Tear and Wear
At any given time, an estimated one in four people s t r u g g l e w i t h shoulder pain. For some, an ache might only mildly interfere with their golf game; others, however, may struggle to get dressed in the morning.
“The other big thing people complain about with the shoulder is pain at night,” said Dr Drew Lansdown, an assistant professor in the orthopedic surgery department at the University of California, San Francisco, US. “It keeps you from sleep because you can’t find a comfortable position — can’t lie on that side, can’t lie on the other side.”
While some injuries happen suddenly and traumatically, damage usually occurs over time. The ball-and-socket joint of the shoulder is secured by the four muscles and tendons of the rotator cuff, which can become irritated, torn or overstretched.
Often, you’ll have more than one problem at time, and it may not be clear exactly what’s causing your pain, said Lori Michener, a physical therapist and researcher at the University of Southern California in Los Angeles in the US.
Athletes who use their arms overhead face greater shoulder risks, as do workers whose jobs involve heavy loads or awkward arm positions, such as truck drivers and dental hygienists.
Fortunately, you can take steps to safeguard the shoulder, including strengthening, stretching and gradually increasing overhead activities.
Strengthening the muscles surrounding the shoulder increases its resilience, warding off pain and injury, said Behnam Liaghat, a specialist in sports physiotherapy and an assistant professor at the University of Southern Denmark. Work both the big muscles in your upper back and chest and the smaller, stabilising muscles surrounding your shoulder and scapula, the shelf on which your shoulder joint rests.
Exercise programmes, such as a classic group called the Thrower’s 10, meant to bolster the joint in high-risk overhead athletes, have been shown to reduce shoulder injury risk by as much as half if they’re done two to three times per week.
Such a programme should be part of regular maintenance for even recreational overhead athletes, said Ioonna Félix, a physical therapist and owner of Optimal Performance, based in New York City, US.
If you’re not regularly involved in overhead activities, a few key exercises can help keep your shoulders healthy, she said. The three she recommended were scapular rows and shoulder extensions with a band, as well as scapular retraction, a simple movement that strengthens the stabilising muscles. For that last one, lie face down, arms by your side and palms facing the floor. Pull your shoulder blades back and down as you lift your arms up to the level of your hips; hold the position for a couple of seconds, then slowly release.
Before you attempt an overhead sport or weightlifting move — or as a general gauge of how well your shoulder is functioning — try a simple threepart test for shoulder mobility, Michener said.
First, stand in front of a wall — with your toes touching it — and see if you can raise one arm at a time over your head to touch the wall in front of you, with your palm flat. Then bring your hand down to touch the back of your head, keeping your elbow out to the side. Third, bring your arm back down to your side, then reach up behind your back, aiming to touch the opposite shoulder blade with the back of your hand. Repeat with your other hand.
If you have trouble doing these movements or reaching the end positions, you could benefit from more mobility, Michener said.
Even if you’re diligent about strengthening and stretching, you can still trigger pain or cause damage if you jump into a new shoulder-straining activity — or return to one — a little too quickly.
To keep an eye on how much you’re stressing your shoulders, consider what scientists call the acute-to-chronic workload ratio, said Travis Pollen, assistant professor of exercise science at Thomas Jefferson University in Philadelphia in the US and a former Paralympic trials swimmer.
Tally the average weekly amount of a given activity — say, laps of swimming or hours of tennis — you’ve logged over the past four weeks. That’s your chronic workload. Divide that by what you’re doing this week, the acute workload. Some estimates suggest when this number rises higher than 1.5 — meaning you’ve done 50 per cent more this week compared with your average for the previous month — your odds of injury increase soon after.
Often, minor inflammation or irritation in the shoulder joint can resolve within a few days. Applications of ice and anti-inflammatories may help, Lansdown said.
Once pain subsides, consider whether your routines might benefit from rebalancing the strain on the front and back of your shoulders, Pollen said.
If pain lingers — or if it’s accompanied by weakness, clicking sensations or a feeling of the joint shifting or slipping — it is best to see a medical professional, Lansdown advised. Some injuries will only get worse, and the sooner you seek treatment, the more straightforward and successful it may be.