Shoulder pain: Is it really my shoulder that hurts?

Here's the scenario: You are having right shoulder pain located at the top of the shoulder going down the shoulder/deltoid area into your biceps area.  You haven't had really bad neck pain since this shoulder started hurting and you haven't seriously injured your neck before either.  But you do rub your neck quite a bit throughout the day. You have a hard time lifting your arm up with weights either in front of you or to the side, reaching in front of you, sometime even holding a glass or cup of coffee.  It's been coming on little by little and has gotten to the point where it's really affecting your normal day.

So which is it?  is it your shoulder or something else???

In a this type of scenario, you want to get your shoulder looked at first and do some basic strengthening for the shoulder.  This includes scapular stabilization exercises, scapular retraction exercises, stretching all your tight muscles (pecs and lats and teres), then some isolated strengthening for the rotator cuff both in static and dynamic positions.  

But after about 2-4 weeks, it's gotten a lot better, but still hasn't fully resolved.  What else could it be?!?!?

Well, when you go to an orthopedic doctor who specializes in the shoulder, more often than not, they are focused on the shoulder and the problem at the shoulder.  They may even get imaging at the shoulder as well to verify their findings.

But more often than not, there is also a component relating to the neck that might be the culprit.  This is due to a cervical radiculopathy, which in lay mens terms is a mild impingement at the neck that makes the shoulder weak and also be painful.

Treatment for this is pretty easy once you've identified it as this.  A physical therapist or a trained professional can perform gentle joint mobilizations to the neck, more specifically to the two vertebrae which are locked/impinged to loosen them up.  Also you will want to retrain your neck muscles to find midline again without any deviations.  Once you are aware that your neck is stronger, then you will want to slowly incorporate functional movements with keeping your neck muscles engaged and in midline while slowly incorporating shoulder strengthening so that you're whole system begins working together again.

Now your shoulder problem/pain should decrease.  But remember, strengthening quickly does no one any good.  Strength can take about 6-8 weeks to make a substantial change.  And most of all, remember that your neck muscles are endurance muscles, so the exercises should be repeated at least 2-3 times a week just to keep them in check!  =)

Braces: helping or hurting you?

I commonly get asked about whether or not to wear braces.  So here's my thinking behind it all and when to wear it and when not to wear it.

Braces are intended to lend support to structures that are weak or be used to aid in recovery.  So there are two situations in which you want to wear a brace as I just mentioned.  When someone has a recent injury, i.e. throws out their back, sprains their ankle, sprains their knee, has a car accident, a brace can help keep things more stable and help prevent the injured area from getting any worse. In this case, the brace is there to help increase stability to the injured area, decreasing the movement, and ultimately decreasing the amount of pain.

The second situation is when there is no stability any more because the ligaments are too loose to support it, or when the ligaments have actually completely torn, causing excessive degrees of motion to the joint.  In this case, the motion in the joint cannot be restrained by the ligaments any more and in normal activity, may result in a new acute injury, if not braced.  The brace is used to replace the ligaments, or passive structures of a joint.

Now the do's and don'ts according to my logic.......

As I mentioned in the first situation, after severe pain  or recent injury, braces can help reduce pain and help in returning to daily activities.  BUT, if a brace is worn too long, it can begin inhibiting involuntary muscle contraction from deeper stabilizing muscles which are meant to help support the area, resulting in greater weakness.  So for example, after having back surgery, a brace may be recommended so that there is greater support to allow for normal activities of daily living.  But after pain and inflammation have gone done and are tolerable, there should be effort made to reconnect to the stabilizer muscles to engage them in bracing your back.  In all honesty, who wants to have to wear a brace the rest of their life unless they really had to?!?!??

The second situation, where a ligament, let's say an ankle sprain, has repeatedly been sprained for a soccer player over several years and now there are just about no ligaments left.  An ankle brace may be appropriate to help the soccer player feel more stable during running as to prevent any additional injuries to their ankle.  In this case, exercise is still important to make the musculature as dynamic and reactive as possible, but it will probably not be enough, so a brace would be important to add an additional layer of support/stability.

I hope this helps clear up any confusion as to when and when not to wear a brace.

Again, this is just advice, and the best thing would be to ask your local physical therapist for specific instructions.  Take care and don't "brace" yourself too much!! =)

Dr. J Wong