During National Chiropractic Health Month 2019, the American Chiropractic Association is focusing on how musculoskeletal health leads to strength, stability and ultimately the success of a life lived more fully and actively. In today’s Medical Monday, Dr. Allen examines why women in mid-life are more likely to develop shoulder problems and ways to treat and prevent it.
Dear Dr. Pat,
Recently, I started a more frequent upper body exercise program using a video recommended by a friend to prepare for an upcoming summer wedding and a sleeveless dress. I injured my left shoulder and I have no idea how it happened. Certainly, it wasn’t a sudden event.
My chiropractor told me that the injury occurred from overuse with the new exercise program. (I was doing the routines everyday.) He recommended over-the-counter drugs like Ibuprofen, rest and physical therapy. That was two weeks ago and I am not much better. Suddenly there seems to be an epidemic of shoulder disorders among women my age. None of them were immediately aware of any acute injuries but, over time, developed significant restriction of movement and pain that seemed to take forever to resolve. None of them had surgery but everyone did need physical therapy.
What causes shoulder injuries? It seems that my friends have been given different diagnoses for their shoulder pain and dysfunction. What can women do to prevent damage to their shoulders?
Susan
Dear Susan,
Shoulder pain and restriction of movement of the shoulder are common concerns of patients in my practice. I work with a trusted team who will provide a diagnosis and a treatment plan for recovery. I am not surprised that you have not noticed significant improvement in only two weeks of work with the physical therapist. The shoulder is a very complicated part of our musculoskeletal system and is used all the time even when we think we are “resting” it. I am glad that you were referred to a physical therapist who should be able to guide you through a program that will improve range of motion and decrease pain. The anti-inflammatory medication that you were told to take is a common first line treatment to help with the damage to the shoulder joint. If you do not notice improvement in a month, or if the pain increases or range of motion decreases, ask your medical team if you should have an evaluation by a physiatrist. These medical doctors specialize in the non-operative management and rehabilitation of common sports and other musculoskeletal injuries. The physiatrist may order imaging tests of the shoulder to help with a more precise diagnosis and treatment plan.
The shoulder joints move every time you move your arms. The shoulder is a ball-and-socket joint with three main bones: the upper arm bone (humerus), collarbone (clavicle), and shoulder blade (scapula). These bones are held together by muscles, tendons, and ligaments. The shoulder joint has the greatest range of motion of any joint in the body. Because of this mobility, the shoulder is more likely to be injured or cause problems. The Acromioclavicular (AC) joint, which lies over the top of the shoulder, is also easily injured. The muscles of the shoulder complex provide stability and movement. During shoulder movements such as lifting, certain muscle groups help to move the shoulder, while other muscle groups help to stabilize the shoulder complex. Much of the stability in the shoulder complex is provided by this muscular coordination.
Women in mid-life are more likely to develop shoulder problems, which can be minor or serious. Shoulder injuries most commonly occur during sports activities, exercise without proper form or with the use of weights that are too heavy, and work-related tasks or projects around the home. Poor posture, carrying heavy purses or work-bags, muscular weakness, or ligament injury can lead to abnormal biomechanics of the shoulder, which can result in abnormal forces in the shoulder. Over time these abnormal forces can cause injury to the soft tissues or the articular cartilage of the glenohumeral joint.
The most common causes of shoulder pain are:
Osteoarthritis occurs when the cartilage protecting the joints wears down. It is known as “wear and tear arthritis” because it tends to be linked to long-term overuse off the joints. Previous injury to a joint is another common cause of this kind of arthritis.
Rotator Cuff Injuries involve the group of four muscles and tendons that surround the shoulder joint, keeping the ball (head) of the upper-arm bone (humerus) in the shoulder socket. It protects the shoulder joint and allows movement of arms over the head. It becomes especially important in sports like baseball, swimming, or tennis. Common injuries to the rotator cuff include rotator cuff tear, tendinitis (an inflammation or irritation of a tendon that attaches to a bone), or bursitis (when the bursa, a small sac filled with fluid that protects your rotator cuff, gets irritated).
Frozen Shoulder is a common condition in which the shoulder stiffens, reducing its mobility. It occurs when the capsule of connective tissue that is lining the shoulder joint thickens and becomes inflamed also known as adhesive capsulitis. When frozen shoulder develops spontaneously, without a prior shoulder injury or operation, physical therapy often plays an important role in the management of this condition. A physical therapy team works with your physician to develop a plan suited for you and helps you return to your regular routine as quickly and safely as possible. When you first meet, the therapist will evaluate your injury, take your medical history, listen to your fitness goals and help you develop a plan to reduce inflammation, restore range of motion and rebuild muscle strength. In most cases, your therapist will teach you exercises you can do at home. Do not discontinue your physical therapy without consulting your doctor.
Treatment: In addition to a supervised physical therapy program, analgesics and non-steroidal anti-inflammatory drugs (NSAIDs), such as acetaminophen, ibuprofen or aspirin are often recommended as a first line of treatment. These over-the-counter pain relievers help reduce pain and inflammation associated with frozen shoulder. Always take your medications as prescribed.
The good news is that women are becoming more physically active, often for the first time over forty. However, prevention of injuries is understandably crucial for women to continue to participate in exercise programs and competitive sports like tennis and golf. Exercise has tremendous health benefits and I encourage most of my patients to remain very active, unless they are over-training. The bad news is that participating in a high intensity activity can lead to injuries in those who have not done their homework before embarking on strenuous physical activity.
Once you have been cleared by your chiropractor and physical therapist to resume exercise involving the upper body, do so with a skilled personal trainer. Physical therapists often work with personal trainers who can continue to help with the recovery from the shoulder injury while increasing strength and mobility around the shoulder girdle and working on the development of those upper arms for that summer sleeveless dress. Take it slow and get expert training for the best results.
Dr. Pat
