…Tired of hurting?
…Confused about what to do with your shoulder pain?
…Worried about masking your shoulder pain with medications or having to
get injections or worse yet, surgery?
…Learn about natural healing options for your shoulder pain
…PUT YOURSELF BACK IN THE DRIVER’S SEAT
FOREWORD
By Karen Napierala, PT, MS, AT, CAFS
PT, Peak Performance PT & Sports Training
I was getting more into exercising myself…longer and harder types of things. Burpees, and planks were so popular, and I loved doing them. I had finally gotten to the point that real pushups were easy. Unfortunately that started to change was waking up every night after two hours of fitful sleep. I was sore in my right shoulder every day as I worked on patients and reached for things. I tried a few quick stretches, but it wasn’t helping. I do work out 5 days/wk and would add on some spine and shoulder exercises to my program, but nothing was changing.
“I don’t even know how I got this,” I thought to myself. I’m a PT, and I work out hard! I shouldn’t have this, but if I did, I should be able to fix myself!!!! I was even starting to dread going to sleep because it was just uncomfortable to lie in any position and especially painful to move after I was in any position for a while. I was so frustrated. It literally got depressing. I couldn’t reach or cook, or carry things the way I used to. I had always prided myself on how much I could do for my age! After a while I started noticing that I hurt down in my elbow, and I couldn’t straighten it any more.
Finally, I had to ask my husband, Mike, for help. He wasn’t the last choice by any means, but he was very busy running Peak PT, and I hated to add more onto his plate. My elbow was sore and stiff, but I thought it was just maybe something small that needed a quick fix and I would be back on track. My elbow hurts, but at my age and intensity of exercise, that happens, right? I ended up going to an orthopedist, who reminded me that my elbow was really worn out! I mean arthritic, like an old person… (I just turned 60 this year, and I have never really embraced the fact that I am old!)
It turns out that your elbow is pretty important because it is connected to your shoulder. If the elbow isn’t doing its job, the shoulder needs to step up. Mine had been taking over, and it was screaming for me to give it some rest, or change the forces on it!!!
Looking back, it is so obvious that the pain and arthritic change was compensation from my exercise regimen that I was doing to create positive change yet it created negative! I also had a very old fall or catapult off of my bike 25 years prior that helped create my old elbow injury.
The good news: In both cases, a shoulder that experiences a trauma, or one that as an unknown origin of pain that takes years of small stress to be felt, PT is a low cost, low risk, effective option. While there are times that MRI’s are necessary and useful or medications and injections are indicated, and even that surgery is eventually necessary…these options are expensive and not always needed initially before PT. They are also higher risks for side effects.
The key to successful treatment is addressing the real underlying cause of symptoms, and then fixing it!
At Peak PT, we want you to not only feel better, but to BE BETTER.
Hope these next ten burning shoulder questions help you to understand how to BE BETTER!
KAREN
OUCH, my shoulder hurts! At some time we’ve all felt this. Here’s some answers to the questions you may have asked when YOUR shoulder pain kept you awake, made you stiff in the morning, or stopped you from reaching, throwing, or leaning on your arm…
- How long is this going to take to go away?
In general, it takes 4 weeks to go through the first 2 phases of healing (to reduce pain and restore movement). Certainly every person and every injury is unique. For some in days or a week their pain is much less…for others it takes longer. It’s usually quicker when you address the problem earlier vs having been in pain for weeks or months (and for some, even years!) before coming to PT for help.
It may take another 4 weeks to get your strength increased substantially (3rd phase) and then be able to actually do your activities (ie, like lifting objects) or move more quickly reaching or with athletic demands (4th phase) “Feeling better” means you have reduced the stress on the injured or angry tissue that’s causing your shoulder pain. “Being better” means that you have developed the underlying mobility, control, stability, and strength to resume your normal activities without recreating your irritation.
Healing also depends on you! Besides your ability to follow the plan, there are some variables that determine how fast someone like you can heal:
(Remember there are always exceptions like Aunt Mary who didn’t always follow any healthy rules and was still just fine… or your friend, John, who was healthy to the max, and still had pain.)
- Overall health. Healthy people heal faster. Younger people heal faster…in general.
- Other underlying health issues such as diabetes, heart disease, high blood pressure, tobacco or alcohol use and body weight all influence healing rates… and increase healing time.
- Prior injuries. If you’ve had injuries to other body parts or recurring injuries to the same body part or those nearby those other areas may have to be exposed and corrected. Sometimes the unresolved issues from those “old” injuries can be contributing to why your shoulder hurts. (ie. An old car accident, throwing injury, or a fall that either hurt your shoulder, neck, or back.)
- Rest levels. Sleep and rest rebuild injured tissue. A lack of this will slow healing time. Your job is to create the environment for your shoulder that will heal the fastest with the least negative stress on the shoulder tissues that hurt!
- High stress levels can mean healing more slowly.
- Sed
- People who follow thru with their plan of care in PT and listen to the advice and instruction of their PT or health care provider just plain heal faster! Research has shown that coming to PT twice a week can shorten the healing time significantly over only coming once a week.
- Awareness of your posture throughout the day, and how they affect the shoulder. People that sit up straighter, and have better posture and spine mobility… heal quicker and in general have less shoulder and neck pain. Not only can you adjust your sleep or sitting positions to relieve pain, but you can help your shoulder by your posture!!! Yes, your neck and shoulder are intimately connected!
Try this. Slouch (more than you already are 😀) – and then lift one arm overhead. Now, sit up really tall. Lift that arm overhead again. Do you notice how your shoulder feels freer at the top and moves higher toward the ceiling?
And… Last but not least – you’ve got to have HOPE! Having optimism about what’s possible, that you can get better…that hope allows you to be more persistent to not let little setbacks stop you! The question is: what do you do with these setbacks? It’s totally normal to have some “downs” along with the “ups” during your recovery. We’ll be right there with you to encourage and guide you during these times.
2. How long before I see improvements?
Most people we see at Peak start to feel better within the first 2-3 visits and others within the first two weeks. You will usually get better in stages with pain reducing first and then typically motion improving next. Movements like reaching away from your body or lifting overhead are often the last to return.
3. Can I be completely healed or will this come back again?
This is really a key question. . First, you have to “do the right thing” in your therapy to achieve the success of “feeling better”, right? But then, you’ve got to follow through and complete your PT to get to the actually “being better” part where you develop the capacity to do things again, where you become more resilient – you know…so you can “take a hit” that life throws at you and still bounce back without starting the whole cascade of injury again.
Most people who complete their program and continue with their exercises a few times a week will stay better. Yes, I do mean that you do your exercises for years….or forever. Listen, you take a shower, wash your clothes, or brush your teeth daily, right? These are forever things also. But we tend not to think twice or balk at that! Why? Because we’ve come to realize they are necessary for health.
So, for shoulder problems that weren’t from a “trauma” but rather came on gradually over time (that’s most by the way!) chances are that the underlying shortcomings of tightness or weakness or poor movement patterns that originally caused your pain to develop can be a “comfortable habit” sort of place your body wants to go back to (like plaque on your teeth). You have to keep enough strength and motion in the right places to keep the pain gone.
4. Do I need special equipment?
We don’t do big and fancy. If you are going to do this at home we will use your own home equipment. Once you are ready for resistance, you can use weights you have or you can ad lib with a can of beans, a water bottle, or the inexpensive resistance bands you can buy right from us at Peak Performance. There are many times that your body weight will suffice if done right! There is the possibility that we will look at your home office or work set up to check on where your stresses come from. You may have to think about a raised desk, a chair modification, or a second keyboard. Or just rearranging your area. Sometimes those things may require special equipment. We don’t sell office chairs but we do have great “gadgets” for laptop users that help improve your set up and provide adaptability to standing or even sitting on the floor.
5. Should I use heat or ice on my shoulder?
Ice is great for decreasing the pain! It is an anesthetic – so it really temporarily numbs all sensations. And relieving pain is definitely helpful, even if just temporary. The same for heat which often relaxes and soothes an area. Heat is an analgesic, meaning it’s a pain reliever – but for some the higher sensory reduction from ice may be their preference…even though those first minutes aren’t so fun.
Newer research has shown us that ice may not have as much effect by reducing swelling as was originally thought. Many of you have heard that you should use ice the first 24-48 hrs and then change to heat. That was actually a “theoretical” concept and never really proven with research to be true. But old adages can be hard to forget. Heating in the 1st few days of an injury is generally still not recommended and then after that trial and error for best results may be your best bet. In general we find that more “experienced” (i.e. older 😀) joints with wear and tear (arthritis) often like heat. Use the one that makes you feel better for the longest time.
6. What exercises should I do?
This is a crucial question. Picking the right exercise for you is the key. As a matter of fact there are 4 keys:
A. Do you need movements/exercises to take your pain away?
B. Do you need to restore motion?
C. Is this a strength issue?
D. What are your underlying factors that caused your issue?
If we have 10 patients with the generic diagnosis of “rotator cuff tendonitis” what would we, at Peak, give them to do? Well – consider this. There are more than 10 bones and 27 muscles in the shoulder/ arm. Then include the neck and thoracic (mid-back) spine and all of its muscles. Each of these patients is in a different profession, different body types, different underlying causes, and different weaknesses…etc.
The bottom line is that there is no “one size fits all” exercise program! It requires a full biomechanical and functional evaluation to decide where to start and where to progress.
Some small percent of people will “luck out” doing some generic exercises they found on the internet or that their “buddy did in PT” or that their personal trainer showed them for a shoulder. But we’ve seen plenty of those people who spent hard earned money on things that essentially were a waste of time and effort, delayed their recovery, and in too many cases made their condition worse because they didn’t start with really knowing what it was that was causing their pain or what we call the “probable suspects” underlying it all to begin with.
7. How do I know if you need shoulder surgery?
There are times after a fall or a car accident or a bigger trauma that you may need surgery. Orthopedic surgeons are incredibly brilliant and a huge blessing to those who need changes made to their anatomy. But, the great news for most of you with shoulder pain is that most of the shoulder aches and pains people experience have been shown in research to be effectively and more economically treated with Physical Therapy. From tendonitis to impingement and even many rotator cuff tears (degenerative) PT has been shown to be as or more effective (and less costly) than doing medications and injections or surgery. For most shoulder problems a course of non-invasive, “conservative” natural care (ie, Physical Therapy) is the first approach that should be taken.
8. What if my MRI says I have a Rotator cuff Tear?
MRI can be an extremely valuable tool, or it can really scare you. Research shows that even when an MRI that shows a rotator cuff tear(“wear and tear“, degenerative…not necessarily if from an accident/trauma) that people do really well with Physical Therapy. And here’s the “scary” part about MRI’s – did you know a study from 2017 showed that 90 % of people who had a positive MRI for a rotator cuff tear on the painful/injured side also had a tear on the opposite side that they didn’t know about, and it didn’t even hurt! So we have to be careful about how quickly we rush to judgement on MRI findings! It’s normal to see changes as we age. Reading of an MRI by your surgeon, combining that with your symptoms and your function are crucial to making the right decisions for your shoulder! And, it’s been shown that when an MRI is done early in care that it often leads to a typical cascade of greater medical intervention (tests, visits, prescription meds, injections…sometimes surgery) compared to starting with conservative care despite not producing better outcomes…and certainly all that extra care/services end up costing you more in the long run.
9. If my shoulder hurts, does that mean I tore my rotator cuff?
The short answer is “It could be,” but in all likelihood – probably not. Let’s look at the simplest causes first. Many structures over time can stiffen up and/or become weak, or be pinched, and can cause resultant inflammation leading to pain from tendons and internal joint structures, but this doesn’t always indicate an actual muscle or tendon tear. It’s more often a “tendonitis”, or a “bursitis”, or neck pain sending signals to your shoulder. Getting the shoulder evaluated by a skilled professional like a PT or your physician/orthopedic specialist is the first step in figuring out not only what exactly is causing your pain but then what the right thing to do about it is.
10. Should I have shoulder pain with stretching?
Take your finger and push it backwards until you feel tension. That is a stretch. That “discomfort” of about a 1-3/10 is ok. If you pushed it farther would it hurt so much that you wanted to let go? That is probably a 4-6/10 or PAIN! You don’t want to get to the point where you tense up and contract your muscles during a stretch. That extra tension will not allow you to relax enough to stretch the tissues long enough to get lasting changes. You can always find an alternate path, angle, or position to accomplish the goal, and still feel the stretch.
BONUS QUESTION:
11. My shoulder hurts so much I can’t sleep! What can I do?
Here is a suggestion:
– If your left side hurts, start with your pillow height such that your head is in neutral (head not tipped to either side). Then place a pillow folded over and another pillow over top lengthwise. Lay on your left side placing the pillow under your ribs and your left shoulder falling into the gap between your head pillow and the pillow under your ribs. (See below)
