Shoulder Health

Shoulders

Get Your Head Around Your Shoulders this Summer!

With summer fast approaching, many of us are jumping back into one or more of our favourite fair weather activities, be it golfing with an orchard view, volleyball on the sandy beach, swimming in the crystal clear Okanagan lakes, playing tennis with friends or a little extra gardening for all of you green thumbs! Whatever the summer activity of choice, we all hope this warm weather finds us ready to tackle the ‘fun in the sun’ at full steam without having to worry about those pesky aches and pains that often set in over the winter.

One aspect that many summer activities have in common is that you will undoubtedly require a pair of healthy shoulders to fully enjoy them. As a practising physiotherapist treating patients with various conditions and injuries for almost a decade, I must say that shoulder pathology and dysfunction are some of the most common conditions walking in and out of our clinics on a daily basis.

When you dissect this shoulder issue further, there are a few key things that make the shoulder one of the most biomechanically impressive but also one of the most vulnerable regions to injury in our body.

First of all, the shoulder is the most mobile joint in the human body. The ‘ball and socket’ anatomy of the shoulder allow for movement that we see in no other body region. Whether it be flexing the shoulder 180 degrees overhead to smash a beach volleyball or fully externally rotating your shoulder during your golf swing follow-through, the shoulder girdle demonstrates phenomenal flexibility.

This fantastic mobility in the shoulder girdle however comes with a price. In order for this flexibility to be functional when teeing off with your driver on 18 or lifting heavy pot of flowers up on your deck, the shoulder requires a significant amount of dynamic stability. This dynamic stability is accomplished by work of a few important muscles that surround the very flexible shoulder joint…most notably, the rotator cuff as well as other scapular stabilizing muscles.

For our shoulders to remain healthy and function at the high levels required for our summer fun, this balance between flexibility and stability must be maintained.
Some common conditions and injuries that we as physiotherapists assess and treat where shoulder flexibility and stability become compromised include; Shoulder Impingement, Tendinitis/Tendinopathy, Bursitis, Rotator Cuff Tears, Shoulder Dislocations/Separations, Frozen Shoulder, and Scapulothoracic Dysfunction.

If your summer involves getting or staying active and you want your shoulders to be ready for the action, book a consultation and some treatment with your physiotherapist to ensure your shoulders are ready to shoulder the load!

Shoulder Pain

Shoulders

Do you lie awake at night with an aching shoulder? Do you feel sharp grabs of pain while reaching up into the cupboard or into the back seat of your car? Did your shoulder pain start one day without any injury that you can remember? Shoulder pain can keep us awake at night and limit our day-to-day activities – even the most basic ones like washing our hair or getting dressed. In this article we are going to talk about how shoulder problems can start and what there is to do about it.

First let’s talk about what is inside your shoulder. The shoulder is what we call a ‘ball and socket’ joint. This means that the top of the upper arm bone has a ‘ball’ like surface, and this ball connects with the concave surface of the shoulder blade, similar to a golf ball sitting on a tee. This type of joint (like your hip joint) is build for maximum mobility. Having so much mobility is a good thing because it allows our shoulder and arm to reach in all different directions. However, this excess mobility can also predispose the shoulder to injury.

Almost everyone has heard of the rotator cuff. The rotator cuff is a group of 4 muscles responsible for protecting the shoulder. These are often the muscles that are injured in the shoulder because they can become pinched inside the joint (referred to as ‘impingement’). The rotator cuff muscles work alongside the muscles of your shoulder blade to ensure that the ball is always positioned in the centre of the socket so as to avoid pinching, inflammation and pain. Impingement can occur if any of these shoulder muscles become tight or weak or if the neck and upper back are too stiff to allow for proper arm movement.

People that spend a large portion of their days sitting often become very weak in their shoulder blade muscles while at the same time also becoming tight in their chest, upper back and neck. Others spend a lot of their workday doing repetitive movements with their arm that also can create irritation and muscle imbalances in the shoulder. At night many of us tend to lay on our ‘favourite’ side while sleeping which squeezes the blood out of the shoulder thus causing further irritation and preventing recovery from the strain during the day.

If you start to have shoulder pain the best strategy is to avoid the movement that is creating the pain and to ice the shoulder for 15 minutes 2-3 times per day for the initial 3 days (after 3 days switch to heat for 20 mins, 2-3 times per day to increase blood flow/healing). Make sure to continue to move the shoulder in motions that don’t hurt in order to prevent your shoulder from getting stiff. Also try as best as you can to not sleep on the painful shoulder at night in order to allow healing.

If the pain does not subside within a week it is advisable to see your health care professional so that the specific reason for the shoulder pain can be diagnosed. In physiotherapy, pain control and stretching out tight muscles are usually the initial goals. Treatment then fairly quickly progresses to focusing on strengthening specific muscles as well as increasing overall flexibility. Often the conversation of prevention will focus on daily stretching or Yoga as well as emphasizing good posture while sitting.

I hope that you have learned a little bit about how the shoulder works and what can cause shoulder pain. If you are starting to have nagging shoulder pain or tightness, remember that it is much easier to deal now then ‘down the road’. Happy spring (summer) everyone!

Swimmer’s Shoulder

Shoulders

With the May-long weekend marking the unofficial start of summer, and the weather quickly heating up, many people are hitting up the lake to take their swimming practices outdoors. Like any sport, aches and pains can occur in swimming, with shoulder pain being the most common complaint. The term swimmer’s shoulder is used to describe painful shoulder overuse conditions that occur in the sport.
The shoulder is a ball-and-socket type of joint, which allows for a large amount of motion. This excessive mobility is balanced by surrounding tissues to make it more stable. Included in the structures that help stabilize the shoulder is a fibrous capsule that surrounds the head of the humerus (the arm bone), as well as the rotator cuff. Four muscles make up the rotator cuff, and serve to keep the humerus properly placed in the joint. The bony structure that you can feel on the top of your shoulder is called the acromion, where impingement can occur.
Many movements occur at the shoulder during swimming, a lot of which is overhead. Different swimming strokes involve different patterns of motion, but all have some combination of rotation, circumduction and scapular movements. These positions can put the swimmer at risk of impingement, especially if the biomechanics are off.
Injuries to the shoulder complex from swimming are typically microtrauma: small injuries over time from the repetitive activity rather than a macrotrauma from a one-time incident. There are many factors that can contribute to injury, typically described as intrinsic and extrinsic.
Intrinsic factors can include the positioning of the joint itself; if the capsule surrounding the joint is tight at the back, it pushes the humerus forward, increasing the likelihood of impingement of the tissues under the acromion, and placing more stress on the tendons of surrounding muscles. Opposite of that would be if the joint is lax, which creates more demand on the rotator cuff muscles to provide stability. Another intrinsic factor is posture, with rounded shoulders and an increased forward bend in the upper back being common amongst swimmers. This lengthens and weakens muscles that stabilize the scapulae, can contribute to a tight posterior capsule in the shoulder, and decreased mobility in the spine.
Extrinsic factors are related to the use of your shoulder: overuse (your training schedule), misuse (swimming form), abuse (too strong of demand placed on your shoulder), and disuse (time off from training).
To maximize your season, it is worthwhile to assess your shoulder mechanics, preferably before injury occurs to be preventative. Any impairments should be addressed, which can include mobilizing stiff or tight structures, strengthening the rotator cuff and other supporting musculature, and improving technique. Be cautious of overtraining – don’t increase your distance, intensity or frequency of training too quickly. Give yourself adequate time to make strength and endurance gains, as well as time to recover.
Consulting your physiotherapists to address shoulder and posture impairments, and a coach to look at your form, can help keep you swimming strong this summer.

The Frozen Shoulder

Shoulders

Frozen shoulder is a condition that gets its name from the way it causes a gradual stiffening of the shoulder joint, ‘freezing it up’. The proper term for this condition is adhesive capsulitis – adhesive implying stuck and capsulitis meaning inflammation of the capsule.

Although a very common condition affecting approximately 2% of the population, the exact cause of frozen shoulder remains a mystery. In most cases there is a trigger such as straining the shoulder that then develops into a frozen shoulder, but in many cases it is idiopathic i.e. it just happens. When it is triggered, the capsule – that is the connective tissue sack – that surrounds the shoulder joint undergoes a change in elasticity from being somewhat loose and stretchy to being tight and without much stretch.

When it does happen, it follows a distinct pattern of which there are three stages.

The first stage is the freezing stage and is characterized by the onset of a quite intense pain in the shoulder and upper arm and a gradual seizing up of the shoulder. It becomes very difficult and painful to lift the arm up, rotate it outwards, or reach behind your back. This stage typically lasts about 3-6 months then frozen shoulder moves into stage two, the frozen stage, in which the pain starts to subside but the stiffness remains. The shoulder will begin to feel more comfortable in stage 2 but as it is still very stiff, its function remains limited. Again stage 2 can last anywhere between 3 and 6 months before progressing onto stage 3, the thawing stage, when the stiffness finally begins to resolve and the shoulder range of motion is restored.

Although every frozen shoulder will go through these 3 stages, the duration of each stage can vary in each case. Most of the time a full recovery will be made but occasionally full pain-free range of motion does not return. In order to optimize recovery, physiotherapy can help to restore range of motion with techniques such as mobilizations and muscle energy techniques. A prescribed home exercise program is also important so that you can work on stretching the shoulder every day at home. Along with this there are many treatments the physiotherapist is able to do to help control the pain particularly in the early stages of frozen shoulder. This will enable a much more effective stretching regime, which can ultimately lead to a quick and fuller recovery.