How to Prevent Shoulder Injuries

Over hundreds of thousands of years of evolution, the human shoulder has undergone dramatic changes to make it more versatile – allowing our arms to reach above our heads, behind our backs and swing in full circles. But he’s also become much more injury-prone.

At any one time, it is estimated that one in four people suffer from shoulder pain. For some, pain may only slightly interfere with their golf game; others, however, may struggle to get dressed in the morning.

“The other big thing people complain about with the shoulder is pain at night,” said Dr. Drew Lansdown, assistant professor in the department of orthopedic surgery at the University of California, San Francisco. “It keeps you from sleeping because you can’t find a comfortable position – you can’t lie on this side, you can’t lie on the other side.”

Although some injuries occur suddenly and traumatically, the damage usually occurs over time. The ball joint in the shoulder is attached by the four muscles and tendons of the rotator cuff, which can become chafed, tear, or overstretched. The labrum – a cut of cartilage that surrounds them – can also tear.

Small fluid-filled sacs called bursae, which normally cushion the joint, may instead swell and hurt. Often you’ll have more than one problem at a time, and you might not know exactly what’s causing your pain, said Lori Michener, a physical therapist and researcher at the University of Southern California in Los Angeles.

Athletes who frequently use their arms overhead – including baseball pitchers, swimmers and tennis players – face greater shoulder risks, as do workers whose jobs involve heavy lifting. heavy or awkward arm positions, such as truck drivers and dental hygienists. Dislocating your shoulder once also increases the chances of it happening again. Genetics can also play a role, and with age, the risk of rotator cuff tears and shoulder arthritis increases for everyone.

Fortunately, there are steps you can take to protect the shoulder, including strengthening, stretching, and gradually increasing aerial activity.

Strong muscles strengthen your shoulders.

Strengthening the muscles around the shoulder increases its resilience, preventing pain and injury, said Behnam Liaghat, a sports physiotherapist and assistant professor at the University of Southern Denmark. Work both the large upper back and chest muscles and the smaller stabilizing muscles surrounding your shoulder and your shoulder blade, the shelf your shoulder joint sits on.

Exercise programs, such as a classic band called the Thrower’s 10, designed to strengthen the joint in high-risk athletes, have been shown to significantly reduce the risk of shoulder injury, right down to the half if done two to three times a week. To do them, you will need a light dumbbell and a resistance band.

Such a program should be part of regular maintenance, even for recreational athletes, said Ioonna Félix, physical therapist and owner of New York-based Optimal Performance‌. She regularly plays tennis and devotes two days a week to shoulder conditioning.

If you’re not regularly involved in overhead activities, a few key exercises can help keep your shoulders healthy as you age, she said. The three she recommended were scapular rows and shoulder extensions with a band, as well as scapular retraction, a simple move that strengthens stabilizing muscles. To do this, lie on your stomach, arms at your sides and palms facing the floor. Pull your shoulder blades back and down as you lift your arms up to hip level; hold for a few seconds, then slowly release.

First test your mobility.

Before attempting an overhead sports or weightlifting move — or as a general indicator of how your shoulder is functioning — try a simple three-part test for shoulder mobility, Dr. Michener says.

First, stand in front of a wall – your toes touching it – and see if you can raise one arm at a time above your head to touch the wall in front of you, with your palm flat. Next, bring your hand down to touch the back of your head, keeping your elbow at your side. Third, bring your arm to the side, then raise your hand behind your back, aiming to touch the opposite shoulder blade with the back of your hand. Repeat with your other hand.

If you have trouble making these moves or reaching end positions, you may benefit from greater mobility, Dr. Michener said.

To improve your range of motion, perform the same until you feel a stretch, then hold for 30 seconds to a minute. Do this three to five times, twice a week. Then, monitor your progress — if your mobility isn’t improving, you may need to hold your stretches longer or repeat them more frequently, Dr. Michener says. After a few weeks, if your mobility is still limited or you feel pain while stretching, see a physical therapist or other healthcare professional.

Also work your lower body.

Much of the power in a throw, serve, or other overhead move comes from the base. The weaker your legs and core are, the more force your shoulder has to produce, which increases stress on the joint, Dr. Michener said. In a study she published earlier this year, minor league pitchers with one hip weaker than the other had a greater risk of injury to the shoulders and elbows of their pitching arms.

To build balanced lower-body strength and stability, she recommended moves like lunges and squats, which work multiple muscle groups. The boards are good too; the prolonged contraction of your trunk and legs improves muscular endurance.

Next, harness the power of your whole body as you use your arms overhead, says Dr. Felix. For example, when you stow carry-on luggage in the overhead compartment of an airplane, bend your knees and lift it with your legs instead of just “muscle” it with your shoulders.

Slowly add to load.

Even if you’re diligent about strengthening and stretching, you can still trigger soreness or harm if you jump into a new shoulder-straining activity—or return to one—too quickly. Some people think, “‘Oh, I played in high school, I can pick up a ball and throw like I used to,'” Dr. Lansdown said. Your muscles and tendons need time to develop the specific strength and control necessary for any shoulder movement.

Even athletes in their early years risk injuries like this. In a small study of college swimmers published in May, two-thirds of athletes who suffered injuries during the season did so during intense mid-season training, when some almost doubled their swimming distance. typical weekly swim.

To keep tabs on how you’re stressing your shoulders, consider what scientists call the acute-to-chronic workload ratio, said Travis Pollen, assistant professor of exercise science at Thomas Jefferson University in Philadelphia. , lead author of the swimming study and a former Paralympic swimmer.

Count the average weekly amount of a given activity – for example, swimming laps or tennis hours – that you have logged over the past four weeks. This is your chronic workload. Divide that by what you’re doing this week, the acute workload. Some estimates suggest that when that number goes above 1.5 – meaning you did 50% more that week than your average for the previous month – your risk of injury increases soon after.

Rest and rebalance for minor pain.

Often, minor inflammation or irritation in the shoulder joint goes away within a few days. Ice and anti-inflammatories can help, Dr. Lansdown said.

Once the pain subsides, ask yourself if your routines could benefit from rebalancing the tension in the front and back of your shoulders, Dr. Pollen says. For example, if you’re a climber who always pulls up a wall – or a yogi who always pushes against the ground – try doing some moves in the opposite direction (eg, adding push-ups for climbers or rows for yogis).

A little physical therapy goes a long way.

If the pain persists — or if it’s accompanied by weakness, popping sensations, or a feeling of the joint moving or slipping — see a healthcare professional, Dr. Lansdown advised. Some injuries will only get worse, and the sooner you seek treatment, the simpler and more effective it will be.

Don’t assume you’ll automatically need surgery or months of physiotherapy. A large clinical trial published last year in The Lancet found that a single session of physiotherapy to teach progressive strength and mobility exercises worked as well as six face-to-face sessions for new rotator cuff injuries.

People who have sudden tears or want to return to more strenuous sports might fare better with surgery, but research has found that three-quarters of people who choose not to have rotator cuff tears repaired full thickness were still doing well after two to five years.

Of course, if you can stave off a tear in the first place, that’s even better – and that means paying extra attention to this complex and vulnerable joint. “Having a strong shoulder and not putting too much stress or load on it would be the best thing to aim for,” Dr. Liaghat said.

Cindy Kuzma is a Chicago journalist and co-author of “Breakthrough Women’s Running: Dream Big and Train Smart.”