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.
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Subacromial Bursitis Made Easy

Understanding Shoulder Bursitis

The subacromial bursa is a thin sac-like structure that is located just under the acromioclavicular or AC joint of the shoulder.  The bursa lies over the top of the rotator cuff.  The bursa acts as a lubricating buffer between the rotator cuff and the undersurface of the lateral clavicle and acromion process of the scapular, both of which articulate with each other to form the AC joint.

The subacromial bursa’s main function is to reduce the friction on the upper layers of the rotator cuff and humeral head during shoulder motion.  As a thin fluid filled sac, similar to a slim water-balloon, the subacromial bursa is quite efficient in acting as a friction reducer for the head of the humerus, the long-head of the biceps tendon and the all-important rotator cuff.  With the amount of motion and stress associated with the shoulder joint, the subacromial bursa has a difficult task each and every day even without involving direct contact to the shoulder girdle.

Rotator cuff tendonitis or a shoulder impingement syndrome are commonly associated with chronic subacromial bursitis.  It is not unusual to have a chronic rotator cuff injury which would alters the mechanics of the shoulder joint resulting in an inflammation of the subacromial bursa.  That is why it’s important to determine if there are any additional upper extremity or torso imbalances or injuries that require treatment when a player demonstrates a bursitis involving the shoulder.

Signs & Symptoms of Subacromial Bursitis

  • Generalized stiffness of the shoulder joint, mostly on the top and front of the shoulder.
  • An increase in symptoms generally associated with either a direct blow to the front of the shoulder joint or a significant increase in shoulder activities usually involving overhead-type activities.
  • A sense of weakness or loss of strength with activities involving the shoulder.
  • A localized puffiness or pocket of swelling in the upper-front area of the shoulder just below the AC joint.  This isolated pocket of swelling becomes more evident when the arm is extended at the shoulder.
  • Active shoulder elevation and abduction demonstrates weakness.

Professional Treatment for Subacromial Bursitis

  • Eliminating all activities that contributed to the bursitis such as excessive overhead activities, trauma or contact to the shoulder, weight training above shoulder level, painful motions during activities of daily living or hanging heavy object like luggage on the involved shoulder.
  • Consistent icing of the front, top and back of the shoulder.
  • Utilization of the necessary therapy modalities to decrease pain and reduce swelling.
  • Easy pendulum swings with no more than 5 lbs.
  • Passive and painfree range of motion (ROM) of the shoulder joint to include flexion, abduction, horizontal abduction and external rotation while minimizing the motions of shoulder extension and horizontal adduction.
  • Progressive resistive strengthening of shoulder external rotation, if painfree.
  • Avoid sleeping on this shoulder while swelling and/or pain remains.

Asking the Right Questions Like a Pro

Here’s what a smart pro athlete would ask his/her sports medicine specialists to ensure a fast and safe return to sports:

  1. Is this an isolated bursitis or do I have other shoulder issues that I need to treat?
  2. Do I have any damage to my rotator cuff?
  3. In your opinion, why did I get this injury and how can I avoid these types of injuries in the future?
  4. Will I need to have this bursa injected with any anti-inflammatory medication in the future?

Elite Sports Medicine Tips from Mike Ryan

  • Looks Worse – Bursitis often looks worse than it feels.
  • Treat Right the First Time – It may not hurt at first but with it’s proximity to the rotator cuff, you don’t want it to spoil the party in the should and become a chronic nightmare.
  • Ice is Key – I know I wear out the “ice thing” but it’s a key tool to quiet down bursitis cool and to reduce localized swelling.
  • Find the Source – If the reason for the bursa swelling is unknown, dig deeper to find out why.  Find the real reason often avoids major shoulder complications a couple of weeks from now.
  • Avoid the Knife – Some will quickly offer a “simple surgical solution”.  Run away as fast as possible and reread this article.

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.