How to Avoid Shoulder Injury
Shoulders are one of the most dynamic joints in the body. They have one of the largest movement ranges of all joints in the human skeleton and are one of the most complicated integrated-joint complexes in the body, so its no wonder they can be so susceptible to injury.
Your shoulder movement does not stem from one joint alone. The true shoulder joint, the gleno-humeral joint, or ball and socket, is only isolated in the first stages of movement. After 50-60 degrees of movement, the other 3 joints of the shoulder girdle become involved: the acromial-clavicular, the sterno-clavicular and scapular-thoracic joints. These are an ‘accessory’ to shoulder movement, although a dysfunction in one of them can knock the whole rhythm of shoulder movement out of sync, potentially causing pain and injury.
Here are some top tips from Zoe, our Head of Orthopaedic Physio, to prevent injuries of the shoulders and to prepare them for upcoming sports events.
Tighten The Cuff
The ‘rotator cuff’ is a collective term for a group of 4 muscles, which contribute to the stability of the shoulder joint. The muscles all come from different parts of the shoulder blade and attach to the top of the arm. The rotator cuff also has other roles to play in the shoulder such as internal and external rotation. The ‘cuff muscles’ are usually the muscles, which are affected in impingement injuries.
If the rotator cuff is weak or damaged, your shoulder is less likely to stay securely and correctly positioned in the joint during upper limb movement. This will also put stress on the ligaments and cartilage of the joint, which can lead to a variety of tears and subsequently poor movement patterns.
If your physiotherapist has determined that one or a group of these muscles are weak, you can work on strengthening them individually. Remember, the cuff doesn’t necessarily have to be bulky to do a good job. If you’re performing cable pulls at the gym with a weight of 60+ kilos, be warned! Huge compensation movements from your hips and arm means that multiple muscle groups are taking the load, and even if you were to isolate this to just the cuff muscles, this will further narrow the space around the shoulder complex, leading to the increased likelihood of impingement injuries. The cuff needs to have correct movement patterns and reasonable strength. A small weight, if any, and controlled isolated movements throughout the range of movement are all the cuff needs to be healthy and functional.
If any of the cuff muscles are damaged, adequate rest and rehabilitation are critical. If an individual is to continue with brisk upper limb movements and contact sports, they are much more likely to have repeated injuries to that same arm due to the lack of stability.
Stabilise your Movement
One of the most common attributes you see in individuals with shoulder pain is poor scapula (shoulder blade) control. Whilst lifting a weight with your arms extended, as in a push-up or ‘plank’, poor control of the muscles in your back can make your shoulder blades ‘wing’ out.
Muscles joined to the shoulder blade need to be balance to have correct movement patterns. If imbalanced, the weaker muscles become stretched, tight and weakened further as they ‘hang-on’ to the scapular being pulled around the rib cage incorrectly.
Something simple such as seated rows, push-ups or ‘superman’ exercises can strengthen the usual suspects in poor scapular control. Your physiotherapist can assess this control whilst you perform a variety of specific arm movements, and can provide you with an exercise program tailored to your area of weakness.
Short-term fixes and stability can be provided by tape. The most common tape used in physiotherapy is zinc oxide. There are recent influxes of ‘Kinesiology’ or K-tape following its heavy use on the athletic track during the London 2012 Olympics. Sturdy tape like zinc oxide is considered to help prevent movement and provide that extra ‘stability’ when required. Often Rugby players will have layers of this applied strategically across their arm if they have had recurrent dislocations, in order to give the joint that additional support.
The K-tape is considered to give ‘feedback’ to prevent your limb going into extremes of movement, so you get to a point where your tissues tell your brain not to go any further. As these tissues may be damaged or not working correctly, they may send weak signals to your brain, so the sensation of the tape pulling on your skin sends this corrected information to your brain instead.
However, K-tape has often been criticised due to the incidences of some dislocations and injuries happening, despite tape being applied, or even resulting from the rigidity of the tape itself. Although I have used shoulder taping previously with a few rugby players following a hard knock or bad tackle, when some players returned for repeated taping season after season, it was often because they weren’t performing their rehab correctly.
Correct rehab is one of the most pivotal stages of injury recovery and it can either set you back to square one by re-injuring the tissues, or even further back by injuring them to a greater extent.
Rehab is defined as the re-introduction of normal movement patterns and physical stresses through the body in order to restore normal function to an individual. Gradual introduction of movements specific to your sport are important in order to achieve these particular physical stresses.
Staggering rehabilitation is the key. If you head back to the training ground ‘all-guns blazing’, it will end in further delay to getting back to normal. Activity in a controlled environment like a gym is best for this steady introduction. Working individual muscle groups and specific actions with slowly increasing weights is the best way to steadily return to normal function.
Taping and supports can take the effort away from the damaged tissues of the body and further contribute to their wasting. For this reason, long-term taping and braces should be avoided. Your physiotherapist can slowly wean you off of taping and support during rehabilitation, by performing movements in controlled environments without this external support. It may still be an idea to use tape or braces initially when you return to your first few competitive sporting events or intense training sessions, but it is very important not to get both physically and mentally reliant on them.
It sounds counter-intuitive, but resting can actually help you get back onto the playing field faster than if you push-on through an injury. If you damage a structure in your body, it will heal naturally. The body has a natural system of repair from the process of inflammation and scar formation. This process needs to be relatively undisturbed to be able to heal at a reasonable level. If it is disturbed, it delays the healing. If the healing is delayed too many times, it will be healed in a haphazard way and could become a structural weak-point in the body.
This is one of the hardest points for patients and sporting individuals to understand. This isn’t to say that you must not put any strain through your arm following an injury for the first 6 weeks, but continuing to train and play at the same intensity without rest is not going to do you any favours. If you do train at the same intensity, it will be more likely that your shoulder issue may become chronic and you may risk missing even more of your sporting season due to this ‘nagging’ injury.
Even if you don’t have a current injury, allowing adequate breaks between training sessions is important. Muscles and tissues are more likely to become torn and injured without rest. Rest periods are also important for the development of strength. It’s in these rest periods that the muscle repairs itself from the workout and increases muscle mass and diameter to cope with the extra stresses expected of them.
The Importance of Physio
Increasing the stability of the shoulder joint, the surrounding joints and strengthening the muscles, which influence the shoulder, is the best way to avoid injury. If you do damage your shoulder, you are more likely to re-damage it as the area becomes a ‘soft-spot’. However, this shouldn’t mean the end of your sporting career. Working with a physiotherapist has been proven to reduce the extent of damage, reduce the likelihood of repeat injuries and the amount of potential repeat injury damage.
Post by Zoe Birch, Head of Orthopaedic Physiotherapy at Physiocomestoyou.