Steven Tran – Sydney CBD Chiropractor
Shoulder pain is something that many of us suffer on a daily basis. Some shoulder pain can come from an acute injury or and a longer standing overuse injury. Often we ignore shoulder pain and do nothing about it; this is definitely the wrong attitude to have.
So what options do I have if I have shoulder pain? First lets understand what is the purpose of pain? Why is it important to move after a shoulder injury? What happens if you don’t move after an injury? What are some ways that you can modify your training to keep you active? In this article we will breakdown the process that occurs after an injury and how keep active and train around pain.
What is the purpose of pain?
Pain is an important warning sign from your body, to indicate that there might be something wrong. However, this is not a sign to completely avoid movement and exercises. In fact, exercises could actually help your symptoms depending on the type of pain you have. If you consider a rotator cuff strain or shoulder ligament sprain we experience acute pain and it may distressing. Our body’s natural response in this situation is initially to tense up and restrict movement, in order to protect the injured area. This protective mechanism usually last 24-48 hours but can be unhelpful long term.
Can movement help pain?
Yes. Movement can be an important part of your healing process and getting back to pre-injury activities/exercise. The idea is not to move enough to cause pain, but to move in very small ways. Start with small motions and build up to bigger and more functional movements. If small motion cause pain regress to passive motion. Passive motion is where you are moving a body part without actively contracting the muscles of that area. An example of passive motion is using your uninjured arm to gently push/pull your injured arm through gentle ranges of motion – aiming for a stretching sensations but not pain.
Why it’s important to move after an injury?
There is significant research that suggests exercise is an essential component in the treatment of pain. Exercise and movement helps improve function and reduce pain in people with musculoskeletal pain.1
So what happens when you don’t move?
- Scar tissue builds up in joints that are not moving. It’s believed that due to lack of movement, scar tissue is created in your joints. Hence, patients tend to report stiffness in their joints after prolonged periods of immobility, such as wearing a cast, sling or with bedrest.
- Poor joint repairing and restricted joint movement will occur if you’re not constantly reminding the body what kind of movement the joint is natural.
- Lack of joint movement will cause reduced fluid flow into the joint and the thus the joint will not get enough fluids necessary for proper healing, leading to stiffness, delayed healing and increased scar tissue.
How do I exercise around pain?
In an acute phase of your injury, the focus is to move slowly, carefully and without placing great resistance or load on the area. This may mean returning to the basics in the gym and decreasing the load (weight, distance, intensity) you are used to training at. We encourage movement early in your healing process to avoid our brain creating poor movement patterns, muscle imbalances, overload and increased pressure on joints. Be aware that in your acute phase of healing it is easy to aggravate your symptoms if you try to return to quickly to certain movements. Common sense is important in this stage – remain mobile but don’t push yourself through exercises or movement which are overly painful. If you’re not certain what movements are encouraged for your new injury consult your health professional for the best advice.
Not in the acute phase? Suffering from nagging or longer lasting discomfort? If pain is still affecting the way you move consider visiting a health professional such as a physiotherapist, chiropractor or osteopath. They can diagnose you appropriately, formulate a treatment plan and advise you best on how to return to exercise and movement in as safe as possible manner. Restoring your range of motion, building strength and correcting your movement patterns. Once you have mastered the basics you can build up to more complex exercises and add variety to your work-outs.
Here are 8 modifications to help you exercises around shoulder pain:
If you have shoulder pain and are trying to to get back into exercise consider altering range of motion, specific exercise selection, differing contraction types, body position, rest time, frequency, weight and rest.
- Range of Motion
- If shoulder front raise to overhead hurts your shoulder, try raising to 90 degrees or less of that range (where the pain is less than 2-3/10 on a pain scale). As you start to feel better – slowly increase your range until you are able to achieve full overhead motion (this may take a few days to a few weeks) .
- Exercises selection
- There are no magical exercises, all exercises have their individual benefits. Look for variety in your workouts. You may find that there is more than one way to strengthen a specific muscle or area of your body. For example – if your goal is to build strength you don’t have to specifically do lateral shoulder raises. Try alternatives like landmine shoulder press, bottoms up kettle bell press or squat machine overhead press
- Contraction Type:
- Try altering the contraction type you use of a specific muscle. If concentric (e.g. shoulder press – where you shorten your muscle) exercises are painful, maybe eccentric (slow lengthening of your muscle) or isometrics (e.g. kettle bell bottom up holds – muscle
- Body Position
- A standard lateral shoulder raise hurt? Lean into a squat rack or a wall. When we do this, we can go through our lateral raise motion and load up the shoulder. You may find this less painful as you avoid the very top range of motion because of your leaned in body position. Finding ways to tolerably load an area that hurts can make it start to feel better.
- Rest Time
- If you’re doing a workout around a timer and you notice your shoulder has started to act up when you’re fatigued, it may be a sign that you may need a longer rest period between sets until build up your endurance.
- Frequency
- Adjust the frequency to work around your tolerance. If training your shoulders 3-4 times a week brings pain, try reducing it to 2 times a week and replace the other days with supplementary exercises, mobility work or rehabilitation focused training.
- Weight
- If 3 set of 8 reps at 20kg on the shoulder press hurts, a simple adjustment such as de-loading to 4 sets of 8 reps at 15kg would be ideal, you are still reaching the same total volume
- Nothing
- Rest is ok! If you are suffering from an acute injury, it is fine to take a day or two off. Alternatively, if something hurts you could find an alternate workout or do something else, and come back to it later. The most important thing is not to fear pain! It’s normal and temporary.
However, if pain is still limiting your daily activities, training regime or you are unsure when to get back into exercises, speak to your chiro, physio or osteo to find the right modifications for you to get you back on track.
