The Shoulder Pain Solution For Athletes
“I can’t close my bra in the back.” “The pain in my shoulder is terrible when I turn on it in bed at night. “It hurts like hell when I try to put on my T-shirt.” “The pain starts in my shoulder and goes down my arm to the elbow.” “The pain is so bad, that I can’t workout without pain.” “Just thinking about exercise makes my shoulder hurt Doc!”
These are typical of the things I hear from patients consulting me about shoulder pain. Most ailments afflicting the shoulder have a gradual, often imperceptible onset. We keep thinking it’s going to get better, but our range of motion decreases progressively because of our natural avoidance of moving into pain. Muscles and tendons shorten, joints tighten and movements are more limited, until daily activities become so difficult we finally have to scream for help.
The shoulder is not a biomechanically efficient joint, nor is it one single joint. The head of the upper arm bone (humerus) sits rather insecurely in an extremely shallow cup at the outer upper angle of the shoulder blade (scapula) called the glenoid fossa. Essentially, it is held in place by the muscles and ligaments attached to it. Extreme movements in any direction, but particularly overhead and/or to the back, subject those tethers to stretching which eventually results in slight tearing of ligaments and tendons. The body attempts to protect these structures and sets up a reaction called inflammation. The inflammatory response is associated with swelling due to increased blood flow, further restricting motion and increasing pain.
MOST COMMON INJURIES FOR PEOPLE WHO EXERCISE
Rotator Cuff Injury. Tears in the rotator cuff can result from the progressive worsening of tendonitis, repetitive strain through overuse, or trauma- especially as a result of athletics. The gradual tearing of the rotator cuff is a process similar to a shirt wearing out- it gets more and more threadbare until the edges fray or a hole appears. This sort of rotator cuff injury can be difficult to repair surgically, and conservative treatment under the direction of a professional is often the best course of action. A “clean” tear to the rotator cuff (due to trauma) can often be repaired surgically. Whether or not surgery is indicated, Sports Medicine treatment will almost certainly be involved in all stages of recovery.
Bursitis/Tendonitis go hand-in-hand. Inflamed bursa sacs and muscle tendons may become thickened and reduce the “free” space in the joint, thus restricting movement. In extreme cases some of the bursa sacs can be removed surgically; otherwise, the therapeutic approach to treating bursitis and tendonitis is similar.
Impingement refers to a condition, sometimes painful, in which the shoulder joint lacks enough room to function properly. Structural impingement is a “built-in” organic condition, e.g., a bone spur in the shoulder joint. This situation is usually the result of years of tendonitis, rotator cuff injuries, and wear-and-tear. It is important to note that structural impingement usually requires surgical intervention.Functional impingements often result from repetitive motion situations (such as pressing movements overhead with weight training). Stretching and rotator cuff exercises, along with proper CORE muscle balance training, can help prevent and alleviate functional impingement.
Trigger Points are “knotted” up muscles in the shoulder that cause significant debilitating pain and restricted movement. The most effective treatment for these points is aggressive Orthopedic Sports Massage.
TRAINING SECRETS ******** TRAINING SECRETS
Balance your upper body workouts
A good way to avoid shoulder injuries is to make sure your upper body strength sessions are balanced. This means that every push or press exercise must be balanced with a pull or row exercise. Too many athletes and weight trainers focus on developing the ‘mirror muscles’, the upper trapezius, anterior deltoid and pectorals. As a consequence, the ‘non-mirror muscles’, lower trapezius, rhomboids, latissimus dorsi and rear deltoid, are underdeveloped. This leads to a muscular imbalance about the shoulder, which results in poor scapular stabilization. since the non-mirror muscles are the ones that work to stabilize the scapula. In addition, over-developed mirror muscles can lead to a round-shouldered posture, which incorrectly places the scapula up and forward. Redressing this imbalance is very important for the prevention and rehabilitation of shoulder impingement injuries
Limit your range of movement, and take it easy
Often this means avoiding certain ranges of motion where the shoulder joint sub-acromial space is compressed the most. The impingement zone to avoid is between 70 and 120 degrees of shoulder abduction (when you move the arm laterally away from the side of the body). To start training the non-mirror muscles, begin with the seated row, because the shoulder joint is not abducted in this exercise. Once the pain is completely gone, then introduce the overhead exercises such as pull ups and lat pull downs. You should be even more careful when it comes to the mirror-muscle exercises. I would avoid lateral raises, upright rows and shoulder presses completely for a while. However, incline bench press with arm abducted to 45 degrees would be a good choice to start again. Slowly build up to the normal bench-press range as strength improves.
Correct scapula positioning when performing exercises
The correct position for the scapula (shoulder blade) is back and rotated down. Essentially, this means maintaining a good ‘military posture’, with shoulders back and chest out. A round-shouldered or hunched posture is to be avoided at all times. To achieve the correct position, you need to use your rhomboids, mid and lower trapezius muscles to retract the shoulder and pull the scapula down.
When you perform any upper body weight training exercise, always get into the habit of starting with good upper body posture and pinching the shoulder blades together. You should feel that the scapula is a solid platform which keeps the shoulder correctly positioned while you perform the exercise. As mentioned last issue, a good way to learn the correct position is during the seated row exercise by keeping your scapula back and down while you move your arms. During the exercise, you should feel that the rhomboids and trapezius muscles are statically contracting to hold the scapula in place, and the latissimus is working to perform the movement. Once you have the feel for maintained scapula stability during the seated row, try to achieve it during all upper-body exercises. What you might find is that exercises such as the press up or front raise, where the shoulder may become impinged, will not be painful if you stabilise your scapula correctly. In effect, by using the scapular muscles you can achieve better shoulder mechanics and avoid injury.
Correct scapular stability is difficult to learn and demands a great deal of practice and concentration during your training sessions. You first need to understand what the correct position is, and often this requires a professional to guide you. Instruction and observation can help you achieve and maintain the correct shoulder position.
Avoid too many consecutive training days
The more consecutive training days you have, the higher your chances of getting hurt. Consecutive days are counted as follows: if you train on Monday, Tuesday, Wednesday, and Friday, you are training on three consecutive days each week (Friday doesn’t count because it has a rest day before and after it). Studies show that reducing the number of consecutive days lowers the risk of injury. This means that if you train for one hour every day from Monday through Friday (five consecutive days), you could reduce your risk by completing 75- minute workouts on four days per week (Monday, Wednesday, Friday, and Saturday, for example). Your total training time (and gain in fitness) would be the same in each case, but the second strategy would reduce your consecutive days from five to two, giving you much more average recovery time between sessions and a lower risk of injury.
PROPER Stretching
Stretching to increase flexibility should never be done prior to training or competition, but instead done during ‘down’ times in the week. This is because of the suppression of the ‘stretch reflex’ that takes place during sustained passive stretching of muscle tissue (i.e., repeated holds of 20-30 seconds). If one were to do rapid forceful movements such as lifting weights straight after such passive stretching, there would be an increased chance of muscle and tendon tears. For flexibility every muscle needs to be stretched three to four times at 20-30 seconds each, and repeated three to four times per week. The best way to learn how to stretch the above areas is to be taught by a sports physiotherapist, sports conditionist or personal trainer. It is important not to stretch the ligaments of the shoulder, which in due time can cause laxity of the joint and potential instability.
If you have a shoulder injury and would like to try to treat yourself, please remember:
It would be wise to visit a Sports Medicine Specialist to rule out structural damage first, via X-rays, CT-Scan, US Scan or MRI, particularly if your shoulder joint experiences sharp catching pains, locking sensations, clunks, pins and needles or numbness, looseness or laxity, or the history of the injury was in any way traumatic, involving body contact or a fall. The length of time it took to develop your problem will give you some indicator of how long you will need to persist with correcting the faults before the results will be felt. Don’t forget, that the pain is often only the tip of the iceberg, directing you to the real issue.
Dr. Perry Nickelston, DC VP of Practice Development for K-laserUSA.
1-866-595-7749 Ext. 102
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