Shoulder Pain Talk

Rights of Spring

The sports pages are already filled with pitchers who are having shoulder problems.  We see it every year and we know that the pitching process does put a lot of stress on the rotator cuff, specifically, the superspinatis tendon.  The Detroit Tigers have been hit most hard seemly this year.  First they have Joel Zumaya out with a somewhat of a freak shoulder accident.  This when he was clearing out his parent's San Diego house from the wild fires that swept through California.  This required shoulder reconstruction; he seems to be responding well to that, and has had some painless episodes of throwing for the first time since that surgery.  Unfortunately, they are having their set-up man, Fernando Rodney, having problems similar to last year with painful throwing shoulder and he has not pitched in several days.  This is obviously a problem for the Tigers who expected to do well thisyear, and had significant offensive players picked up.  Tigers do have very strong starting pitching; however, typically as the season goes on, the reliance on the bullpen is great.  Finally, they lost their comeback kid in Matt Mattei, I believe, who retired this year at the age of 35.  He had a really nice major baseball career.  He was trying to make a comeback with the Tigers and felt pain in his shoulder after throwing against the Cleveland Indians.  He was not particularly interested in shoulder surgery or prolonged rehab and retired.  He shared with us that the reason he tried to make a come back from previous problems with shoulder pain was that his 5 year old son wanted to see him pitch in the majors; unfortunately, he'll have to the video tape.

What needs to be done new with baseball conditioners, trainers, sports trainers?  Why does this continue to happen with literally hundreds of millions of dollars in pitching salary sitting on the sidelines or in physical therapy or on the operating table each year?  It would be nice to see some forward thinking with rehab of these shoulders and really considering what does need to be done differently after pitching that would prevent these injuries.  I hope these teams have got their pitchers jumping rope and I also wonder if they are considering some of the new braces such as the night time shoulder immobilizer to be used on the night after the players pitch.

Go Tigers!

Shoulder Pain Caused by Swimmers' Shoulder

Shoulder pain is an affliction of many modern athletes.  Swimming is no exception.  Swimming typically involves a fair amount of freestyle swimming stroke.  It has been said that high level competitive swimmers will have as many as 16,000 arm rotations a week.  This activity of forward movement in the shoulder and the repetitive fashion does cause significant strain on the shoulder.  Swimming coaches and swimmers will know frequent episodes of anterior and superior shoulder pain, both during the swimming and as the process worsens throughout the day.

What is going on here?  Firstly, swimming, an excellent form of exercise and a very popular competitive sport, has to some degree some possibility for over use of the shoulder.  Over use is defined as using a body part in a repetitive way beyond which it was designed.  This stress can, at times, lead to impingement upon the superspinatus tendon, therefore, setting off a cascade that leads to full blown rotator cuff tendonitis. This condition causes significant shoulder pain.  It more frequently limits a swimmer’s training schedule due to shoulder pain. 

How are swimmers able to prevent shoulder pain caused by swimmer’s shoulder?   A few things are very helpful in understanding the anatomy of the rotator cuff.  Firstly, the superspinatus is only one of four muscles comprising the rotator cuff.  It also is the muscle that is most stressed and at times the one most warn down by repetitive use of free stroke swimming.  Swimmers need to understand that there are three other muscles of the rotator cuff that need to be strengthened.  Trying to balance out the amount of freestyle with at least increasing the amount of backstrokes when swimming will relatively strengthen some of the other three muscles, particular the infraspinatus.  Additionally, I typically recommend that swimmers include a very slightly weighted jump rope at the end or beginning of their swimming workout.  The jump rope by keeping the arms low and particularly when used in a very rapid fashion will strengthen the other three muscles of the rotator cuff.  This allows for balance within the very complex shoulder joint and specifically the structure of the rotator cuff.  This will go a long way towards helping prevent swimmer’s shoulder.  Specifically, I typically recommend the blue jump rope put out by Lifeline Fitness.  It’s called a speed/workout jump rope.   

Problems with shoulders are common with both high level and low level competitive and fitness swimming.  It is important to address this problem early.  It is important to understand that the shoulder needs balance in its strength.  Again, I recommend to my swimmers that they employ usually some increase backstroke and again I recommend using a weighted jump rope for ten minutes of jumping rope at the beginning or end of their practice. This will hopefully prevent shoulder pain, shoulder disease, and allow people to enjoy the rather incredible and unique sport of swimming which I uniformly recommend as an excellent form of low impact exercise.

NyteTyme Immobilizer

There are SO many products on the market today that promise to relieve your shoulder pain, and it is often difficult to wade through the exaggerations in order to find those that are actually going to be helpful and worthwhile. The NyteTyme Immobilizer is definitely one worth "wading" for.

In an earlier post I referenced a nighttime shoulder brace that had amazing results in a study at The American College of Sports Medicine, and this is the brace I was talking about. The Immobilizer acts to simulate the natural position of the shoulder in the daytime, avoiding the normal nighttime shoulder positions that cause the chronic pain by pinching important parts of the joint.

The results of using the Immobilizer are amazing both because of the brace's effectiveness, and also its speed. As I mentioned before, patients only had to use the brace for a month before they saw drastic results when compared to traditional shoulder pain treatments.

The Immobilizer is a treatment option that gives hope to those who had given up on relief of their chronic shoulder pain as a result of a rotator cuff tear or other shoulder condition.   

Rotator Cuff Injury Cycle

There is a frequent pattern of injury amongst those who suffer from rotator cuff inflammation. The shoulder goes through a cycle of injury followed by healing and then the patient will have a certain period of pain-free time only to re-injure it. Soon enough, the periods of pain-free times are less and the movements that cause pain are more and the threshold for re-injuring the rotator cuff lessens.

What is going on is that the rotator cuff will become injured as it is impinged under the coracoacromial arch. The rotator cuff has a very sensitive area on its superior muscle called the supraspinatus. The rotator cuff is made up of four different muscles. 90% of the injuries originate at the supraspinatus muscle. As a person goes through years of this cycling, the rotator cuff becomes scarred; becomes less flexible; it becomes more easily torn; it becomes less subtle. In affect, this rotator cuff prematurely ages and in this cycle of injury, inflammation, healing, scar tissue, the rotator cuff at some point becomes torn. The key to treatment is to break that cycle of repeated injury to allow the rotator cuff to restore some of its flexibility to reduce some of its scar tissue. Constant re-injury needs to be avoided at all cost. It delays the healing process and contributes to scare tissue and overall decreases the range of motion.

If you have a shoulder injury, it is critical to heal it quickly and completely.

Nighttime Shoulder Pain

Nighttime shoulder pain is a frequent part of rotator cuff tendonitis. Nighttime shoulder pain occurs fairly early on in the process. The patient will frequently complain of disturbed sleep. Nighttime shoulder pain is interesting in that during the night the body typically restores itself and does its own healing; however, during the night with this rotator cuff problems, there is actually more damage being done to the superspinatus tendon.

Nighttime shoulder pain occurs because during the day the arm acts as a traction upon the shoulder that opens up space and allows blood to flow freely to the tendons. At night, the body is horizontal and so gravity is lost as a traction force. Nighttime shoulder pain is caused by the top of the arm pinching the superspinatus tendon, and therefore, impairing blood flow and healing. This relative starvation of oxygen and blood to the superspinatus causes inflammation and this results in nighttime shoulder pain.

This is a problem for many reasons, primarily it sets up a rather vicious cycle as people tend to sleep horizontally. Typically if someone sleeps with their arm away from their head, that can make matters worse as the greater tuberosity of the upper part of the humerous will further impinge the superspinatus against the coracoacromial ligament.

Again, the nighttime shoulder pain is quite common with rotator cuff tendonitis and if this symptom is present, certainly the patient needs a medical assessment of the shoulder pain.

Shoulder Pain Affects Millions

What Are the Most Common Shoulder Pain Problems?

The most movable joint in the body, the shoulder is also one of the most potentially unstable joints. As a result, it is the site of many common problems resulting in shoulder pain. They include sprains, strains, dislocations, separations, tendinitis, bursitis, torn rotator cuffs, frozen shoulder, fractures, and arthritis. All of these conditions can result in painful shoulder issues which limit your ability to function and enjoy life.

How Common Are Shoulder Problems Resulting in Pain?

According to the Centers for Disease Control and Prevention, about 13.7 million people in the United States sought medical care in 2003 for shoulder problems.  Shoulder pain is one of the most common problems affecting people of all ages.