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!


Shoulder Therapy Made Easy

Shoulder Therapy Made Easy

If you are experiencing general shoulder pain and want to work out the kinks and reduce your shoulder soreness, this article is for you. Rather than address any one specific injury or diagnosis, I’m excited to share my general philosophy for shoulder treatment along with exercises that may save you thousands of dollars in medical bills.

With that said, it’s important to stress that I believe you’re always better off turning to your healthcare providers before implementing any therapy plan, and I encourage you to do so.  More specifically, I want to enlighten you with tips and knowledge to help you ask better questions to help strengthen these meetings with your wonderful sports medicine specialists as you, quite literally, place your shoulder in their hands.

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

A smart starting point is to first understand your anatomy:

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

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

The acromioclavicular (AC) joint is where the clavicle and scapula come together.  This is located at the side or “tip” of the shoulder and rests directly above the shoulder joint. AC joint injuries, common when someone lands on the side of his/her shoulder, are sometimes more painfully debilitating than seen 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. An SC sprain is not common and rarely requires surgery. However, when this injury does occur, it is not quick to heal. Limited motion typically persists due to this impairment.

Shoulder Exercise Dos & Don’ts

One of my goals as a physical therapist is to ensure an athlete returns to the field or court safely.  Those I train of course have the same goal. The following tips are the same rules I use with my professional athletes and can help you, too, get back in the game quickly and safely.

Shoulder Therapy Dos:

  • DO perform a 5-to-10 minute warmup of the four joints and countless shoulder girdle muscles prior to any exercise or shoulder treatment.
  • DO focus on strengthening the rotator cuff, especially if the injured shoulder is not as strong as its partner.
  • DO listen to your shoulder and follow its lead.  If your shoulder exercises tell you that a specific exercise worsens your symptoms, discontinue or adjust the plan.   This may sound too simple, but trust your instincts and your insight.  I always tell both my athletes and myself: “Work with your body, not against it!”
  • DO work hard to increase the pain-free range of motion for your shoulder joint and shoulder girdle.

Shoulder Therapy Don’ts:

  • DON’T sleep on the injured shoulder.
  • DON’T engage in shoulder exercises with the thumb pointed downward, which has a tendency to create rotator cuff impingement syndrome.
  • DON’T perform high-intensity shoulder exercises above the shoulders unless it’s a functional position your sport.  Comfortable stretching of this area is great, but aggressive strengthening is usually too risky.

Ask the Right Questions Like a Pro

Prior to exercising your shoulder, mirror what professional athletes with shoulder pain do to ensure a safe return to sport: ask their sports medicine specialist the following questions:

1. Is my rotator cuff damaged, and if torn, is it partial or full thickness?

2. What specific shoulder exercises or motions should I avoid in my shoulder therapy?

3. What can I expect with this injury over the next 2-6 weeks?

4. When testing the external rotation (ER) strength for both shoulders, what would you grade the percentage strength on my injured side versus my healthy one?

5. Do you think I presently have or am at risk for impingement syndrome?

Sports Medicine Tips for the Best Results

  • Know Your Priorities – Ask yourself: “What do I really need from this shoulder?”  If the answer is “less stiffness,” focus on stretching.  If it’s “better function,” focus on strength. “Less aching and pain?” Prioritize pain-free motion and icing.
  • Seek Stability – Your shoulder is not a stable joint, so avoid any position that risks furthering the injury in an unstable manner.
  • Ice is Your Friend – Ligaments, bursas, and muscles…oh my! With so much “stuff” around the shoulder joint and shoulder girdle, ice is a high priority.  Its chill may sting, but ice is exactly what the doctor orders for almost every shoulder injury.  The pros will tell you that ice is their best teammate, so stop complaining and do what you know you need….ICE and lots of it.
  • Hands on the Ground – Add a new wrinkle to your shoulder treatment that will open a new door for your stretches, stability exercises and 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 as well as a fun change.  I know it sounds kind of yoga-ish, so channel your inner yogi and give it a try.
  • Long in the Front & Short in the Back – Improving the resting position of the shoulder girdle is a key part of almost every shoulder therapy program.  In today’s busy lifestyle that sometimes includes staring at a computer all day, rounded shoulders are a common problem. Thereby, it is important to lengthen the front of the shoulders (stretching the chest and internal rotators) while shortening the back of the shoulders (strengthening the upper and middle back and external rotators).

Avoiding Long-Term Problems with a Dislocated Shoulder

Avoiding Long-Term Problems with a Dislocated Shoulder

Shoulder dislocation is an all-too-common injury for many athletes.  Although possible in any direction, approximately 90% of these injuries occur in an anterior, or forward, direction.  With a shoulder dislocation, the head of the humerus (upper arm bone) is forced anterior from its shallow joint, and the glenohumeral (shoulder joint) is disrupted.

This injury typically occurs when the arm is raised away from the side (abduction) at an angle greater than 70 degrees and then externally rotated.  This is referred to as a “throwing position.”  If your arm or hand is forced past the normal range of motion in this position due to a fall, contact with an object or strike from another person, the humeral head dislocates from the joint and causes damage to the stabilizing structures.

Dislocated shoulders are more common than other joint injuries for two reasons:  First of all, the shoulder joint is very mobile and thereby not very stable.  As with any structure, the higher the mobility, the lower the stability.  Secondly, many sports require the athlete to employ the throwing position of shoulder abduction and external rotation described above.

What is a Shoulder Subluxation?

Less severe disruption of the shoulder joint can occur where the humeral head starts to dislocate but returns safely to the joint.  This is referred to as a shoulder subluxation or separation.  Some tissue damage can occur with this injury, which can predispose you to future shoulder dislocations.

What Happens When You Have a Dislocated Shoulder?

Tissue surrounding the shoulder girdle may become damaged when a shoulder dislocation takes place.  The capsule, which surrounds the joint and holds vital lubricating (synovial) fluid, is stretched and damaged as the humeral head relocates outside the joint.  Numerous ligaments reinforce the capsule, which gives stability to the shoulder joint.

Shoulder dislocations can also tear the glenoid labrum, 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 joint disruption can injure surrounding ligaments, bones, blood vessels, nerves and tendons.

This injury can fester as a recurring problem, and damage to tissues surrounding the joint will result in instability. A well-balanced rehabilitation program may decrease the likelihood of a chronically unstable joint but cannot completely prevent additional shoulder dislocations.

Signs & Symptoms of a Shoulder Dislocation

  • An acute or sudden dislocation usually results in significant pain encompassing the front half and top of the shoulder.
  • A “pop” is often heard as the upper arm shifts, usually in an anterior and downward manner.
  • It is difficult to move the arm due to pain and the inability to voluntarily contract the musculature surrounding the shoulder joint and upper arm.
  • The arm (supported by the uninjured arm) is most comfortably held in a position slightly away from and in front of the body while leaning forward and toward that side.
  • The shoulder takes on a flat and deformed-like appearance, unlike its typical, rounder shape.
  • If blood vessel or nerve damage occurs, numbness and/or a pins-and- needles feeling may present in the shoulder, arm and hand.

Treating a Dislocated Shoulder

Trained medical specialists should attend to shoulder dislocations that require reduction (moving the joint back in place) in a hospital setting.  Serious secondary injuries to nerves and blood vessels can easily occur when reducing a dislocated joint.

  • Lean on an X-ray and/or MRI to look for any fractures, labral tears or extensive soft tissue damage following a reduction.
  • A thorough evaluation by a shoulder-oriented orthopedic surgeon is extremely important to confirm an exact diagnosis and solid rehab protocol. This is a crucial first step that ultimately sets the course toward either a full recovery or, in its absence, a chronic, life-long problem.
  • Applying ice to the area helps decrease pain, spasms and swelling. Do this every hour for 15 minutes with ice bags covering the front, top and back of the shoulder.
  • Wear a sling for the first three to seven days post-injury. This helps support the weight of the arm and allows it to rest while restricting motion of the injured tissue.
  • If a fracture is ruled out, perform easy range-of-motion (ROM) activities, beginning with elbow motion and pendulum rotations.
  • When the time is right, a physician can recommend and monitor a progressive strengthening program for the shoulder, arm and core.
  • ROM exercises, strengthening programs and activities of daily living (ADLs) should not include any activities that place the arm in an “up and away” position, typically referred to as a throwing motion position.
  • The specific protocol, including the timeframe for sling use, range of motion (ROM) progression, strengthening plan and return to play procedures, must be directed by a physician rather than this article, the purpose of which is to provide a general overview of this injury.

Surgical Options for a Shoulder Dislocation

Surgical shoulder repair is sometimes necessary after a dislocation.  The main objective for the surgery is typically to improve joint stability, hence improving the function of the entire upper extremity.

Parameters for surgery as well as the types of surgeries available for this injury are beyond the scope of this article.

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

1. Degree of shoulder instability and secondary injuries

2. Sport(s) of interest

3. Projected lifestyle and quality of life adjustments

4. Athlete’s ability to put forth the necessary effort with post-operative rehabilitation

5. Many shoulder-stabilizing surgical procedures result in a permanent reduction in some shoulder motion such as external rotation. Consider this important factor when determining the type of surgery and rehabilitation protocol.

Ask The Right Questions Like a Pro

To ensure you receive the best possible care for your injured shoulder, ask questions like smart professional athletes who seek help from their sports medicine specialist to quickly and safely return to their sport:

1. In 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 so, which type would you recommend and why?

5. When can I get out of my sling and start my ROM drills/strengthening exercises?

6. Is there a detailed rehab protocol I can follow during my recovery?

Sports Medicine Tips for a Quick Recovery

  • The RC Rules – Shoulder joint stability is important, but the rotator cuff drives that train.  It’s crucial to strengthen the RC but in a smart manner to avoid chronic issues with both.
  • Don’t Let the Labrum Scare You – Labral tears in the shoulder mimic small cartilage tears in the knee.  If your doctor finds a labral tear, don’t panic – many of us have them and do just fine.
  • Honesty is the Best Policy – Be true to yourself and consider factors related to both your shoulder and lifestyle when considering surgery.  If your shoulder is unstable and activity level ambitious, stability is a must.
  • Be Mindful of the Big A – You want to minimize arthritis, or it’s cooler name of Degenerative Joint Disease (DJD).  A combination of poor mechanics and a “sloppy” or loose shoulder is the easiest way to accelerate DJD in a very active athlete.
  • Rehab With Passion – As with any injury, physical therapy is key to your recovery and beyond.  Put your heart into your one opportunity to gain back your range of motion and strength. Focus right now, kickstart a great maintenance program and get back in the game!