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

Subacromial Bursitis Made Easy

Subacromial Bursitis Made Easy

Understanding Shoulder Bursitis

The subacromial bursa is a thin, sac-like structure located just under the acromioclavicular, or AC, shoulder joint. It acts as a lubricating buffer between the rotator cuff, undersurface of the lateral clavicle and scapular acromion process.

Specifically, the bursa’s main function is to reduce friction in 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, it is quite efficient at specifically doing so with respect to the head of the humerus, long-head of the biceps tendon and the (all-important) rotator cuff.  Given the level of motion and stress associated with the shoulder joint, the subacromial bursa certainly faces a trying task every single day. However, this does not even involve direct contact with the shoulder girdle.

Rotator cuff tendonitis and shoulder impingement syndrome are other conditions commonly associated with chronic subacromial bursitis. Additionally, it is not unusual for a chronic rotator cuff injury that alters shoulder joint mechanics to result in subacromial bursa inflammation. It is therefore extremely important to assess for any additional upper extremity or torso imbalances/injuries that require treatment when an athlete presents with 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
  • Symptom escalation generally associated with either a direct blow to the front of the shoulder joint or increased shoulder use, usually involving overhead-type activities
  • A sense of weakness or loss of strength with activities involving the shoulder
  • Localized puffiness or a pocket of swelling in the upper-front area of the shoulder, just below the AC joint, which becomes more evident when the arm is extended at the shoulder
  • Weakness with active shoulder elevation and abduction

Professional Treatment for Subacromial Bursitis

  • Eliminate all routines that contributed to the bursitis. This can include excessive overhead activities, trauma or contact to the shoulder, weight training above shoulder level, painful motion during activities of daily living (ADLs) or carrying heavy objects like luggage with the affected shoulder.
  • Consistently ice the front, top and back of the shoulder.
  • Utilize available therapy modalities to decrease pain and swelling.
  • Do easy pendulum swings with no more than 5 pounds of weight.
  • Perform passive and pain-free range of motion (ROM) shoulder joint exercises, to include flexion, abduction, horizontal abduction and external rotation. At the same time, minimize shoulder extension and horizontal adduction motions.
  • Employ progressive resistive strengthening of external shoulder rotation, if pain free.
  • Avoid sleeping on the affected shoulder if still swollen and/or painful.

Ask the Right Questions Like a Pro

Here’s what smart pro athletes would ask their sports medicine specialist to ensure a fast and safe return to the game they love:

1. Is this an isolated bursitis, or do I need to treat other shoulder issues as well?

2. Is my rotator cuff damaged?

3. What do you believe caused this injury, and how can I avoid these types of injuries in the future?

4. Should I expect future anti-inflammatory injections for this bursa?

Elite Sports Medicine Tips from Mike Ryan

  • Looks Can Be Deceiving – Bursitis often looks worse than it feels.
  • Get it Right the First Time – Don’t let the lack of initial pain fool you – with the bursa’s proximity to the rotator cuff, seek swift, appropriate treatment to avoid a chronic nightmare.
  • Ice, Ice Baby – It’s said time and time again, but the “ice thing” is a key tool to quiet down bursitis and reduce localized swelling.
  • Pinpoint the Source – If the reason for bursa swelling is unknown, dig deeper to find out why.  Quickly finding the source helps avoid major shoulder complications down the road.
  • Avoid the Knife – Some doctors are quick to offer a “simple surgical solution.”  Run away quickly and reread this article.

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).