormones, inflammation, and tissue resilience.
Editor’s note: This article first appeared in Clinical Insights newsletter, a publication of the Endeavor Business Media Dental Group. Read more articles and subscribe.
References
- Longo UG, Mazzola A, Carotti S, et al. The role of estrogen and progesterone receptors in rotator cuff disease: a retrospective cohort study. BMC Musculoskelet Disord. 2021;22(1):891. doi:10.1186/s12891-021-04778-5
- Frizziero A, Vittadini F, Gasparre G, Masiero S. Impact of estrogen deficiency and aging on tendon: concise review. Muscles Ligaments Tendons J. 2014;4(3):324-328.
- Navarro-Ledesma S. Frozen shoulder as a systemic immunometabolic disorder: the roles of estrogen, thyroid dysfunction, endothelial health, lifestyle, and clinical implications. J Clin Med. 2025;14(20):7315. doi:10.3390/jcm14207315
- Hansen M, Kongsgaard M, Holm L, et al. Effect of estrogen on tendon collagen synthesis, tendon structural characteristics, and biomechanical properties in postmenopausal women. J Appl Physiol (1985). 2009;106(4):1385-1393. doi:10.1152/japplphysiol.90935.2008
About the Author
Katrina Klein, RDH, CEAS, CPT
Katrina Klein, RDH, CEAS, CPT, is a 15-year registered dental hygienist, national speaker, author, competitive bodybuilder, certified personal trainer, certified ergonomic assessment specialist, and biomechanics nerd. She’s the founder of ErgoFitLife, where she teaches that ergonomics and fitness are a lifestyle to prevent, reduce, and even eliminate workplace pain.