What should you do after you hurt your Shoulder?

Intro to the 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 the first 6 months.

In our practice, this equals to approximately one in three patients who consult for shoulder pain.

The reason behind this is that shoulder pain is very hard to manage due to the intensity of pain and the amount we use the arm 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's Stability:

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.

This is where the muscles come into play to stabilize the ball regardless of which direction it is pushed in. Like a suspension bridge, it is the cooperation between different muscles coming in from different angles that allow the shoulder to stay stable despite it’s high degree of mobility.

Due to the anatomy of the shoulder, the most 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 prone to injury. This is also because most of our daily tasks, like typing on the computer, washing dishes, or opening doors, all involve having pushing our shoulders forward.

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

Tips to Diminish Shoulder Pain:

1) SLEEPING:

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

Back Sleeper:

When sleeping on the back, it is important to have only one pillow under the neck and avoid having the shoulder on the pillow. Too many pillows or sleeping with the shoulders on the pillow would encourage the shoulder to be tilted forward and in a more irritable 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 further back into a resting position (If you're wondering, the resting position of the shoulder is in 30 degrees of flexion, 30 degrees abduction, and slight internal rotation).

Side Sleeper:

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 positions because the tendons are prone to being pinched against the shoulder bones in that range. Instead, try to lie on the unaffected shoulder but make sure there is support for the affected arm (that is on top). You can put a pillow under the injured arm to prevent the shoulder from rolling forward and to help support the weight of the arm.

2) GETTING DRESSED:

Getting dressed is a task we need to do at least twice a day, therefore avoiding pain from this task is crucial. During the recovery process, the easiest clothing option is to wear a button up shirt or to wear a loose collar shirt.

Putting on clothes:

First, try to keep your injured arm in the front of body with the elbow bent, this will require much less shoulder muscles contraction (especially if it’s a heavy jacket).

Start by putting on the sleeve of the injured side, then reach back with the non-injured arm to put on the other sleeve.

Taking off clothes:

Unbutton the front and take off the sleeve of the non-injured side first. Then have the non-injured arm pull off the whole shirt from the front of the body so you don't need to use the injured arm.

If you are wearing a T-shirt type of top, then bend both elbows, keeping the arm close to you, and pull the collar of the shirt just above your head. You can use the un-injured side to do more of the pulling. Then using the un-injured arm, pull up from the bottom of the shirt so it clears your head and then you can pull the shirt down the arms to clear the sleeves. Do not have your arms overhead to take off the shirt as this would be painful.

5) WORK DESK:

Please refer to the pictures/checklist below.

There are a couple of things that need to be highlighted.

The use of a lumbar roll can help prevent slouching by bringing the low back into a neutral spinal alignment, which will also help the shoulders/upper back/neck to an optimal position
By keeping your elbows at a table level close to your body, you are allowing your arms/shoulder to be in a relaxed position rather than overusing them
To avoid your neck from protruding forward and causing shoulder pain, make sure your screen is at eye level, and tuck your chin in.
When reaching for a distant object, make sure to turn your chair fully, rather than just your back, to prevent over-contractions of the muscles

6) STANDING/HOLDING :

In the standing position, gravity can drag the arm down and create an excessive load on the shoulder. In severe acute cases such as traumatic injuries from sports, it may be recommended to wear a sling. In less severe cases, you can simply put your hand in your pocket to support the weight of the arm.

It is not recommended to use a sling for the arm without it being advised professionally as the sling position, with the arm on the belly, can in fact be an irritable position for the shoulder if kept for a long period of time.

When holding grocery bags or other heavy objects, you should keep them closer to your body in order to minimize the muscle contractions necessary to lift the bags. This will prevent irritation of the shoulder.

CONCLUSION:

Seeing as the most common mechanism of injury is prolonged anteriorization of the shoulder, here is a summary to allow your shoulder to remain in a comfortable position throughout your day:

AVOID reaching backwards and keep your arms in the front of the body
Bend your elbow to create SHORT LEVER ARM
Keep your elbow tucked into your body to engage BIGGER CORE MUSCLES

When it comes to sport bio-mechanics, there are even more recommendations depending on the type of sport you play. These recommendations are designed to help people experiencing shoulder pain with their daily activities. If other movements or positions hurt your shoulder, bring it up to your therapist who will further assist you in your healing process.