A good friend of mine surfs daily in order to maintain his sanity (it’s a rough life out here in Los Angeles!)… or at least he did, until a shoulder injury sidelined his healthy hobby for an indeterminate amount of time (so far spanning half the year). He is despondent about losing his daily outlet, in constant pain, and unsure of when things will return to normal for his body. Shoulder injuries, it turns out, are no joke—some can come on for seemingly no reason, too, and then go on to last months or even years, significantly reducing quality of life.
The good news is, early intervention can help tremendously, which is why it’s important to know what to look out for. “If you’re having on and off shoulder pain for a few days, that’s pretty normal, so you should stop doing activities that bother you and if it gets better, that’s probably all you need to do,” says orthopedic surgeon David Geier, MD. “Where you might need to start watching out would be when you’re consistently having trouble lifting up overhead, like reaching into a cabinet or blowdrying your hair, or reaching behind your back.” The doctor also notes that it’s not just pain you should be on the lookout for. “Sometimes your shoulder is getting stiffer and it’s getting harder to do something, not because it hurts but because the motion is actually getting tighter,” he says.
How to prevent common shoulder injuries
1. Shoulder impingement
Shoulder impingement, which is sometimes referred to as “swimmer’s shoulder,” occurs when the shoulder’s tendons or bursa, the cushions between bones and soft tissue, become pinched and then inflamed. “It’s something that occurs over time rather than with any one acute event,” says Dr. Geier, who notes that impingement is most common in people who repetitively raise their arms overhead, like a swimmer or house painter. When you start having this type of shoulder pain—in which it hurts to raise your arm above shoulder height or pull it behind you—it’s best to modify the offending activities immediately. “If it’s still persisting over four or five days [of modified behavior], you should get it checked out by a physical therapist before it becomes something that lingers three or four months, at which point it can take awhile to get over,” he says. To further prevention beyond ceasing detrimental behavior, Los Angeles-based orthopedic doctor Bal M. Raj, M.D. FRCSC recommends regular stretching and avoiding heavy lifting.
2. Rotator cuff tears
“Rotator cuff tears are on the same spectrum as shoulder impingement, but they typically occur in older populations,” says Dr. Geier. “For a younger person to get a tear, you typically need a traumatic event, but in 50-year-olds or older, typically it can happen just out of the blue, it just comes on over time.” These injuries, Dr. Geier says, typically require surgery. To prevent them, avoid heavy lifting, engage in stretching, and listen to your body. “If there’s pain, don’t do it,” says Dr. Raj. Once any discomfort arises, Dr. Geier again advises getting it checked out quickly. “If you can do some preventative exercise with a physical therapist, you can prevent impingement from becoming a rotator cuff tear,” he says.
3. Labral tear
The labrum is a piece of tissue which helps keep the ball of the shoulder joint in place, and it can be torn via quick movements, especially when done repetitively, e.g. while playing tennis or pitching a baseball. Typically, it can only be fixed via surgery, says Dr. Geier. To avoid this type of injury, Dr. Raj recommends avoiding fast motions or quick movements (if possible) and working on your flexibility. If your work or leisure activities require quick movements extending into the shoulder, you should be sure to train properly so that all muscles in the area are adequately strengthened and stretched.
4. Frozen shoulder
“Adhesive capsulitis, aka “frozen shoulder,” is where the lining that surrounds the ball and socket joint starts to scar down, and as it does so you lose range of motion,” says Dr. Geier. “As you try to reach overhead, your shoulder starts to hurt so you use it less and less and it’s sort of this downward spiral—tightness and then pain, which leads to more tightness and more pain, and then you get a significantly limited range of motion.” Frozen shoulder typically presents in slightly older populations, people in their 40s and 50s, and you may also see it in diabetics more than others, but it can also happen to anyone out of the blue. “Frozen shoulder can be very difficult and take a long time to get better,” Dr. Geier says. “If you notice pain and stiffness, I’d get it checked out fairly early because sometimes working with a physical therapist or at the direction of an orthopedic surgeon, you can try to break that cycle before it becomes full-blown frozen shoulder.” This is important to avoid, he says, because it can take a year or two to resolve on its own.
Ultimately, both doctors caution against repeating any movements that cause pain, and getting an expert opinion around any discomfort which persists for days, particularly if you’ve discontinued the offending action which caused it. For general prevention, Dr. Raj suggests regular stretching, training to build up shoulder strength (as long as it doesn’t cause pain!), utilizing a foam roller regularly, and making sure you sleep on a good pillow.
Your wrists need special attention, too:
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