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.

Impingement Syndrome of the Shoulder: Tennis Shoulder

Impingement Syndrome of the Shoulder: Tennis Shoulder

Years back, a friend of a former colleague came to see me with left shoulder pain. I had helped him resolve prior issues in this other shoulder, so I took it as a compliment that he came back to see me when a new problem arose on the opposite side.

Given that his case was fairly typical, I think it provides a helpful example of how to quickly and properly manage acute “tennis shoulder.”

The Athlete:

  • Approximately 38 years old
  • Active military, excellent health, top-notch strength and conditioning
  • Right-hand dominant (with a history of impingement syndrome in the right shoulder), but favors his left arm when playing tennis

The Symptoms:

  • Significant sharp shoulder pain in the left AC joint
  • Approximately 50% strength loss in functional activities such as turning the steering wheel in car or holding something away from the body
  • Shoulder pain while lifting the arm
  • Inability to sleep on the left shoulder due to pain

The History:

  • No falls, accidents or episodes that would lead to shoulder symptoms
  • Competitive tennis player in his youth; recent tennis activity with his daughter on a frequent basis
  • Over the last two weeks, an increase in localized shoulder pain while lifting his arm, along with more intense point tenderness on the AC joint (tip of the shoulder)

The Examination:

  • Point tenderness, approximately the size of a dime, was easily located at the end of the left collarbone on the front of the AC joint.
  • Intense pain occurred with active motion when attempting 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 wrist pronated, maximized the stretch on the longhead of the biceps brachii muscle.
  • Manual muscle tests used to assess shoulder strength with motions including external rotation, flexion, abduction, supraspinatus elevation and extension demonstrated approximately 70% less strength than observed in the right shoulder.
  • Other tests performed to rule out issues such as shoulder joint instability, AC joint separation, nerve pathologies and an SC joint sprain were normal and symptom-free.

The Diagnosis:

Acute Impingement Syndrome of Shoulder, aka Tennis Shoulder

The Plan:

  • Discontinue tennis and all other activities that lead to shoulder symptoms for two weeks.
  • Perform consistent pendulum swings with a light weight.
  • Implement an aggressive one-week strengthening routine for external rotation (ER).
  • If strength in ER returns to approximately 90% in one week, resume pain-free weight training while continuing to avoid all overhead lifting and exercises involving the left arm crossing the midline of the body.
  • Improve posture with pain-free chest and anterior shoulders stretches.
  • Consistently massage chest muscles immediately before exercising the upper-mid back with shoulder blade retraction or “pulling together” exercises.
  • Ice the shoulder three to five times per day.
  • Consume over-the-counter anti-inflammatory medicine for a short period of time, only as needed for pain.
  • Avoid sleeping on left shoulder for two weeks.
  • Nail down 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’s external rotators to help decelerate the arm during the follow-through phase of the tennis swing

It was a pleasure working with this gentleman, who understood he may need to permanently limit his overhead lifting and consistently focus on the strength of his external rotators bilaterally based on his history. More imminently, I expected him to be able to return to his normal activities as an active military specialist and tennis vet within three weeks following his exam. Game, set, match!