Find out how to avoid and alleviate shoulder pain – 03/16/2023 – Equilíbrio

Over thousands of years of evolution, the human shoulder has undergone massive modifications to make it more versatile, allowing us to extend our arms overhead, stretch them back, and make full circles. But he also became much more prone to injuries.

It is estimated that one in four people will experience shoulder pain at some point. It could be a mild pain that just gets in the way a little when playing sports. Or difficulty getting dressed in the morning.

“The other big complaint people have about their shoulders is pain at night,” says Drew Landsdown, an assistant professor in the department of orthopedic surgery at the University of California at San Francisco. “She doesn’t let the person sleep because it’s impossible to find a comfortable position: you can’t lie on one side or the other.”

Some injuries occur suddenly and traumatically, but more commonly the damage occurs over time. The ball joint of the shoulder is protected by the four muscles and four tendons of the rotator cuff, which can become irritated, torn, or overstretched. The glenoid labrum—a cartilaginous sheath that surrounds them—can also tear.

Small, fluid-filled sacs called bursae, which normally cushion the joint, can swell and become painful. Often you have more than one problem at the same time, and it may not be clear exactly what the cause of the pain is, says physical therapist Lori Michener, a researcher at the University of Southern California in Los Angeles.

Athletes who frequently raise their arms above their heads – such as baseball pitchers, swimmers and tennis players – are at greater risk with regard to their shoulders. This is also the case for people whose work involves carrying heavy loads or being in awkward positions, such as truck drivers and dentists. If you’ve already dislocated your shoulder once, this increases your risk of repeating it. Genetics can also play a role, and with age, everyone’s chances of rotator cuff tears and shoulder arthritis increase.

Fortunately, you can take steps to protect your shoulder, including strengthening, stretching, and gradually increasing activities that involve lifting your arms overhead.

Strong muscles protect the shoulders

Strengthening the muscles around the shoulder increases its resilience, preventing pain and injury, says Behnam Liaghat, a specialist in sports physiotherapy and adjunct professor at the University of Southern Denmark. Work both the big muscles in your upper back and chest and the smaller stabilizing muscles around your shoulder and scapula, the platform on which your shoulder joint rests.

Exercise programs such as the so-called Thrower’s 10 (10 exercises for pitchers), designed to strengthen the joints of high-risk athletes, have been shown to significantly reduce the risk of shoulder injuries by half if done two to three times a week. For this you will need light weights and an elastic resistance band.

Such a program should be part of regular maintenance for athletes, even amateurs, who have movements that raise their arms above their heads, says physical therapist Ioonna Félix, owner of Optimal Performances in New York. She herself plays tennis regularly and devotes two days a week to conditioning her shoulders.

If you don’t regularly engage in activities that involve lifting your arms, he says, a few key exercises can help keep your shoulders healthy as you age.

The three she recommends are scapular rows and shoulder strap extensions and scapular retractions, a simple move that strengthens your stabilizer muscles. To do this, lie on your stomach with your arms by your sides and palms on the floor. She pulls her shoulder blades back and down as she raises her shoulders to hip height. Hold like this for a few seconds and release slowly.

Test your mobility first

Before trying a sport that involves elevating your arms or lifting weights — or simply to gauge your shoulder function — do a simple, three-part shoulder mobility test, recommends Michener.

First, stand in front of a wall with your toes against the wall and see if you can lift one arm at a time above your head to touch the wall with your open palm. Then bring the hand down to touch the back of the head and then reach back, trying to touch the opposite shoulder blade with the back of the hand. Repeat with the other hand.

According to Michener, if you have difficulty performing these moves or getting into late positions, you may benefit from more mobility.

To improve your range of motion, perform these same movements until you feel a stretch, then hold for between 30 seconds and one minute. Do this three to five times twice a week and monitor your progress. If your mobility doesn’t improve, you may need to hold the stretches longer or repeat them more often. After two weeks, if your mobility is still limited or you experience pain when you stretch, see a physical therapist or medical professional.

Work your lower body too

Much of the power for a throw, serve, or other overhead movement comes from the bottom up. The weaker your core and legs are, the more force your shoulder has to produce, which will increase the strain on the joint, Michener said. In a study she published earlier this year, minor league pitchers with a weaker hip than others were found to be at greater risk for shoulder and elbow injuries in their pitching arm.

To build lower-body strength and stability, she recommends moves like lunges and squats, which work multiple muscle groups. Planking is also good; prolonged contraction of the core and legs benefits muscular endurance.

After that, Felix said, use the strength of your entire body as you swing your arms overhead. For example, when stowing a carry-on bag in the overhead bin, drop your knees and lift with your legs instead of just shouldering.

Increase the load of exercises gradually

Even if you do regular strengthening and stretching exercises, you could still get pain or injury if you start doing a new activity that strains your shoulder too quickly. According to Lansdown, some people think “Oh, I played baseball in high school. I’ll be able to pick up a ball now and pitch it like I did then.” But the muscles and tendons need time to build the specific strength and control needed to execute any movement that strains the shoulders.

Even athletes in top physical shape can suffer injuries of this type. In a small study of collegiate swimmers, two-thirds of athletes who suffered injuries during the season did so on a mid-season intensive training trip, when some of them nearly doubled the usual distances they swam.

To see how much you’re straining your shoulders, consider what scientists call the acute-to-chronic workload ratio, recommends Travis Pollen, professor of exercise sciences at Thomas Jefferson University in Philadelphia, lead author of the study on swimmers and former swimmers. Paralympics swimmer.

Count the average weekly amount of a given activity—say, how many laps in the pool or how many hours of tennis—that you’ve done over the past four weeks. This is your chronic workload. Divide that number of times you’re doing this week by the acute workload. Some estimates suggest that when the number rises above 1.5 – meaning you did 50% more this week than your weekly average for the previous month – your chances of getting injured increase.

For minor pain, rest

Inflammation or minor irritation on the shoulders often goes away within a few days. Anti-inflammatories and applying ice can help, says Lansdown.

When the pain subsides, see if your exercise routine needs to be revised to rebalance the tension in the front and back of your shoulders, recommends Pollen. For example, if you’re a climber who’s always climbing walls, pulling yourself up — or if you’re a yoga practitioner who’s always pushing yourself against the ground — try doing some moves in the opposite direction.

A little physical therapy can help

If the pain persists — or is accompanied by weakness, tightness, or a feeling like the joint is dislocating or slipping — see a medical professional, Lansdown advises. Some injuries will only get worse. The sooner you seek treatment, the simpler and more successful it can be.

Don’t automatically assume you’re going to need surgery or months of physical therapy. A clinical study published in The Lancet concluded that a single session of physical therapy to teach progressive strength and mobility exercises worked as well as six face-to-face sessions for new rotator cuff tears.

People who suffer sudden tears or want to get back into more intense sports may do better with surgery, but research shows that three-quarters of people who chose not to surgically repair full-thickness rotator cuff tears were still doing well two to five years later. afternoon.

Of course, if you can avoid a rupture, so much the better – and that requires paying some attention to this complex and vulnerable joint. “The best thing to aim for would be to have strong shoulders and not put excessive stress or burden on them,” says Liaghat.

Translated by Clara Allain