Keys to Managing Your Shoulder Pain

Shoulder pain is a game changer. A painful shoulder can quickly limit the activity level for athletes and non-athletes alike.

The shoulder joint is the most mobile joint in your entire body.  With that being said, eliminating the pain in such loose joint is no easy task.

7 Sports Medicine Tips to Manage Your Shoulder Pain.

Pendulum Swings – With the hand of the pain-free shoulder resting on a chair and a 10-15 lbs weight in the other hand, slowly move the weighted hand in a slow circular motion.  This will distract and relax the muscles surrounding the painful shoulder joint. Swing the hand/arm like a pendulum in both clockwise and counter-clockwise directions.

Pliable Chest Muscles – Longer and more flexible chest muscles are vital for a happy pain-free shoulder. Start by aggressively massaging the deep chest muscles with fingers or a baseball (warning; it hurts but it works). Next, stretching the superficial chest muscles in a door frame is a simply way lengthen your broad, strong chest muscles.  By doing so, the more flexible chest muscles will now allow for greater mobility of three (3) bones which make up your shoulder girdle (upper arm bone, shoulder blade & collar bone).

Strong Shoulder Blade Stabilizers – You have 17 muscles anchored to each of your shoulder blades.  Keeping your upper back strong helps protect the shoulder joints by controlling the intricate motions of the shoulder blade.  To do so, seated rows, bent-over flies, cable “T’s” and good ol’ scapula squeezes need to be part of your shoulder plan.

Enduring External Rotators – Of the four (4) muscles forming your rotator cuff, the two external rotators are the most important when it comes to prevent shoulder injury.  The key factor with shoulder external rotators is not just strength. Hence, having great endurance of the external rotators should be your goal.  Doing high repetitions (>15 reps) using cable weights or simple exercise bands will help accomplish this.

Overhead Stretches – Add low-intensity pain-free overhead stretches to your routine. Examples include 25-50% body weight hangs from a pull-up bar/door frame or bend-over stretches with hands on a high counter.

Limited Overhead Strengthening – Anytime you perform strength work above your shoulder level, you’re increasing the stress on your rotator cuff. You can sufficiently strengthen all your shoulder, back and chest muscles without ever elevating your elbows above your shoulder.

Strong Posture – Daily tasks like driving, working on a computer and carrying objects all contribute to poor posture and shoulder pain.

Strong posture = Shoulder blades “back and down” + chin over ribs

The Quest for Happy Shoulders

Most of the painful shoulder joints I treat have key problems related to their shoulder girdle. These 7 sports medicine tips will help you protect two very important joints.

Remember this simple formula: Happy shoulders have mobile shoulder girdles, great endurance of their external rotators and strong upper back muscles.

Tennis Shoulder: Impingement Syndrome of the Shoulder

IMPINGEMENT SYNDROME OF THE SHOULDER

A friend of one of our coaches came to see me yesterday with left shoulder pain.  He had shoulder issues with his right arm last year that I helped him resolve so I’m taking it as a compliment that he came back to see me when the left shoulder caused him problems!

His medical case is quite typical and I think it will prove to be a helpful example of how to quickly manage acute Tennis Shoulder.

The Athlete:

  • Approximately 38 yrs old
  • Active military, excellent health, excellent overall strength and conditioning.
  • Right hand dominant although he plays tennis with the left arm with a Hx of impingement syndrome of the shoulder on the right.

The Symptoms:

  • Significant sharp shoulder pain on the left AC joint.
  • Approximately 50% strength loss with functional activities such as turning the steering wheel in car and holding anything away from his body.
  • Shoulder pain lifting arm and an inability to sleep on the left shoulder.

The History:

  • No falls, accidents or episodes that would create shoulder symptoms.
  • The athlete has a history of being a competitive tennis player in his youth and he has recently been playing a significant amount of tennis with his daughter.
  • Over the past 2 weeks, localized shoulder pain lifting arm has increased and point tenderness on the AC joint or tip of shoulder has become intense.

The Examination:

  • Point tenderness, approximately the size of a dime, was easily found at the end of the left collarbone on the front of the AC joint.
  • Intense pain with active motion with an attempt to reach across the body with the left hand to touch the back of the right shoulder.
  • Passive extension of the shoulder with the elbow extended and the wrist pronated which maximizes the stretch on the longhead of the biceps brachii muscle.
  • Manual muscle tests to assess his shoulder strength for motions such as external rotation, flexion, abduction, supraspinatus elevation and extension demonstrated left shoulder strength of approximately 70% of the right shoulder.
  • Other tests to rule-out issues such as shoulder joint instability, an AC joint separation, nerve pathologies, and an SC joint sprain were normal and symptom-free.

The Diagnosis:

Acute Impingement Syndrome of shoulder or Tennis Shoulder

The Plan:

  • Discontinue tennis and all activities that create any shoulder symptoms for 2 weeks.
  • Consistent pendulum swings with light weight.
  • Implement an aggressive strengthening routine for external rotation (ER) for 1 week.
  • If strength of ER returns to approximately 90 in 1 week, return to painfree weight training while continuing to avoid all overhead lifting and any exercises involving the left arm acrossing the midline of the body.
  • Improving posture with painfree stretches of the chest and anterior shoulders.
  • Consistent massage of chest muscles immediately followed by exercising the upper-mid back with shoulder blade retraction or “pulling together” exercises.
  • Icing the shoulder 3-5 times per day.
  • Only if needed for pain, consuming an over the counter anti-inflammatory medicine for a short period of time.
  • Avoid sleeping on left shoulder for 2 weeks.
  • Determine a successful pre-tennis routine that will:

> Warm-up the shoulder joint, AC joint and surrounding musculature.

> Allow for normal mechanics and patterns for movement.

> “Fire up” the shoulder external rotators to help decelerate the arm during the follow-through phase of the tennis swing.

It was a pleasure working with this gentleman and I believe he will do very well with this action plan.   I expect him to be able to return to his normal activities as an active military specialist within 3 weeks.  He may need to permanently limit his overhead lifting and consistently focus on the strength of his external rotators bilaterally based on his history.