Over the past year, we have been spending more time at home. That may entail sitting at the kitchen or dining room table on zoom work calls all day, or being even more active and taking advantage of the time you otherwise would be commuting. However, this part really doesn’t necessarily matter...you are still in shoulder pain.
This pain can be something that occurs all day every day, or something that happens when you make "just the right move." Something that keeps you up at night when you lay on your side or limits how much activity you can do.
What matters is that you are looking for the right solution to deal with it. Something natural and non-invasive that can get you back to doing the activities and sports that you love to do as soon as possible. Am I right?
Whenever I work with patients and clients that have these types of issues, they always have the same questions: Why me? Why now? What's causing this? Why won't it go away? How can I fix this?
Why me? Why Now?
The straightforward answer is that this all probably started from something you have been doing for weeks, months, or even years (especially if there was no specific origin like falling, lifting something that resulted in immediate pain, etc.). It can be something as simple as the way you have been leaning to the side on your desk or the number of times you move your mouse. It can even stem from the length of time you have been using that arm to do the same type of task every day, such as moving the mouse on the keyboard.
Oftentimes, it is not what you specifically do that is the issue but rather how long you are doing it.
As technology, systems, and our overall workforce have changed over the years to a more desk-oriented, computer-based society, we have been spending more time sitting. As injuries started to develop because of sitting, the pain was originally associated with "poor posture." However, more recent studies have been coming out saying that really it doesn't matter how you are sitting but rather how long you are sitting. The same goes for how long you are typing, using your mouse, lifting and carrying things, reaching, and how often you are doing the same repetitive motion without a break.
Now don't get me wrong; performing an activity in a "good" and "normal" posture is what you want to do. The goal should be to have your joints, muscles, and other bodily tissues interact with each other to perform activity efficiently without excessive stress. When performing these activities outside of that most efficient posture, your weakest structures will tend to breakdown first.
Therefore, make sure regardless of whether you are sitting, resting, active, or exercising, you are being mindful of how long you are currently doing the activity, as well as how many times you have engaged in the activity in the past (days, weeks, months, etc.). This should be the same practice when you begin any sport of physical activity for that matter. You aren't going to be starting out with a marathon that first week. With every activity, aim to start small, gradually build. Don't forget to take breaks...even if it is for a few minutes. Change it up.
What's Causing This? Why Won't It Go Away?
As we sit in an inefficient posture, slouched for example, the more that our head sticks out from our body or our center of mass, the "heavier" our head gets. The muscles responsible for holding up our heads located on the back of our neck and shoulders AND even a couple on the front of our neck are put under more strain than usual. The longer we continue to maintain this position, the quicker our stabilizers get fatigued. When this happens, our global muscles, forced to extend to the top of our shoulders, get tight and achy. This is the dull achy pain we get throughout our upper shoulders and neck.
"What does this have anything to do with my shoulder?" you may be asking. Almost everything, especially if you have been doing this for a LONG time.
Sitting in a slouched posture and not moving into other postures or getting out of our daily routines of movements and activities can take their toll. Being mindful of your levels of activity and what you are doing is important to avoid the compensations that occur.
Obtaining and maintaining a slouched posture will result in weakening and increased strain on the posterior shoulder muscles and shortening/contracture of muscles on the front of your shoulders. When this happens, it reduces the amount of room that your shoulders have to move within the joint and the muscles themselves have less room to slide around, causing them to be "pinched" within the joint, per se. The longer this occurs and goes on, the more these tissues become irritated and the more painful it becomes over time. Sometimes so much so that you become unable to first do the things you love, like sports and exercise, before it creeps into daily function.
You can improve your posture by engaging in activities like core strengthening exercises, Pilates, tai chi and yoga. Other ways in which you can improve your posture during the day is by setting reminders using a posture app or sticky notes.
Intervention and planning are key. Procrastination is always the causation in the reason why something becomes worse than it should be. Prevention in the first place and being prepared will always be more important. As we get into "What do I do now?" portion, regardless of where you are in your injury, activity, or recovery level, education and knowing what to do when is the most important.
How Can I Make This Go Away??
Let's start off by setting the groundwork with prevention of this issue as prevention is similar to the solution. All you need to do is maintain balance or, in the case if you are in pain, REGAIN balance between your posture, muscle balance, and shoulder stability.
This involves stretching the muscles on either side of your neck including the upper trapezius, levator scapulae, and sometimes even the scalenes while also stretching the muscles in the front of your chest and into your bicep using a bicep stretch or a doorway stretch. From there, you can work on strengthening and stabilizing your neck and shoulder by working on your rotator cuff strength and stability, improving the strength and activation of your middle and lower trapezius muscles, and improving the activation and endurance of your deep neck flexors, allowing you to keep a more upright and erect posture.
Additionally. having the appropriate equipment sets you up for success as well. As long as you have a chair that is supportive on your bottom, has a lumbar support (or you create one with a pillow or rolled up towel), and allows you sit upright, you’re in a good place. You can also get relief from mouse shoulder by using an armrest or a different mouse. For example, you can use a mouse with a trackball or a vertical mouse. Another option is to invest in a specially made computer arm-rest for supporting the weight of your arm.
For severe cases, shoulder joint injections may be needed to manage inflammation and stiffness in the joint. The injections are typically a mixture of steroids and anesthetic. However, some pain specialists are starting to use regenerative therapies like Platelet Rich Plasma (PRP) injections. You can read about PRP injections in another one of my blogs HERE.
When you are in pain and dealing with discomfort or tightness, this all comes into play as well. You cannot become "fixed" until you fix the problem in the first place. You will save more money upgrading your equipment than if you are in pain and need medical intervention. Maintaining mobility, stability, and taking breaks during the day are all involved in allowing your body to do what it can to gradually recover. You may need to take more breaks more often if you are in pain and you may need to use less of a stretch and less resistance with any of the strengthening exercises which you are doing to help correct imbalances. As you recover, you can then gradually add more activity and resistance as your body tolerates it.
There is no one simple solution. if you are unable to get rid of this on your own by correcting your chair or maintaining balance between your musculature through stretching, mobility work, and trying to get up regularly, then it’s in your best interest for you to check out your favorite Physical Therapist. No need to see an MD right away. Get started today as you have 10 visits or 30 days, whichever comes first before needing a prescription to continue. This way we can start getting you better immediately EVEN while you are waiting to get in for an appointment for the MD.
Don't wait. Don't procrastinate. Take Hold of your Life and Control it.
If you have any questions, please feel free to check out my website and send that question directly to me at rberghorn@ascentphysicaltherapyny.com or call at (516) 387-4669 for a FREE call with a Doctor of Physical Therapy.