As a society we are obsessed with the idea of thinness, there is a preconceived notion that our level of fatness is the best indicator of our overall health. A recent book, The Obesity Paradox by Cardiologist
We use our shoulders for just about everything so when injury strikes it can be extremely debilitating. It can turn mundane tasks like carrying groceries into a gruelling performance, not to mention more physically demanding activities like playing recreational sport or working out. Whether you’re working at a desk, building a cubby house, trying to improve your overhead squat, or chasing that elusive 4th grade rugby premiership, shoulder pain can have an enormous impact on your wellbeing and prevent you from achieving your goals.
But because we use our shoulders so much, injury is almost inevitable so it is no surprise approximately 70% of people will experience shoulder pain at some point in their life. However, there are methods we can implement which can prevent an injury from occurring, or at the very least, prevent subsequent reinjury.
So, what causes it? We often hear about the big impact-related injuries such as a shoulder dislocation, but the far more common injuries affecting office workers and athletes alike are shoulder impingement and tendinopathy. They often go hand in hand – here is a brief run-down for each:
Impingement:
- Generally caused by a lack of mobility and muscular imbalances, impingement occurs when a tendon or bursa is irritated at a particular range of motion. It is characterised as a sharp pain when the shoulder is in a certain position, but the pain will generally subside outside of this position.
Tendinopathy:
- Tendinopathy is a disorder of the tendon where it becomes inflamed or diseased, resulting in pain and dysfunction. This pain is generally sustained over longer periods of time and feels more like a constant ache. This is usually caused by a repeated movement aggravating the tendon.
What can you do about it? If you find you often get an aching upper back at work or are regularly hunched over at your desk, it may be worth considering your working posture. When we hunch over, our shoulders can become rounded. This then puts them at a greater risk of future pain or discomfort due to the poor position of the scapula. Typically, we are told to stretch out our chest and other anterior muscles. This will provide some short-term benefit, but in order to get a lasting effect on our posture and shoulder position, we need to incorporate some exercises as well.
Current research suggests that strengthening the muscles of the back, particularly the ones around the scapula, is going to help improve shoulder movement competency and reduce the chance of acquiring an impingement injury. Taking this into account, make sure to include a variety of compound ‘pull’ exercises in your gym routine to target some of the larger back muscles, such as seated row, lat pull-downs and single-arm row. Also include some exercises designed to improve mobility, stability, and control of your shoulder such as YTWs, band pull-aparts, push-up plus, and face-pulls. The aim of each of these is essentially to depress and retract your scapulas, which will help to counteract a poor scapula position caused by prolonged sitting and muscle imbalances. Doing these in conjunction with some chest, back, and lat stretches will help maintain healthy shoulder function and prevent injury.
While there is an absence of literature linking sitting duration with shoulder pain, there is a relationship between sitting time and a lack of thoracic mobility. This lack of mobility can then result in poor scapula position and rhythm, as well as decreased shoulder strength. Therefore, while at work try to avoid that hunched posture, and try to get up and moving every hour or so to break up long periods of sitting.
If you work a more active job where you’re constantly having to lift and move things, or if you have an office job but play recreational sport, it is important to prepare the shoulder for the stresses it may experience. Also consider how much work you are doing with your shoulders. Try to ease yourself into these movements if you haven’t done much of it before – i.e. avoid playing 4 hours of tennis if you haven’t played since you were 14 – work your way into it. Likewise, if it is part of your job, strengthen up your shoulder and avoid working through pain as this is more than likely going to make things worse.
Tendinopathy injuries are often the result of overuse, particularly if those tendons aren’t used to the forces they are being exposed to. We typically associate this type of injury with rotator cuff dysfunction, and current research has suggested that poor cuff strength has a direct relationship with shoulder injury. One particular systematic review of the literature looked at the efficacy of treating shoulder tendinopathy with eccentric strength training of the rotator cuff. They concluded that this particular mode of exercise reduced shoulder pain and increased strength in their patients. However, we can prevent this kind of injury altogether by strengthening the rotator cuff via eccentric banded internal and external rotation exercises. Performing these in conjunction with some of the other exercises mentioned earlier, is a great way to condition the shoulder and prepare it for both the workplace and weekend activities.
Regardless of whether you find yourself in front of a computer all day, or keep fairly active throughout the week, avoid hitting a roadblock because of a sore shoulder by keeping them strong and mobile.
Lachlan Border is one of our Senior Trainers based in Brisbane. See his profile here.
References:
1. Baker, D. and Newton, R. (2004). An Analysis of the Ratio and Relationship Between Upper Body Pressing and Pulling Strength. The Journal of Strength and Conditioning Research, 18(3), p.594.
2. Barrett, E., Keeffe, M., Sullivan, K., McCreesh, K., & Lewis, J. (2016). Is thoracic spine posture associated with shoulder pain, range of motion and function? A systematic review. Manual Therapy, 25(98). doi: 10.1016/j.math.2016.05.171
3. Bullock, M., Foster, N., & Wright, C. (2005). Shoulder impingement: the effect of sitting posture on shoulder pain and range of motion. Manual Therapy, 10(1), 28-37. doi: 10.1016/j.math.2004.07.002
4. Cools, A., Johansson, F., Borms, D. and Maenhout, A. (2015). Prevention of shoulder injuries in overhead athletes: a science-based approach. Brazilian Journal of Physical Therapy, 19(5), pp.331-339.
5. Dabholkar, A. and Yardi, S. (2015). Effects of scapular muscle strengthening on shoulder function and disability in shoulder impingement syndrome (SIS) -A Randomized controlled trial. International Journal of Therapies and Rehabilitation Research, 4(4), p.26.
6. Hallman, D., Gupta, N., Mathiassen, S., & Holtermann, A. (2015). Association between objectively measured sitting time and neck–shoulder pain among blue-collar workers. International Archives Of Occupational And Environmental Health, 88(8), 1031-1042. doi: 10.1007/s00420-015-1031-4
7. Hrysomallis, C. and Goodman, C. (2001). A Review of Resistance Exercise and Posture Realignment. The Journal of Strength and Conditioning Research, 15(3), p.385.
8. Linaker, C. and Walker-Bone, K. (2015). Shoulder disorders and occupation. Best Practice & Research Clinical Rheumatology, 29(3), pp.405-423.
9. Kebaetse, M., McClure, P., & Pratt, N. (1999). Thoracic position effect on shoulder range of motion, strength, and three-dimensional scapular kinematics. Archives of Physical Medicine And Rehabilitation, 80(8), 945-950. doi: 10.1016/s0003-9993(99)90088-6
10. Luime, J., Koes, B., Hendriksen, I., Burdorf, A., Verhagen, A., Miedema, H. and Verhaar, J. (2004). Prevalence and incidence of shoulder pain in the general population; a systematic review. Scandinavian Journal of Rheumatology, 33(2), pp.73-81.
11. Macías-Hernández, S., & Pérez-Ramírez, L. (2015). Eccentric strength training for rotator cuff tendinopathies with subacromial impingement. Current evidence. Cirugía Y Cirujanos (English Edition), 83(1), 74-80. doi: 10.1016/j.circen.2014.09.001
12. Niederbracht, Y., Shim, A., Sloniger, M., Paternostro-Bayles, M. and Short, T. (2008). Effects of a Shoulder Injury Prevention Strength Training Program on Eccentric External Rotator Muscle Strength and Glenohumeral Joint Imbalance in Female Overhead Activity Athletes. Journal of Strength and Conditioning Research, 22(1), pp.140-145.
13. Park, S., & Yoo, W. (2013). Effect of Sustained Typing Work on Changes in Scapular Position, Pressure Pain Sensitivity and Upper Trapezius Activity. Journal of Occupational Health, 55(3), 167-172. doi: 10.1539/joh.12-0254-oa
14. Roetert, E., Ellenbecker, T., Chu, D. and Bugg, B. (1997). Tennis-Specific Shoulder and Trunk Strength Training. Strength and Conditioning Journal, 19(3), p.31.
15. Safeworkaustralia.gov.au. (2016). Statistics on Work-Related Musculoskeletal Disorders. [online] Available at: https://www.safeworkaustralia.gov.au/system/files/documents/1702/statistics_on_work-related_musculoskeletal_disorders.pdf [Accessed 17 Apr. 2019].
16. Umer, M., Qadir, I., & Azam, M. (2012). Subacromial impingement syndrome. Orthopedic reviews, 4(2), e18. doi:10.4081/or.2012.e18
17. Wang HK., Cochrane T. Mobility impairment, muscle imbalance, muscle weakness, scapular asymmetry and shoulder injury in elite volleyball athletes. J Sports Med PhysFitness. 2001;41(3): 403–10
