We are moving to part 2 of the shoulder pain series.

Treatment and Management of Shoulder Pain

Shoulder pain may not be a life threatening medical condition but without the right approach, the pain may limit your arm movement and affect the quality of your life.

Your shoulder pain may affect your activities of daily living, such as:

• brushing your teeth
• combing your hair
• putting a book on a shelf
• sleeping on that shoulder
• opening doors
• reaching to the side to grab something
• holding your cellular phone
• carrying your purse or lap top bag

The above tasks may require a great deal effort and irritate your shoulder pain. It is important to keep in mind that all types of shoulder pain should never be overlooked.  Whether the pain is mild or severe, the best option is to consult your physician to determine the cause of the pain and to obtain the right treatment regimen for you.  Shoulder pain can be progressive in nature and lead to other problems.

Shoulder pain is initially treated with conservative or non-invasive measures. During the early stages or uncomplicated cases of shoulder pain, the goals of the treatment are relief of pain and restoration of the normal function of the shoulder.  These goals are mainly achieved through rest, ice and heat application, compression, use of pain medications and exercises.

#1 – Active Rest for Shoulder Pain

If your shoulder is injured or in pain, the most immediate and important action is to reduce or stop using the injured arm for about 48 hours.  Prevent performing activities that aggravate your shoulder pain.  It is also recommended to avoid heavy lifting and overhead activities until your shoulder feels better, which could take around 4 to 7 days after the occurrence of the shoulder pain.  Resting the affected shoulder can reduce the swelling and the pain.  It is important to emphasize that complications may arise when the shoulder area is immobile for a lengthened period of time.  It is important to keep moving your shoulder in movements that are pain free.  It is suggested to perform simple isometric exercises during shoulder pain in order to activate the muscles of the shoulder.  This is discussed in the next section.

#2 – Ice and Heat for Shoulder Pain

Application of ice reduces the pain and inflammation during the first 24 to 48 hours following your shoulder injury. You may put an ice pack, a bag of frozen vegetables or a towel filled with ice on the affected shoulder for 15 to 20 minutes at a time, 4 to 8 times a day.  Apply ice for about 20 minutes. Never apply ice directly unto the skin as it may cause a skin burn.  Use a protective barrier between the ice and the skin, such as a towel.  You can also apply ice after activities to control inflammation and pain.  Everyone responds to ice differently.  Try it out and see how your shoulder responds.  It should help with decreasing inflammation, decrease pain and recovering from activities or exercise.

Heat applications are not recommended within the first 72 hours. Heat can cause vasodilation and may cause more swelling and pain. After 72 hours, when the pain and inflammation have improved, you may start heat applications to relax tightened muscle tightness.  Heat should be limited to 20 minutes per application.

#3 – Pain medications for Shoulder Pain

Nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen or naproxen may help reduce mild to moderate shoulder pain.  It is important to talk with your doctor to see what pain medication is most suited to you.

#4 – Compression of the Shoulder

Compressing the injured area with elastic wrap may be helpful as well.  This could help with controlling inflammation, keep the shoulder out of painful movements and your body in a posture that is more comfortable.

Exercises for Shoulder Pain

Exercises are an essential part of preventing and overcoming shoulder pain and injury.  Above we talked about what you can do to manage your shoulder pain but it is important to move and exercise the shoulder in order to overcome and recover from your shoulder injury.

The most valuable exercises when resolving shoulder injuries and pain are range of motion, stretching and strengthening exercises.

Exercises You Can Do Soon After Your Shoulder Injury

Prolonged immobilization of the shoulder can result in a wide range of complications, including increased joint stiffness or tightness, which consequently worsens shoulder pain. Although you need to rest the affected shoulder during painful periods and limit your activities, it is recommended to perform the following exercises to maintain muscle strength without risking joint damage as you recover. The next two exercises contract the shoulder muscles without moving the joint.

#1 – Grip Strength Exercise.

1. Using the hand of the involved arm, squeeze a small ball, either a stress ball or a racquetball, with gentle and consistent pressure as many times as you can throughout the day.

#2 – Isometric Triceps Exercise

1. Position the involved arm on a tabletop with your elbow at 90-degrees.
2. Make a fist and push the tabletop, using the force coming from the fist to the elbow, and hold for 5 to 10 seconds.
3. You should feel the muscle on the back of your upper arm contracting without moving your arm.
4. Gradually release the contraction.
5. Repeat the exercise 5 times

Range of motion exercises

Gentle and early active, active-assisted or passive range of motion exercises are the most recommended exercises after shoulder pain has been controlled and managed.  These exercises are helpful in gradually restoring the affected shoulders range of motion.  Codman or pendulum exercises are commonly included in the earliest stage of treatment to improve muscular relaxation, a pain free range of motion and to prepare the shoulder for more complex activities.

#3 – Circular Pendulum Exercises (Arm Circles)

1. Use your good arm to hold onto a sturdy chair or tabletop.  Bend at the waist and then at the knees.  Let the involved arm relax, hanging in a resting position. Remove all tension from the shoulder blade.
2. Using the involved arm, create small circular patterns in the air.
3. Make 5 circles in a clockwise direction, and 5 more circles in a counterclockwise direction.
4. You can gradually draw bigger and more circles as your shoulder improves.
5. Repeat the exercise 5 times a day.

#4 – Flexion-Extension Pendulum (Arm Forward and Back)

1. Use your good arm to hold onto a sturdy chair or tabletop.  Bend at the waist and then at the knees.  Let the involved arm relax in a resting position.  Remove all tension from the shoulder blade.
2. Swing the involved arm forward and back, 5 to 10 times.
3. Repeat the exercise 5 times a day.

#5 – Shoulder Flexion (Lifting Arm Up)

1. Stand tall with both arms on your sides.
2. Raise the involved arm, reaching the ceiling as the elbow is kept straight.   As you reach the highest point, hold for 10 seconds.
3. Release, and return to your standing position. Repeat 5 times.

Shoulder Stretching Exercises

Stretching exercises regain and maintain the flexibility and mobility of the soft tissues, such as the muscles, tendons and fascia in the injured arm.  These exercises improve the range of motion, prevent muscle stiffness and reduce the risk for shoulder injuries.  All of which encourage long-term pain relief.

#6 – Posterior Stretch

1. Stand tall, and grasp the elbow of the involved arm using the hand of the good arm.
2. Gently pull the involved arm across the chest with the good arm at the shoulder level, or at whatever level you can lift it which is pain-free.  You should feel a light stretch in the back of your shoulder. Hold the position for at least 10 seconds.
3. Release the stretch. Repeat the exercise 3 times.

#7 – Chest Stretch

1. Stand tall in the doorway, and extend both arms out at a right angle. Bend elbows at 90-degrees.
2. Position the forearms against the door jamb and lean forward.  Hold the stretch for at least 10 seconds.  To stretch the upper chest area, position the elbows below the shoulders.  Stretching the middle fiber requires the elbow placed at the shoulder level. To stretch the lower fibers, elbows are positioned above the shoulder.
3. Release and repeat the exercise 3 times.

Rotator Cuff Strengthening Exercises

For improved shoulder strength, the use of dumbbells, tubing and your own body weight are commonly combined with other types of strengthening exercises. Isometric exercises, a form of strengthening exercises, contract and build muscles without moving a joint or bone. Strengthening exercises are only introduced or included in the exercise regimen if the involved shoulder is strong enough to tolerate the pressure and is able to complete the exercises in a pain-free range.

#8 – Shoulder Extension

1. Stand tall with your back against the wall. Move the involved arm behind the back. The pinkie (ulnar) side of the hand should be resting against the wall.
2. Push the involved arm against the wall. Keep the elbow extended. Hold the position for 5 to 10 seconds.
3. Release. Repeat the exercise 5 times.

#9 – Shoulder Abduction with Tubing

1. Stand tall with your straight arms at your side.
2. Lift the tubing away from your body until the arm holding the tubing reaches the shoulder height, or to the point that you can do it pain free.
3. Gradually return to the starting position. Repeat up to 10 times.

Key Points to Remember

• If any of the exercises cause or aggravate pain, stop doing the exercise and make sure you are doing them correctly.   You may have to limit the shoulder range of motion as you exercise.
• Do not overdo things. Later in the day and the next day, you should feel like you have done something but your shoulder pain should not increase.
• It is recommended to start slowly and gradually increase the intensity of your exercises. If you are using weights, you may need to lower the weight or completely get rid of the weights until your shoulder is well enough to tolerate the exercises.
• After the exercises, you may have to use some of the pain management strategies we talk about above.
• If you have any concerns about these exercises, contact your doctor to see if they are appropriate for you.

I hope this program gets you started on the road to recovering from your shoulder pain.

If you would like to read the first part of this series, click the below link:

==>  What Causes Shoulder Pain?

Rick Kaselj, MS

Today was the day to dig into what is new in the research world.

To be honest, I started it in yesterday’s blog post.

In yesterday’s blog post I talked about new research in muscle imbalances.

Yes, there is research about it. More and more keeps coming out.

Now to today’s research.

Harrington S, Padua D, Battaglini C, Michener LA, Giuliani C, Myers J, Groff D. (2011). Comparison of shoulder flexibility, strength, and function between breast cancer survivors and healthy participants. J Cancer Surviv. 2011 Jan 12. [Epub ahead of print]

I know this is a little new for me, to be talking about breast cancer and exercise.

I have been having more questions about this of late, plus it reminds me of the group of breast cancer survivors that I trained while working in Penticton, BC, Canada.

The ladies were a group from a local Dragon boating team that were all cancer survivors.  It was amazing to train these ladies and they were so much fun.

Here we go into the research.

What They Looked At:

Read the rest of this entry »

I took an hour off to head into the coffee shop and look at some journals.

I am sitting here, listening to Christmas music and checking out what is new in the journal world.

Here we go with the first article.

Do the Buns in a Pitcher Affect the Shoulder?

What They Looked At

They looked at the relationship of how the movement of the pelvis and torso (trunk) affected the shoulder in high school pitchers during the pitching movement.

Cool Points

I like reading the discussion of a research paper as there are always really cool things in there, like this:

- the trunk leads to 50% of the kinetic energy and force produced during throwing

What They Found

They found that the rate of torso rotation strongly related with the shoulders.

Baseball pitchers may exhibit a decreased ability in controlling torso rotation which increases the risk of shoulder injuries.

They feel high school pitchers, when performing their strength training, should focus on creating a strong core, including gluteus maximus, in an attempt to control the rate of torso rotation.

Take Home Message

I think the above results can translate over to others, even if you are not a high school baseball player.

Torso Rotation – Working on torso rotation is important for all.  Doing exercises that work concentrically, eccentrically and isometically is very important to prevent shoulder and lower back injuries.  You can do this with plank variations.

Gluteus Maximus Work – It is important to do gluteus maximus work in your exercise program.  It has to be more than just squats and deadlifts.  Single leg work is more transferable to real life when it comes to gluteus maximus.

Where to get more info – Oliver GD, Keeley DW. (2010). Pelvis and torso kinematics and their relationship to shoulder kinematics in high-school baseball pitchers. J Strength Cond Res. 2010 Dec;24(12):3241-6.

I go through some of the gluteus exercises I use in The Most Effective Gluteus Maximus Exercises :

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I have been doing research this week.

A colleague, Brenda Adams, emailed me and asked if I had any reference on what muscle is being used during the bench press.

I know what muscle works, but I did not know if what I knew was right; so I hit the books.

I found the answer but also some information on grip and bench press; plus which is better  – machines or free weights – when it comes to the bench press.

Enjoy!

What Muscles Are Working during Different Bench Presses?

What They Looked at

This experiment investigated the effects of varying bench inclination and hand spacing on the EMG activity of five muscles acting at the shoulder joint.

What They Did

Six male weight trainers performed bench presses under four conditions of trunk inclination and two of hand spacing at 80% of their predetermined maximum.

What They Found

- The sternocostal head of the pectoralis major was more active during the press from a horizontal bench than from a decline bench.

- The clavicular head of the pectoralis major was no more active during the incline bench press than during the horizontal one, but it was less active during the decline bench press.

- The clavicular head of the pectoralis major was more active with a narrow hand spacing.

- Anterior deltoid activity tended to increase as trunk inclination increased.

- The long head of the triceps brachii was more active during the decline and flat bench presses than the other two conditions, and was also more active with a narrow hand spacing.

- Latissimus dorsi exhibited low activity in all conditions.

Where to get more information – Barnett C. (1995). Effects of variations of the bench press exercise on the EMG activity of five shoulder muscles. 1995 Nov;9(4):10-14. (Yes, it is an oldie but a goodie.  Let me know if you have something more recent.)

If the research above interested you, make sure to get my free seminar that I did on exercise and shoulder injuries, you can get it here.

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I got  a guest post for you.

It is from Ben Greenfield.  I have been reading his stuff for some time and I asked him to send me a blog post.

I liked it and I know you will as well.  It talks about inflammation which is a huge issue in recovery from injuries, enjoy.

How To Recover Like Wolverine From X-Men

By Ben Greenfield, MS – Author of The Bulletproof Knee & Run With No Pain

Let’s make just one giant assumption and assume that you know all about Wolverine from X-Men.

You know he possesses animal-keen senses.

You know he competes like a super-human weapon.

You know he has retracting bone claws made from space-age metal.

And, perhaps, most importantly, you know he possesses a special healing factor that allows him to quickly recover from virtually any wound, disease or toxin.

Read the rest of this entry »

Hey, it is Friday, lets ramble.

Well, let me ramble.

More Rambles about Facebook

It is very cool to get comments like this on my Facebook account:

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Exercise Rehabilitation of the Shoulder

DESCRIPTION:

“Nearly 6 million people a year visit their doctor for shoulder pain, strains, dislocations or other shoulder related problems”

In the Exercise Rehabilitation of the Shoulder course, functional anatomy of the shoulder joint will be reviewed. In addition, common shoulder injuries (frozen shoulder, shoulder impingement, rotator cuff tear and shoulder instability) will be discussed, and rehabilitative principles and exercises for each will be presented.

OBJECTIVES:

What’s My Cue? (Part 2)

Addressing Shoulder Dysfunction Beyond the Shoulder Itself

By Tara Keller, BSc.(KIN), MES

Part I: The Kinetic Chain

Whether you work with multisport athletes or older adult populations it is common to see soft tissue stress surrounding the shoulders during repetitive actions like freestyle swimming or during sustained posturing at a computer. Excessive protraction, elevation and internal rotation (forward rounding) at the shoulder can narrow the joint spaces surrounding the shoulder itself and cause shoulder impingement and strain on the rotator cuff injury.

When we have areas of weakness or inflexibility, the body finds ways to compensate and perform movement, often putting our joints in these compromised positions. As a result, adverse tissue stress is often present before our clients are even aware of it; setting the stage for inflammation, soft tissue swelling and eventual scar tissue development to occur. In the realm of athletic training, elite athletes regularly display the best (or should I say, worst) compensation strategies in avoidance of addressing their foundational weaknesses. As a result, addressing shoulder pain and dysfunction when it does arise requires skilled practitioners to look far beyond the symptoms to uncover the silent triggers. Read the rest of this entry »

I have another interview for you today.

It is with Eric Cressey.

Eric is the author of a great resource for fitness professionals, called Assess and Correct.

Here is a testimonial that I sent Eric about the great resource he created:

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