5 STEPS TO PAIN-FREE SHOULDERS
Last week, I received an email from a local physician that simply said ... “We need Medical Exercise Specialists in our offices!”
It included an article from PubMed, an online resource for medical literature, research journals and book citations. It was from “The Journal of Orthopaedic and Sports Physical Therapy” and discussed the role that exercise plays in preventing and recovering from shoulder injuries; specifically rotator cuff tendinopathy.
Tendinopathy refers to disease within a tendon, often including inflammation, pain and weakness. With an affected rotator cuff, painting a ceiling, reaching into a sleeve or throwing a ball can be very difficult.
The article entitled “Rotator Cuff Tendinopathy: Navigating the Diagnosis-Management Conundrum” says that people with shoulder pain that participate in a wellstructured, graduated exercise program can experience the same improvement in symptoms that had been seen in surgical trials. Furthermore, participants also receive the additional benefits of exercise such as less sick leave, faster return to work and reduced costs to the health-care system.
One point of emphasis is the idea that an “underused” tendon may suffer, just as an “overused” one will. To maximize strength one needs to find balance. Too much stress isn’t good and now we know that too little stress can also be problematic.
The principles guiding exercise for rotator cuff tendinopathy as outlined in the journal article are:
1. Relative rest. In the case of the rotator cuff, relative rest means that you remain active on the whole, while allowing your shoulder to rest. This means that you should continue with your daily activities to maintain your general health and fitness. Part of relative rest might include the use of a sling or taping of the area for support. When I went through shoulder surgery last year, it meant that I wore a sling and did lots of hiking instead of working out in the gym.
2. Modification of painful activities. Arranging a work station or kitchen to minimize reaching overhead is an example. If you are a swimmer; switching to the breast stroke from the front crawl would be helpful and an example of modifying an activity rather than stopping it altogether.
3. An exercise strategy that does not increase pain. This begins with the use of “isometric” exercises to strengthen the shoulder from several different angles. Isometric means contracting a muscle without moving it through a range of motion. Imagine pushing your arm out to the side against a wall for a 5 count. Due to the risk of increasing blood pressure, however, people with hypertension should avoid doing isometrics and instead should start by using limited range of motion exercises with light resistance bands.
4. Controlled reloading. Once inflammation and pain have been reduced and some strength has been restored, it is time to start increasing the demand that you place on your shoulder by using weight resistance exercise in a safe and effective way. Most strength movements will limit overhead activities at this point and will focus on the rotator cuffs and the upper back muscles around the shoulder blades. An important consideration at this point is to note the presence of “night pain.” If your shoulder keeps you up at night and/or you cannot sleep on it, then it is likely that you have gone too far, too fast and you’ve inflamed the area. Slow down, take a step back and move forward at a more reasonable pace.
5. Gradual progression from simple to complex shoulder movements. This means that things like pressing overhead and sporting activities like throwing or swinging a club can gradually be added back into a strength routine.
Last year I underwent shoulder surgery to repair both old and new injuries. I went through all of the stages above and am now back to doing the activities that I did before my operation. The bottom line is that we now have evidence that movement is better than inactivity both for preventing disease and for restoring full health after tendinopathy has been diagnosed.
There is evidence that movement is better than inactivity both for preventing disease and for restoring full health after shoulder injury has been diagnosed.