As more people find themselves in Florida during both seasonal months and permanently, activity levels seem to increase as well. Due to the (mostly) beautiful weather encountered on a daily basis, recreational activity participation becomes an essential part of the everyday life. This may include exercises within the home, body weight exercises, cardiovascular exercises, or sporting activities. As these become more regular, so too, unfortunately, do injuries. A common issue that occurs with increased activity are shoulder pathologies due to the novel stresses being applied to the upper extremity.
A common issue that occurs with increased activity are shoulder pathologies due to the novel stresses being applied to the upper extremity. Shoulder rehabilitation can be challenging for a variety of reasons. Due to the many degrees of freedom within the joint, properly stabilizing and strengthening the shoulder can be difficult. Unlike the knee or elbow which simply flexes and extends, the shoulder moves in many more motions. While the shoulder also flexes and extends, it also abducts (moves away from the body) and rotates internally and externally. Because of all the available motion in the shoulder, strength to control this motion becomes essential to properly move through any range of motion.
The shoulder joint is a ball and socket joint where the humerus (upper arm bone) fits into the scapula (shoulder blade). The clavicle (collarbone) moves to the shoulder and connects to the acromion, which is a small projection off of the scapula. This acromioclavicular joint forms the superior (top) aspect of the shoulder joint. Several other important structures also attach to the shoulder. The rotator cuff is four muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) that attached to the scapula and work to rotate and elevate the shoulder. The deltoid muscles (anterior, middle, posterior) are the primary movers for the shoulder joint to raise the upper extremity. The trapezius muscles (upper, middle, lower) work to rotate the scapula for normalized scapulothoracic rhythm. The labrum is a round piece of cartilage that inserts in the scapula and works to hold the head of the humerus inside the shoulder joint.
Every part of the shoulder as described above has the potential to become injured or damaged through any variety of mechanisms. A fall can lead to a broken bone or tearing of the muscle. Repetitive motion issues from performing an activity or motion many times over any period can lead to “wear and tear” issues. Poor posture can cause compensatory patterns that can lead to radicular pains (feeling discomfort in an area other than where the issue is occurring). Lifting objects with excessive weight can damage the muscles and cause pain and injury throughout the arm. Although these are just a few ways to harm the shoulder and many others exist, proper treatment of these issues can be vital to reduce pain and improve function.
Initially, when the injury is acute or new, ice application to the location of pain and surrounding areas can limit swelling or edema. Nonsteroidal anti-inflammatory drugs (NSAIDs) can also be used to limit the symptoms during this stage. Examples include Aleve, Advil, and Motrin to name a few. Typically, these steps will be enough for any minor shoulder injury to allow the patient to return to their previous activity level. For more significant shoulder injuries the last longer and are more severe in nature, seeking medical attention for follow up is always an option. A primary care doctor or orthopedic specialist may recommend imaging such as x-rays or MRIs for further evaluation of the condition or may recommend seeking physical therapy intervention to reduce symptoms and return functional independence.
In order to properly return an injured shoulder to its previous state, range of motion (ROM), strength, stability, and proper postural alignment must return to ensure full safety of the joint. As mentioned above, ROM is very intricate at the shoulder joint. Therefore, basic exercises to work on the general movement of the joint need to occur consistently. By simply raising the arm straight in front of the body as high as possible without increasing pain symptoms, the patient can independently improve their mobility. The same can be done by raising the arm to the side or raising the arm behind the body. Strengthening is vital to ensure proper stability and function for the shoulder with daily activities. Due to all the motions and related muscles that function to complete those motions, strengthening for the shoulder is complex. Moving the arm through a comfortable ROM while holding a weight is an easy way to strengthen the shoulder. The shoulder can also be strengthened by pushing up from surfaces using the arms to raise the body. Proper posture is an essential part of exercising the shoulder. Ideally, the patient will be sitting/standing with an upright positioning where the ear, shoulder, and hip move into in a straight line. With computers, cell phones, gravity, and even boredom constantly pulling our head/neck forward and causing us to slouch, maintaining an ideal alignment ensures the joints and tissues move appropriately. A simple way to practice proper posture is to stand with the back against a wall and try to place the buttocks, shoulders, and back of the head all on the wall. This ensures the patient becomes aware of the positioning to work on in everyday life. Another way to practice maintaining appropriate alignment is to practice a scapular retraction. This is done by moving the bottom of the shoulder blades down and back, attempting to pinch them together at the low back. This should be held for a few seconds and then relaxed. This exercise ensures the shoulders align over the hips, as described above.
While this is a brief introduction to the shoulder joint, I hope it is found with understanding and optimism that you, the reader, feel more comfortable addressing your own issues in the future. I highly recommend reaching out to a licensed physical therapist any time an injury or pain occurs as we are educated to be the “movement experts” and have the skill and knowledge to help return you to all your desired activities. A comprehensive evaluation can then be performed and a plan of care can be established to ensure all your goals are met. Please reach out if any other questions require answers and we look forward to helping in the future.
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