HEALTH & WELLNESS
Pain in your shoulder?
It won’t just go
away magically!
BY NOE SARIBAN
Pickleball has provided an opportunity for people who played sports
in their younger years to get back out there and enjoy the thrill of
competition, while playing a sport that is social, fun, addictive and
accessible! I’ve seen patients in the clinic who come to me with
complaints of shoulder pain, often describing it as a subtle pain that
started a few weeks back, but they don’t remember doing anything that
would have caused an injury. They forget to mention that they’ve been
playing pickleball six times a week for two to three hours each day!
The most common category of shoulder pain is called shoulder
impingement. Impingement can be primary or secondary. A primary
impingement is when there are anatomical structures in the shoulder
causing pinching of tendons, bursae, and narrowing of the subaccromial
space. Conditions like osteoarthritis, bone spurs, and certain types of
acromion can cause primary impingement.
A dynamically unstable shoulder causes secondary impingement. This
means that a combination of excess motion and decreased strength
and stability around the shoulder is present, which in turn can lead to
structures being compressed.
The shoulder joint is one of the most unstable joints in our bodies. In
order to understand how impingement pathology can lead to more
serious problems, it’s important to get a visual of the shoulder anatomy.
With this article is a simplified picture of a right shoulder.
As you can see, there are a lot of structures under the acromion,
including the bursa, and one of the rotator cuff muscles (Supraspinatus).
In 80 percent of rotator cuff tears, the Supraspinatus is the muscle
involved, and the reason is that it’s lodged in the tight space under
the acromion.
A combination of both primary and secondary impingement is not
uncommon, especially in people over the age of 60. Symptoms of
impingement usually include pain with movement, especially at
shoulder height, pain at nighttime and with lying on the affected side,
reaching for the seatbelt, and pain with reaching behind your back or
hitting overheads.
It’s important to stop performing painful activities when you have these
symptoms, and consult a healthcare professional such as a physical
therapist. Impingement can be corrected through an individualized
rehabilitation program, but it won’t go away on its own. It’s crucial to
shut down painful activities and start the healing process in order to
prevent aggravation and possible tearing of the rotator cuff down the
line. Fixing the mechanics and increasing the stability of the shoulder
are key to avoiding further complications.
Most people train their upper bodies focusing on the main pushing
and pulling exercises such as push-ups, pull-ups, bicep curls, tricep
presses, etc. These exercises are not inherently bad, but they’re not
enough in order to maintain a healthy and stable shoulder. Rarely do I
see athletes incorporate rotational movements of the shoulders in their
workouts. It’s no surprise that over time, this becomes a problem as
there is an imbalance between the demands placed on the rotator
cuff structures by the sport (for example hitting an overhead), and the
strength and stability of the rotator cuff musculature.
The rotator cuff is comprised of four different muscles: the
Supraspinatus, Infraspinatus, Teres Minor, and Subscapularis, and
are sometimes referred to as the “S.I.T.S.” muscles. These muscles
surround the shoulder joint and provide stability of the humeral head
inside the socket as our arm moves through the range of motion.
Unlike the hip joint, which is a stable deep “ball-in-socket” type of joint
made to bear a lot of weight, the shoulder socket is a very shallow joint
that relies on ligaments and muscles for its stability. This means the
rotator cuff musculature plays a vital role in stabilizing the shoulder
during dynamic movements.
This is why it’s imperative to incorporate rotational movements in
a strengthening routine, and to develop appropriate strength in the
rotator cuff in order to avoid chronic shoulder pain and injury. If you
would like to see some examples of rotational strengthening, visit
www.thepickleballdoctor.com and go to the Strengthening tab to
see a video demonstration of beneficial exercises. Always consult a
professional, and preferably a qualified physical therapist, if you are
unsure about how to strengthen your shoulder.
Playing pickleball with pain in your shoulder is not normal, and should
be addressed. There are many techniques and treatments available
these days to alleviate shoulder pain and get you back to playing
without pain, and with improved strength and stability. Please don’t
ignore the problem thinking it will get better with time. This method
has been tested and doesn’t work. Be proactive and take control of your
health—it’ll pay in the long run! If you have any questions, contact The
Pickleball Doctor at [email protected].
Noe Sariban is a Doctor of Physical Therapy, Certified Pickleball Teaching Professional through the IPTPA, and an Engage sponsored athlete. Please visit www.
thepickleballdoctor.com for more information on injury prevention and rehabilitation tips. Noe started his website to provide pickleball players around the world
with a reliable and free source of information. Please like his Facebook page, www.facebook.com/pickleballdoctor, for updates and new information.
JULY/AUGUST 2019 |
MAGAZINE
59