The Myths and Truths Inside a Painful Shoulder

Because it is one of the most mobile joints, the shoulder joint is also one of the most injured joints in the human body. This is because joint mobility and stability are inversely related.

Simply stated; The more motion a joint has the more instability of inherits.

Because of the high stress on the shoulder joint during a demanding and active lifestyle, it gets injured often.  A painful shoulder may have multiple sources of pain including tendons, muscles, bursas, labrums, loose bodies, rotator cuff or arthritis.

Learn the top 3 myths of shoulder pain and the simple solutions to manage your painful shoulder.  The recovery doesn’t have to be complicated.   During my past 30 years as a physical therapist, I’ve learned the patients with a simple plans and a consistent routine typically have the best outcome.

Click Here For My Spartan Race Article Titled: SHOULDER PAIN? 3 MYTHS & 3 SOLUTIONS

As the Sports Medicine Expert for Spartan Race, I write posts for fellow Spartan racers and SGX coaches related to helpful sports medicine topics.

How to Shorten Your Shoulder Scope Recovery Time!

Shoulder - AC sprain 281Today is a true day of “role reversal” for me.  Instead of being the physical therapist, I’ll be the patient rolling into the operating room for surgery to fix a chronic shoulder injury by Jacksonville Jaguars Head Team Physician Dr Kevin Kaplan at Jacksonville Orthopaedic Institute.

I have to admit, consulting others about a shoulder scope is much more fun than being the one starving yourself after midnight and wearing the paper-thin johnnie!  I’ve had my share of surgeries.  I find them all to be great opportunities for me to learn better ways to help athletes recover quicker when they have to “go under the knife”.

The AC Joint Injury

I’ve had a chronic grade 3 acromioclavicular (AC) joint sprain for many years that needs to be fixed.  How did I get it?  Here comes the entertaining part of the blog post.  I crashed hard on my mountain bike doing a downhill slalom race at Mt Snow in Vermont……in March….in blizzard conditions!  No, it truly wasn’t my smartest day, but it sure was a fun event until I slammed on the ice with my shoulder.  As a fan of extreme sports I might not be any smarter today than I was back then but I’ve learned how to crash more gracefully.

Here’s my game plan for a successful shoulder surgery:

Loosen Up the Good Stuff

I started doing extra shoulder, upper back, neck, rotator cuff and chest stretching during the past week.  Those ligaments, joints, muscles, fascia and tendons are the very things that will dictate my shoulder function after the surgery.  Therefore, I want those structures to be limber, strong and relaxed going into the operation.

Get Rid of the Bad Stuff

Inflammation and edema are bad so my shoulder filed a Restraining Order against them just last week.  Meanwhile, I’ve focussed on icing, controlled exercises and massage as key steps to start the recovery process from my  surgery before I even get to the hospital.

Hydrate the Right Way

Healing tissue needs to be happy tissue.  Approximately 60% of the human body is water.  Staying well hydrated starting three days before the surgery will make the doctor’s job easier and my recovery faster.  I take my hydration serious in any type of weather so when it comes to recovering from surgery, water is my best friend.

Tune Up My Rotator Cuff

Resisted rotator cuff exercises such as external rotation, forward flexion and side raises will continue to be done 3 times per day right up to 2 hours before the surgery.  I want “my cuff” to be as active and as strong as possible before Dr Kevin Kaplan sticks that scalpel into my arm.

Listen to Your Commanders

The surgeon and his staff are your commanding officers so listen to them closely.  They know best so read their memos and listen to their tips.  They will ultimately play a huge role in your outcome so be a great patient before, during and after your surgery.  Post-surgery rehabilitation is priceless.

Plan the Recovery

I have my ice, bottled water, pillows, books and, most importantly, my beautiful wife ready before I leave the house today.  Limping in the door with my arm in a sling is not the time to be setting up my recovery zone.

Think & Be Positive

Healing and recovery starts between the ears.  Positive thoughts and self-talk about my shoulder is dominating my mind today and will continue for the next four weeks.  Those healthy images involve much more than just my body and mind.  They include a strong sense of gratitude for Dr. Kaplan and his highly skilled staff involved with my care.

In Closing……

I view my involvement with today’s surgery as an active process, not a passive event left to the skills of others.  I’ve prepared my body, mind and home to both maximize the benefits of the surgery and accelerating my body’s recovery from the trauma of the operation.

I have way too many exciting things I want to do this off-season with this better-than-new shoulder and just laying around isn’t one of them!

 

Sidelined by the Shoulder [aafp.org]

In the 2011 NFL season so far one of the most common injury is the shoulder. Why is this injury so common, so early in the NFL season? Did not having a full training camp make the NFL player’s shoulder’s more vulnerable to injury? Here are some key exercises that can be done to help strengthen the shoulder.

Shoulder Injury (Photo: Leedman)

In the 2011 NFL  season so far one of the most common injury is the shoulder.  Numerous player’s are missing  games or playing time with this injury.  An example is Washington Redskins running back Tim Hightower who hurt his shoulder on the third play of the game.  Mike Shannon said he could tell a difference in Hightower’s play after the injury.

Why is this injury so common during the first quarter of this young NFL season?  Did the crazy “off-season” have any impact on the vulnerability of these shoulders?

Here are four daily exercises to keep your shoulders strong and healthy.

From aafp.org:
Remember that the exercises described on the next two pages, which help strengthen the muscles of your shoulder (especially the rotator cuff), should not cause you pain. If the exercise hurts, use a smaller weight and stop exercising when the pain begins.

Perform each exercise slowly: lift your arm to a slow count of three and lower your arm to a slow count of six.

Look at the pictures with each exercise so you can follow the right position. Warm up before adding weights: stretch your arms and shoulders and do pendulum exercises (bend from the waist, arms hanging down; keeping arm and shoulder muscles relaxed, move arms slowly back and forth).

Keep repeating each exercise until your arm is tired. Use a light enough weight that you don’t get tired until you’ve done the exercise about 20 to 30 times. Increase the weight a little each week (but never so much that the weight causes pain): start with 2 ounces the first week, move up to 4 ounces the second week, 8 ounces the next week, and so on.

If you do all four exercises three to five times a week, your rotator cuff muscles will become stronger and you’ll regain normal strength in your shoulder. Each time you finish doing all four exercises, put an ice pack on your shoulder for 20 minutes. It’s best to use a plastic bag with ice cubes in it, or a bag of frozen peas, not gel packs.

Exercise 1:

Start by lying on your stomach on a table or a bed. Put your left arm out at shoulder level with your elbow bent to 90 degrees and your hand down. Keep your elbow bent and slowly raise your left hand. Stop when your hand is level with your shoulder. Lower the hand slowly. Repeat the exercise until your arm is tired. Then repeat the whole exercise again with your right arm

Exercise 2:

Lie on your right side with a rolled-up towel under your right armpit. Stretch your right arm above your head. Keep your left arm at your side with your elbow bent to 90 degrees and the forearm resting against your chest, palm down. Roll your left shoulder out, raising the left forearm until it’s level with your shoulder. (Hint: this is like the backhand swing in tennis.) Lower the arm slowly. Repeat the exercise until your arm is tired. Then repeat the whole exercise again with your right arm.

Exercise 3:

Lie on your right side. Keep your left arm along the upper side of your body. Bend your right elbow to 90 degrees. Keep the right forearm resting on the table. Now roll your right shoulder in, raising your right forearm up to your chest. (Hint: this is like the forehand swing in tennis.) Lower the forearm slowly. Repeat the exercise until your arm is tired. Then repeat the whole exercise again with your other arm.

Exercise 4:

In a standing position, start with your right arm halfway between the front and the side of your body, thumb down. Raise your right arm until almost level (about a 45 degree angle). (Hint: this is like emptying a can.) Don’t lift beyond the point of pain. Slowly lower your arm. Repeat the exercise until your arm is tired. Then repeat the whole exercise again with your other arm.
Author Source: http//www.aafp.org/afp/980215ap/98021a.htl

Shoulder Therapy Made Easy

"Look Maa, the Shoulder Therapy is Working!"

If you are experiencing general shoulder pain and want to return to exercising your shoulders or reduce your shoulder soreness, this article is written for you. Today I’m not going to address any one injury or diagnosis.  Instead I’m excited to share my general philosophies for shoulder treatment along with exercises that may save you thousands of dollars in medical bills.

With that being said, it’s very important to stress that I think you’re always better off when you utilize your health care providers before implementing any therapy program.  As I always point out, I do not want to replace nor do I want to discourage you from seeing your health care providers.  Quite the contrary:  I want to help you better utilize your many wonderful sports medicine specialists by enlightening you with tips and knowledge to help you ask better questions and grow your trust in their assistance with your shoulder treatment.

Now, back to your shoulder treatment…  So you have a sore, stiff, cranky, catching, trick, aching and/or unhappy shoulder?  And you want to learn what to do and what to avoid as you return to getting your shoulders, upper back and chest stronger, more flexible and symptom free—right?

A smart starting point is to first understand your anatomy so you can get the best shoulder treatment possible.

Your shoulder girdle involves three main bones, four articulations or joints, 20+ muscles and plenty of miscellaneous “stuff”.  The upper arm bone is called the humerus, the collar bone is known as the clavicle and the shoulder blade is medically referred to as the scapula

The shoulder or glenohumeral joint is located where the upper arm bone connects to the scapula.  Structurally, this is a mechanically unstable joint and a common source of stability issues and sequentially, shoulder pain.  Most therapy for the shoulder joint is focused on increasing range of motion (ROM) and improving muscle strength.

The acromioclavicular (AC) joint is where the clavicle and the scapula come together.  This AC joint is located at the side or “tip” of the shoulder and it rests directly above the shoulder joint.  Commonly injured when someone lands on the side of his/her shoulder, the AC joint can be more painfully debilitating than with a sprain or “shoulder separation” (addressed in this article[Insert link to article].

Lastly, the sternoclavicular or SC joint is located in the upper and inner chest region where the clavicle and sternum merge.  The SC sprain is not common and rarely requires surgery.  However, when this injury occurs, it is not quick to heal. Plus limited motions typically remains with a little disability because of this impairment.

Do’s & Don’t for Shoulder Exercises

One of the goals of my position as a physical therapist is to make sure an athlete gets back on the field safely.  Of course the athletes I train also want to get back as quickly as possible too. The following tips are the rules I use with my professional athletes and will help you too—get back in the game quickly and safely.

The Do’s of Shoulder Therapy:

  • Perform a 5 to 10 minute warm-up of the four joints and countless muscles of the shoulder girdle before any exercise or shoulder treatment.
  • Focus on the strengthening the rotator cuff, especially if the injured side is not as strong as the other shoulder.
  • Listen to your shoulder and follow its lead.  If your shoulder exercises are telling you that a specific exercise makes your symptoms worse, discontinue or adjust the plan.   This may sound too simple but trust your instincts and your insight.  I always tell my athletes and myself: “Work with your body not against your body!”
  • Work hard to increase the pain-free range of motion of your shoulder joint and shoulder girdle.

The Don’ts of Shoulder Therapy:

  • Sleep on the injured shoulder.
  • Perform shoulder exercises with the thumb pointed downward, which have a tendency to create an impingement syndrome of the rotator cuff.
  • Perform high-intensity shoulder exercises above the shoulders unless it’s a functional position for the sports.  Comfortable stretching up there is great but aggressive strengthening up there is usually too risky.

Asking the Right Questions

Before you start exercising your shoulder, you’ll want to do like a professional athlete with shoulder pain. To ensure he can safely return to his sport, a pro athlete should ask his sports medicine specialist the following questions:

  1. Is my rotator cuff damaged and if torn, is it a partial thickness tear or a full thickness tear?
  2. With my shoulder therapy, what specific shoulder exercises or motions should I avoid?
  3. What can I expect with this injury for the next 2, 4 and 6 weeks?
  4. When you test my external rotation (ER) strength for both shoulders, what would you grade the percentage strength would you grade my external rotators on my injured side?
  5. Do you think I presently have or am I at risk of having an impingement syndrome?

Sports Medicine Tips To Get The Results You Want

  • Know Your Priorities – Ask yourself: “What do I really need from this shoulder?”  If it’s “less stiffness”, focus on stretching.  If it’s “better function”, focus on getting it stronger.  If your body tells you “less aching and pain”, prioritize the pain-free motion and icing.
  • Get Stable – Your shoulder is not a stable joint so avoid any position that risks injuring the shoulder and making the shoulder more unstable.
  • Ice is Your Friend – With the many ligament, bursas, muscles and stuff around the shoulder joint and shoulder girdle, ice is a very high priority.  Ice hurts but it’s exactly what you need for almost every shoulder injury.  The Pro’s will tell you that ice is their best teammate.  Stop complaining and do what you know you need….ICE and lots of it.
  • Put Your Hands on the Ground – Add a new wrinkle to your shoulder treatment that will open a new door to your stretches, your stability exercises and your strengthening.  Put your hands on the ground and use your body weight to engage the muscles that surround the shoulder girdle.  It’s very safe for most shoulder injuries and it’s a fun change.  I know it’s kind of yoga-ish but that’s okay with me.
  • Lengthen the Front & Shorten the Back – For almost every shoulder therapy program, improving the resting position of the shoulder girdle is needed.  With today’s busy lifestyle that includes a large part of our day sitting in front of a computer, rounded shoulders is often a result. Lengthening the front of the shoulders (stretching the chest and internal rotators of the shoulders) while shortening the back of the shoulders (strengthening the upper and middle back and external rotators of the shoulders) should be addressed.

Avoiding Long-Term Problems with a Dislocated Shoulder

SHOULDER DISLOCATION - "HERE COMES THE PAIN"

Shoulder dislocation is an all too common an injury for many sports with both men and women.  Although it can happen in any direction, approximately 90% of these dislocations are in an anterior or forward direction.  With a shoulder dislocation, the head of the humerus (upper arm bone) is forced anterior from it’s shallow joint and the glenohumeral or shoulder joint is disrupted.

Typically this injury occurs when the arm is raised away from the side (abduction) at an angle greater than 70 degrees and externally rotated.  This is what is referred to as a throwing position.  When in this position, if your arm or hand is forced past the normal range of motion with a fall or comes in contact with an object or is struck by another person, the humeral head is dislocated from the joint and the stabilizing structures are damaged.

Dislocated shoulders are more common than similar injuries with other joints for two reasons.  First of all, the shoulder joint is very mobile which means it is not very stable.  As with any structure, the higher the mobility the lower the stability.  Secondly, a large percentage of sports require the athlete to put their arms in the throwing position of shoulder abduction and external rotation.

What is a Shoulder Subluxation?

A less severe disruption of the shoulder joint can occur where the humeral head starts to dislocate but it returns to the safety of the joint.  This is referred to as a shoulder subluxation or separation.  Some tissue damage can occur with this injury and it can predispose you to dislocating your shoulder in the future.

What Happens When You Have a Dislocated Shoulder?

When a shoulder dislocation takes place, tissue surrounding the shoulder girdle can be damaged.  The capsule, which surrounds the joint and holds the vital lubricating fluid known as synovial fluid, is stretched and damaged as the humeral head is relocated outside the joint.  Numerous ligaments reinforce the capsule, which gives stability to the shoulder joint.

Shoulder dislocations can also tear the glenoid labrum, which is a cartilage ring that surrounds the base of the shoulder joint and deepens the glenoid fossa.   The now deeper bowl-like joint surface allows the humeral head to rest forming the Glenohumeral (or shoulder) joint.  As expected, any disruption of a joint can injure surrounding ligaments, bones, blood vessels, nerves and tendons.

This injury can often become a recurring problem. Due to the many stabilizing tissues surrounding the joint, damaged tissues will result in a highly unstable shoulder joint. A well-balanced rehabilitation program may decrease the likelihood of a chronically unstable glenohumeral joint but it cannot eliminate the change of additional shoulder dislocations.

Signs & Symptoms of a Shoulder Dislocation

  • An acute or sudden dislocation of the shoulder usually results in significant pain encompassing the front half and top of your shoulder.
  • A “pop” is often heard and a shifting of the upper arm, usually in an anterior and downward manner.
  • Difficulty in moving the arm due to pain and the inability to voluntarily contract the musculature surrounding the shoulder joint and upper arm.
  • Arm is most comfortably held slightly away from and in front of your body while you lean forward and towards that side with the arm supported by the uninjured arm.
  • The typical rounded appearance of your shoulder is replaced with a flatter and deformed-like appearance.
  • If blood vessel or nerve damage occurs, numbness and/or pins and needles may be present in your shoulder, arm and hand.

Treating a Dislocated Shoulder

Shoulder dislocations which require reduction (putting the joint back in place) is best when done by a trained medical specialist in a hospital setting.  Serious secondary injuries to nerves and blood vessels can easily occur when reducing a dislocated joint.

  • Once the shoulder is reduced, an x-ray and or MRI should be done to determine if there are any fractures, labral tears or extensive soft tissue damage.
  • A thorough evaluation by a shoulder-oriented orthopedic surgeon is extremely important.  Determining an exact diagnosis and a solid rehab protocol may very well be the most important initial steps that will determine if you fully recover from this injury or if you have a chronically unstable and painful shoulder for the rest of your life!
  • The application of ice helps decrease pain, spasms and swelling to the area.  Ideally ice should be applied every hour for 15 minutes with ice bags covering the front, top and back of your shoulder.
  • A sling is most often needed and helpful for the first 3 – 7 days after a dislocated shoulder. This helps to support the weight of the arm allowing for the arm to rest while restricting the motion of the injured tissue.
  • The specific protocol, which will include the timeframe for use of the sling, the range of motion (ROM) progression, the strengthening plan and the return to play procedures, must be directed by your physician and not by this article.  The purpose of the article is to inform you and to give a general overview of this injury.
  • If a fracture has been ruled out, easy range of motion (ROM) is initiated beginning with elbow motion and pendulum rotations.
  • A progressive strengthening program for the shoulder, arm and core is extremely important and should be started and monitored with the advice of your physician.
  • With your ROM exercises, strengthening program and activities of daily living, avoid any activities that place your arm in an “up and away” position, which is typically referred to as a throwing motion position.

Surgical Options for a Shoulder Dislocation

It is sometimes necessary to surgically repair a shoulder after dislocation.  The main objective for the surgery is usually to improve the stability of the joint and, hence, improve the function of the entire upper extremity.

The parameters for surgery and the types of surgeries for this type of injury are beyond the scope of this article.

The doctor and athlete will typically assess the following variables to determine the need for surgery:

  1. Amount of shoulder instability and secondary injuries.
  2. The sport(s) of interest.
  3. The projected lifestyle and quality of life.
  4. The ability of the athlete to put forth the necessary effort with the post-operative rehabilitation.

Many shoulder-stabilizing surgical procedures result in a permanent reduction in some shoulder motion such as external rotation.  This is an important factor that needs to be considered when determining the type of surgery and the rehabilitation protocol.

Asking The Right Questions

To ensure you receive the best possible care for your injured shoulder, ask questions like a smart professional athlete who wants to safely return to his/her sport as quickly as possible.  Here’s what a pro athlete would ask his sports medicine specialist:

  1. Which direction did my shoulder dislocate?
  2. Do I have multidirectional instability?
  3. How would you describe the extent of the damage to my shoulder joint surfaces, capsule, ligaments and muscles?
  4. Do I need surgery and if I do, which type of surgery would you recommend and why?
  5. When can I get out of my sling, start my ROM drills and when can I start my strengthening exercises?
  6. Do you have a detailed rehab protocol for me to follow during my recovery?

Sports Medicine Tips for a Quick Recovery

  • The RC Rules – The shoulder joint stability is important but the rotator cuff drives that train.  You need to get that RC strong but in a smart manner so you avoid chronic issues with both.
  • Don’t Let the Labrum Scare You – Labral tears in the shoulder are much like small cartilage tears in the knee.  If your doctor finds a labral tear, don’t let it scare you because many of us have them and do just fine.
  • Be Honest With Yourself – Look at all the factors related to your shoulder and your lifestyle when considering surgery.  If your shoulder is unstable and your activity level is ambitious, having stability is a must.
  • The Big A Word – You want to minimize Arthritis or it’s cooler name of Degenerative Joint Disease (DJD).  Poor mechanics and a “sloppy” or loose shoulder for a very active athlete is the easiest way to accelerate DJD.
  • Rehab With Passion – As with any injury, physical therapy is key to your recovery and beyond.  Put your heart into getting your range of motion and your strength because you only have this opportunity one time.  Get it right now, get on a great maintenance program and get back into the game!