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Don’t shrug off shoulder pain

Pain in this joint can curb your independence. Catch problems early, build strength, and avoid injury.


Image: © Barry Austin/Thinkstock

It’s easy to take your shoulders for granted. You don’t think about them when you put your arm through a sleeve or reach out for something. But weak or injured shoulders can limit your daily function and rob you of your independence. You may not be able to open a door, push up from a chair or a couch, or tuck in your shirt without wincing in pain.

“Shoulder pain is common among older adults. Studies suggest it occurs in up to 31% of adults,” says Amy Devaney, a physical therapist with Harvard-affiliated Massachusetts General Hospital.

The vulnerable joint

We think of the shoulders as a center of strength (hence, the common expression “to shoulder a burden”). In reality, the shoulder joint is vulnerable, especially as we age. Wear and tear may cause arthritis — a decrease in the cartilage that cushions the shoulder bones (the collarbone, upper arm bone, and shoulder blade). Symptoms include pain, stiffness, and reduced range of motion.

The four tendons and four muscles that stabilize and help rotate your shoulder (known collectively as the rotator cuff) also deteriorate with age, putting us at risk for tears in our older years. Most tears do not require surgery. When trauma causes a tear through the full thickness of the rotator cuff, surgery typically is necessary.

Overuse of the shoulder — such as a sudden burst of activity from hanging curtains in your house — can lead to tendinitis (inflammation of the tendons).

Other causes of pain

Poor posture can lead to other causes of shoulder pain. “Everything we do with our arm is in front of us, and that builds up the pectoral muscles in the chest. They get tight over time, and pull the shoulders forward,” explains Devaney. As a result, the rotator cuff muscles can get pinched underneath the shoulder blade and collarbone, causing pain and inflammation known as impingement. When impingement continues, it can lead to degeneration and fraying and tearing of the rotator cuff tendons.

The bursa — small, fluid-filled sacs in the shoulder — can also become pinched and inflamed, causing pain. The condition is called bursitis.

Treatment

If your shoulder joint aches for more than a few weeks, it’s probably time to see your doctor. The first line of treatment isn’t typically surgery, but a course of physical therapy that lasts about six to 12 weeks.

For impingement, treatment may include a cortisone injection first to counter inflammation, and then physical therapy when inflammation subsides.

Treatment for tendinitis may also start by resting the shoulder and giving inflammation a chance to go down.

What’s involved with PT?

Physical therapy focuses on strengthening the rotator cuff muscles (such as the infraspinatus and supraspinatus) and the shoulder blade muscles (such as the lower and middle trapezius), improving posture, and increasing your range of motion with exercises that rotate the shoulder.

To improve posture, for example, a therapist might have you do a shoulder blade squeeze, in which you squeeze your shoulder blades together for 60 seconds, and then relax.

Final thoughts

To reduce shoulder pain and injury in the future, you’ll need to continue doing shoulder exercises at home after physical therapy ends. “You’ll have to be consistent, and exercise your shoulders two or three times per week for the long term,” Devaney says.

For more information about strengthening your joints, check out the Harvard Special Health Report The Joint Pain Relief Workout at www.health.harvard.edu/JPRW.

Move of the month: Strengthen your rotator cuff


Photographer: Michael Carroll

Standing row

  • Squeeze your shoulder blades together.

  • Slowly bend your arms and pull back. Keep your elbows close to your ribs and pointing toward the back wall.

  • Pause, then slowly return to the starting position.

  • Repeat it 15 times.

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