A New Years' Resolution: Address that Nagging Shoulder Pain
Steven McCune, PT, PES
Procore Physical Therapy P.C.
Another year has come and gone and that nagging shoulder pain remains.
Pain when putting your coat on? Pain when trying to sleep? Pain when reaching upward or outward? And this time of year, activities such as shoveling and cleaning your car of snow and ice can make your shoulder pain worse. What's wrong with my shoulder, and will the pain ever go away?
Addressing your shoulder pain begins with acquiring a basic understanding and appreciation of how the shoulder works.
The shoulder is a vulnerable area for injury. There are several reasons for this. The shoulder joint is capable of a wider and more varied range of motion than any other joint in the human body. This extraordinary motion allows you to do everything from pitching a baseball to reaching behind your back to fasten your bra. Unfortunately, the remarkable flexibility increases the risk of injury. By virtue of the shoulders' anatomy, there is limited blood supply within the tendons, which at times can become trapped between the bones of the shoulder.
Because the shoulder joint is so flexible, it also tends to be unstable. This joint has been compared to a golf ball sitting on a tee. This instability contributes to a variety of problems, some of which can be treated with rest, and others which may require medical care.
A complex of muscles that encircles the shoulder is called the rotator cuff. These muscles are a major source of muscular stability in the shoulder. Tendons are fibrous cords that attach these muscles to bones. The rotator cuff can be prone to wear and tear due to a number of causes, and can result in a painful, unstable, and weak shoulder.
Poor posture can also contribute to shoulder problems. Posture is closely linked with the movement of the shoulder blade, which in turn affects shoulder function. Poor or rounded shoulder posture can lead to rotator cuff weakness and predispose us for shoulder injury.
Some other common factors involved in shoulder disorders are: the aging process, including disuse and postural breakdown; repetitive strain and overuse; and trauma.
The most common condition is tendinitis, which can be short-lived inflammation of the tendon causing soreness and stiffness in the shoulder. But as we get older the cumulative effects of years of tendinitis can result in more serious ailments.
Because of the aging process, our rotator cuff muscles and tendons undergo a structural weakening and simple tendinitis can quickly develop into actual tearing of the tissue. Gradual tearing of the rotator cuff is a process similar to a shirt wearing out as its threads fray and a hole appears.
Many of us have heard of a bone spur, well how and why do they develop in the shoulder? When rotator cuff fibers begin to tear there is bleeding into this injured tissue. As part of the healing process, scar tissue is formed. Sometimes in the healing process, calcium deposits may accumulate which can form a bone spur. Presence of a bone spur in the shoulder can lead to a very painful and dysfunctional arm.
This is why treatment of shoulder pain at an early stage, along with education about the way the shoulder works, proper exercise, and postural awareness, is crucial to preventing further injury.
A word of caution: Pain felt in the shoulder area can sometimes be caused by a variety of conditions that are beyond the scope of this article, including a pinched nerve in the neck and cardiac ailments. Be sure to consult your healthcare expert.
Here are some practical things to know for helping you address that shoulder pain.
First and foremost listen to your body. Pain is a warning sign, don't ignore it. If your shoulder hurts, read on.
Rest is usually recommened but often a very difficult thing to do, especially in the hustle and bustle of todays' society. And the shoulder is active in so many things we do throughout the day; even sleeping on it can be irritating. So instead of rest, think of protection, meaning refraining from the inciting activity or modifying our approach to some daily chores.
For example, use two hands to lift our children, or trying to carry fewer grocery packages at one time.
Also, avoid the 'chicken wing thing' that is, avoid lifting your arm out to the side when your hand is below your elbow. This motion can pinch and damage the shoulder tendons. Instead let your hand lead the way when reaching upward or outward.
And if possible, avoid sleeping on that painful shoulder because this can further limit blood flow to the shoulder tendons.
Tis' the season for snow and ice. Modify the way you use your snow brush and ice scarper to clean your car. Avoid making horizontal motions across the width of your windows, rather, use up and down strokes. Even on that front windshield, lean forward and use the arm that is closest to the front end of your car for up and down strokes, where use of the other arm would require damaging horizontal chicken wing movements. And of course when shoveling snow, for the sake of your heart and back, take light loads.
Should you use ice or heat on that ailing shoulder? Well the answer is simple. If the pain is new, meaning only present for several days, use ice. Beyond that time use whatever makes it feel better, both can be helpful.
Learn some basic therapeutic exercises that will help to strengthen the rotator cuff muscles and improve your posture. Begin by practicing shoulder retraction, which is moving your shoulders backward expanding your chest forward. This maneuver will increase your postural awareness and begin to strengthen your shoulder blade muscles. You may want to consult your trusted health professional to be instructed in proper rotator cuff exercise, where a demonstration is worth a thousand words.
Painful shoulders and disorders of the rotator cuff are quite common. More so in middle-aged people. There are several means that may reduce your shoulder pain. Modification of daily chores, proper diagnosis, and judicious treatment, often result in decreased shoulder pain and a return to a full lifestyle.
Good luck in the new year and may you succeed in staying true to your resolutions. Please seek medical care if your shoulder pain persists.