WHAT SHOULD YOU DO AFTER YOU HURT YOUR SHOULDER?



Chronic shoulder pain has a major impact on the health of affected individuals, and unfortunately, statistics show that only about 50% of new shoulder injuries result in a complete recovery within 6 months. This is reflected in our practice as approximately one in three patients consulting in our clinic is for shoulder pain.


The reason behind this is that shoulder pain is very hard to manage due to the intensity of pain and the extent of arm use throughout the day. Whether washing your hair, putting on clothes, reaching for a plate, or your seat belt, it all requires a dynamic range in the shoulder. Furthermore, the shoulder is a joint that has a lot of mobility, which means controlling the movement requires a complex interplay and synchronicity between the shoulder muscle groups.


The shoulder joint is comparable to a golf ball sitting on a tee, where the golf ball is the arm and the tee is the glenoid joint. When everything is still, the golf ball sits comfortably on the tee, but any slight push can send it falling off the tee. That is where the muscles come into play to stabilize the ball no matter which direction it is pushed in. Like a suspension bridge, it is the cooperation of all the different muscles coming in from different angles that allow the shoulder to stay stable despite its high degree of mobility.




Due to the anatomy of the shoulder, the more common mechanism of injury is when the shoulder is pulled too far forward. Since the posterior aspect of the shoulder is reinforced by strong ligaments, the front part is generally more fragile. This is also because most of our daily tasks, be it typing on the computer, or washing dishes, or opening doors, it all involves having the shoulder more rounded forward.


To minimize the damage and pain irritation, we need to encourage the optimal positioning of the shoulder. Since the shoulder joint consists of its connection to the collar bone, shoulder blade, neck, and upper back, it is important to consider these parts as well in it’s management.


Here are few things you could do to diminish shoulder pain:



1. SLEEPING



Sleeping is always the first topic because this is so important for any healing and recovery to take place.


  • BACK SLEEPERS

When sleeping on the back, it is important to have only one pillow under the neck and avoid having the shoulders lie on the pillow. Too many pillows or having the shoulders on the pillow would encourage the shoulder in the forward and fragile position. You can also put a cushion under the elbow, elevating the arm slightly, as this will help relax the commonly tight anterior shoulder muscles and bring the shoulder backwards into a resting position.



  • SIDE SLEEPERS

By sleeping on the non-injured side, we can prevent direct compression and irritation of the shoulder joint. When we sleep on our sides, our bottom shoulder naturally slides forward to accommodate space for our shoulder blade. Although normally this position is quite comfortable, when you have a shoulder injury, this rounded shoulder position becomes a position of impingement. It is best to avoid these impingement positions as the tendons are prone to being pinched against the shoulder bones within that range.


Instead, try to lie on the unaffected shoulder but make sure there is support for the top affected arm. You can put a pillow under the injured arm to prevent the shoulder from rolling forward and also helps to support the weight of the arm.



  • STOMACH SLEEPERS

Stomach sleeping is the least ideal position for a healthy shoulder, but if it affects your quality of sleep by changing position, you can put a cushion under your injured shoulder and keep your arm down to keep your shoulder in a supported position to avoid gravity dragging the shoulder forward.



2. GETTING DRESSED



Getting dressed is a task we need to do at least twice a day, therefore avoiding pain from this is crucial.


During the recovery process, the easiest is to wear an open button shirt in the front or very loose neck.


  • PUTTING ON CLOTHES

First, try to keep your injured arm in the front of the body with elbow bent, this will demand much fewer shoulder muscle contractions, especially if it’s a heavy jacket. Put on the sleeve of the injured side first, then reach back with the no-injured arm to put on the other sleeve.



  • TAKING OFF CLOTHES

Unbutton the front, take off the sleeve of the non-injured side first. Then have no-injured arm pull off the whole shirt from the front of the body.


  • PUTTING ON A BRA

Avoid reaching back, tie up from the front, then rotate the buckles to the back. Or you can simply wear bras that close from the front



3. REACHING



Keep the elbow bent as a short lever arm, this will diminish the load on injured shoulder muscle/tendon.


Try to come closer to the object using hips and legs, before reaching out with your arm.


The movement would basically in a few steps:

  1. Come closer with feet
  2. Bend elbows then straighten elbows to reach (avoid reaching with elbows straight)
  3. Pick up the object, bring it closer to the body by bending the elbows
  4. Then step back


4. LIFTING



Keep objects close to the body to encourage core engagement, therefore keep elbows bent and try to use both arms.



5. DESK WORK



Please refer to this blog post to see how to properly set up your workspace. A couple of things need to be highlighted.

  • The use of a lumbar roll can help the upper back being less slouched and thus bring the shoulders back to the optimal position.
  • Keep elbow at table level and near body would allow shoulders in a relaxed position instead of overusing shoulder muscles
  • Ensure that the screen is at eye level and not too far, this will avoid neck protruding forward and thus keep shoulders back
  • Use the office char to turn when reaching further objects to encourage shoulder short lever arm movement and minimize muscles over- contraction.


6. STANDING/HOLDING



Our whole arm actually has a certain amount of weight, in a standing position, gravity can drag the arm down and create an excessive load on the shoulder.


In severe acute cases, such as traumatic sports injuries, you can wear a sling.

In a less painful case, simply put your hand in your pocket to support the arm weight.


When holding grocery bags or heavy objects, using bigger core muscles would be a lot more energy and movement efficient, therefore keep the elbow bent and close to the body.


Another example would be when opening a heavy door, hand on the handle, elbow tucked to the body, use your leg to advance forward, and use the whole body to push the door open instead of solely pushing from your arm.



CONCLUSION



As forward unwanted force is the most common mechanism of injury, here is a little summary to avoid shoulder being in a painful position:


  • AVOID reaching back - keep the arm in the front of the body
  • Bend the elbow - SHORT LEVER ARM
  • Elbow tucked to the body - USE BIGGER CORE MUSCLES


When it comes to sport biomechanics, there is even more specific recommendation depending on the type of sports you are playing.


This is a recommendation for everyone for everyday activities, if other movement or position hurts your shoulder, definitively bring it up to your treating therapist to help you with modification and make that healing process easier for you.