Shoulder Pain and Injury

By Richard J. Jusko, PT

Appeared in “Therapeutic Outlook,” Spring, 2008

Shoulder injuries are one of the most common joint problems in professional or recreational athletes, industrial laborers, and office workers. The most important aspect of shoulder pain control is to be aware that active exercise of proper intensity, duration, and especially proper technique is much more beneficial than quiet rest for the injured shoulder.

Types of Shoulder Injuries

Traumatic injuries
Onset: Dislocation, labral tear, ligament tear, or rotator cuff rupture resulting from a traumatic event, such as falling on an outstretched arm or catching oneself on a handrail when falling down stairs.
Treatment Approach: These injuries require PRICE (Protection, Relative Rest, Ice, Compression, Elevation) and a consult with a medical professional.
Repetitive strain injuries
Onset: Overuse from throwing, swimming, overhead sport activities and repetitive movements.
Treatment Approach: Relative Rest and a thoughtful approach to improving the physiologic condition of the injured area.
Postural dysfunction
Onset: These conditions are quiet shoulder antagonizers and a covert precursor to shoulder pain (also known as, “I reached for my alarm clock and got a sharp stabbing pain on top of my shoulder”). Postural faults may cause stiffened upper back and faulty positioning of the shoulder blade or shoulder socket. Postural dysfunction quietly wears and tears the rotator cuff, overloads the shoulder joint, and biomechanically weakens the support that muscle, tendon, and ligamentous shoulder tissues provide. During postural dysfunction, the shoulder joint assumes positioning that also typically occurs with a shoulder injury.
Treatment Approach: Treatment requires physical exercises, such as stretching of specific tight structures and strengthening of noted lengthened or weak structures.

Once you are injured

Shoulder injuries require proper individualized exercise instruction to help guide the timing and coordination of the muscles that control shoulder function. The muscles and soft tissues all work together in a coordinated mechanism to move the complex shoulder joint.

Traumatic injuries need medical assessment to determine the extent of injury prior to exercising. Medical tests expected at this time include X-ray, MRI, Arthrogram, and physical assessment by a medical professional. Extra care needs to be taken to protect damaged structures and promote controlled exercises to prevent further injury.

Repetitive strain injuries intervention includes a physical assessment of the tissues involved. Injury disrupts the normal mechanism of functional reach, lift, push, and pull, causing a characteristic “shrugging” of the shoulder which needs to be inhibited to promote healing. Intervention for repetitive strain injuries may also include stretching tight structures, strengthening weak structures, and discussing the mechanics of the activity in which the individual is participating.

Postural dysfunction will also benefit from the same type of intervention as the strain category, with additional instruction and more specific treatment for rib cage and thoracic spine position and mobility. Common daily activities, such as driving a car, watching TV, text messaging, using hands in front of the body for eating, or reading a book, and postures for working in the kitchen sink all contribute to a forward-bent upper back. It takes a bit of knowledge and regular work to combat gravity and to not allow ourselves to posturally disintegrate into a slouched posture.

Shoulder pain and dysfunction requires medical intervention. Your physical therapist can help evaluate and treat shoulder injuries and dysfunction to help get you back to enjoying a pain free and active lifestyle.