The Shoulder Series Part One: The Weak and Painful Shoulder

In Part One of the Shoulder Series you will be able to:

• know whether you fit the criteria for a weak painful shoulder

• know and understand what could be affecting the pain

We use our shoulders A LOT! Whether you're using a computer mouse or trackpad at your desk, swinging a hammer during home renovations, or tossing out the heaters from the pitcher's mound, the shoulder joint is constantly showcasing its versatility. It's that heavy use that leads to the shoulder joint becoming one of the most often injured. In North America, shoulder pain is the third highest reason for a Physiotherapy visit.  While there are many things that can go wrong within the joint, the best research shows that we can combine the majority of pathologies into a particular rehabilitation strategy - for the weak(ish) and painful shoulder.

Do I have a weak and painful shoulder?

Of course every shoulder is a bit different, but generally, if your shoulder fits this definition:

• It is painful at some point through the range of motion as you bring it up to over your head, BUT you can still mostly get it up over your head

• It may have happened after a fall, or a 'tear' feeling at the gym, at hockey, or picking up your kid or it could have slowly developed over time, with increasing the load you are putting on it - like putting in longer hours at work, gardening, weightlifting, etc.

• The pain can be SHARP when you lift it, or hit certain spots OR it can be achy at the end of a long day, stiff in the morning, and painful to lie on at night

• the pain can move around, but people will mostly say it starts in around the shoulder and GOES DOWN THE MIDDLE OF THE ARM

****Disclaimer*** Sometimes pain in this region can also come from the neck. If you move your neck and it increases pain in your arm this may be connected. If you are at all unsure (and really either way) it is best to see your physiotherapist to check.

What could be the cause of my weak and painful shoulder?

There are many things going on in and around the shoulder. The rotator cuff is a set of muscles which keeps the area stable, it is possible to strain one of them, or get a repetitive strain injury. This is also possible of the labrum, which keeps the joint together like a golf ball on a golf tee.  There are bursas and nerves which can become irritated; and there could be pain from within the joint itself. REGARDLESS of structure, for the most part the evidence shows that the rehabilitation is pretty much the same! UNLOAD (calm things down) REACTIVATE (get it moving) and then STRENGTHEN the heck out of it!

What does unload mean - and what are some quick tips to change pain?

The unfortunate reality of the weak and painful shoulder is that it is a staged beast.  By that I mean you can't start just at high level exercises when its not ready for it - this will only increase the pain and make it last longer.  Unload means reduce how much you use it, or how much weight is going on it for at least 1-2 weeks.

A big thanks to Adam Meakins and his evidence based shoulder rehabilitation program - from which a large portion of this information comes!