Parallels With Back Pain: Shoulder Pain Rehabilitation

Life can throw challenges at you and how we respond to the challenges is the primary vector through which we can impact the outcome. How you react matters, and you can always react better, even if mere misfortune beyond your immediate control comes your way. Whether it is an unexpected setback or some other flare up. It often gives rise to opportunities if we seek them out.

This week is the perfect example. Lara dislocated her shoulder. Inconvenient to say the least and while on her dominant hand having to look after our one year old daughter at Christmas, she could be forgiven for feeling less than deflated. Knowing that many members of ours have varying issues with shoulders we thought it a good opportunity to share some of these parallels as well as the actions we’re taking to make sure that Lara’s shoulder heals well, and comes out stronger the other side!

Ultimately the goal is to take this set-back, and make it a set-up for a stronger and more resilient shoulder girdle for the long term. Something we should all be doing regardless of the injury, be it a shoulder, knee or lower back. 

What Happened To Lara’s Shoulder?

Unfortunately Lara has had weaker shoulders for some time suffering a similar dislocation some years ago, the area has always been weaker than it should be. Earlier this week while carrying Evelina, one thing led to the next and while reaching for a falling nappy bag in just the right position, an outstretched externally rotated arm, popped out of place. Fortunately Lara was able to quickly reverse the movement after asking a nearby mother to hold the nappy bag. A little internal rotation and some gentle force popped the shoulder back into place after a few moments. 

In the following 10 to 30 minutes the shoulder begins to slowly seize up and start to throb. By the time she’d met me at the new HQ it was pretty immobile.

Reacting to setbacks no matter the cause

It’s easy for thoughts to go through your mind, “what if I had just let the stupid bag fall?” “What if I hadn’t gone to the class in the first place…” Once you’ve had the pity party, it’s time to move on. Taking immediate steps to formulate a plan to start to rehabilitate the shoulder make sure that we preserve a degree off support and set up for the best healing process is how we should react. Sometimes we can do this ourselves, Lara and I being extremely fortunate in this regard. Other times you rely on others to get a plan together, but one thing is for sure…

Wait and see is not a sensible strategy!

Similarities between the shoulder and the lower back

There are stark similarities between the shoulder and lower back however the shoulder specifically has a few quirks that you could say make it a little easier to work with.

Stop making it worse!

For starters, the sparing use of a sling in the immediate aftermath was helpful. This is more because it holds the arm reminding her that the arm is injured. We found without the sling, that the temptation to pick up Evelina, or reach for something was subconscious, and nearly always problematic. The sling just provided immediate cues that that arm is out of action. 

This is fundamentally different to the lower back, with your lower back you cannot use a sling in the same way, for starters you don’t have 2 low backs! So with lower back pain we have the immediate disadvantage that conscious effort is required to be mindful of how we do things on a moment to moment basis. It wouldn’t be too much to say that this is perhaps closing in on 50% of the problem with rehabilitation of lower back pain, people get tripped up by this reality time and time again. 

If we are ever to have success we must stop the continual aggravation of an area or region, and in the case of both this must be through two mechanisms:

• Education: pointing out the types of daily activities particularly provoking and reducing the likelihood of these or offering modifications. In the case of the shoulder, the sling as well as compensation with the other arm works well. In the case of the back we must first understand the challenges, sitting, bending, moving etc.
• Actionable adjustments: the shoulder remains simple, as above. For the lower back it’s a matter of learning how to move correctly, engaging the core and chest pop as well as sitting limitation strategies, for example, the small rolled towel being used to support the lumbar lordosis.

Support the natural healing process & accelerate where possible

Fortunately we have our own Class IV laser, so for the last couple of days, it’s been morning and evening Laser on the shoulder at the anterior portion of the ligamentous capsule (front) and the back portion where some of the rotator cuff muscles have been strained in response to the injury. This is not possible for everyone for obvious reasons, but the particular nuances of laser do make it a great intervention at times like this. Whether for the shoulder or the lower back this is a great option. 

For most of us without direct access to this kind of equipment in this way, the next best thing would be contrast bathing periodically to manipulate the circulation to and through the region. We’ve discussed contrast bathing many times before, this involved hot and cold therapy being alternated in short intervals of 3-5 minutes. For Lara we’ve been doing both, partially because we’ve been trialling a new consumer device that coincidentally happened to arrive yesterday (ordered last week). Lucky indeed! 

Whether it is the shoulder or the lower back, this kind of approach just helps ensure that you’re doing what you can to help the healing process take place as well as possible. Remember, your body heals, and wants to heal, it’s quite remarkable, often it is a matter of you getting out of the way!

Small amounts of pain free motion

One of the big problems with shoulder injuries lies in the anatomy of the shoulder, it is not the same as the hip in that although it is a ball and socket the socket is much less deep and therefore less stable, all be it more mobile, it’s a trade off. This means the shoulders integrity is heavily dependent on muscular competence, but when injured use drops dramatically, and with it, stimulation of the musculature. The same is true for the spinal column in the low back.

In Lara’s case this has meant small movements WITHIN PAIN FREE RANGE regularly during the day with a very light resistance band to “pump” the muscles and wake them up. The same is the case for the lower back with regards to movements like core engagement and walking with good posture. These activities keep the stimulation on the stabilising muscles and often, like in the case of Lara, there is an immediate feeling of greater protection when the muscles have been “pumped up”. This is short lived hence the need top do it regularly through the day in this early phase of recovery.

Steadily improve range of motion

Over the coming days and weeks the main strategy will be a continuation of the above with the addition of improving range of motion in Lara’s shoulder. In one short week of the above protocol, Lara’s movement has come on significantly. It is similar with the lower back, the goal of performing the same sort of rehabilitation exercises with gradually better ranges of motion should be the aim for us all. The key difference between the success or speed of this between the shoulder and lower back however is important to notice. Much of the movement’s we will start to incorporate will involve the lower body in the case of the lower back. Learning to move our hips properly through movements like the squat, hip hinge and lunge, all the while challenging the core and back musculature to maintain control. 

In the case of the lower back we often find that there are significant weaknesses in the hip and back musculature that require significant time and consistency to resolve, for example, Lara would be able to return to a good range of motion in the shoulder long before the average person with lower back pain from a disc bulge will perform a proper squat will FULL range of motion. This is primarily because chances are, most of us have been using our shoulder reasonably well over the years. To the degree this is not the case, recovery will be extended. 

Longer term recovery prospects and goals

As time goes by the more challenging work commences, making measurable change in the gross muscle mass of the shoulder girdle for Lara. This is the same for those with lower back pain. Building muscle tissue in the lower body to support and protect the lower back. To the degree this is done effectively, you will find yourself with a much more resilient body, possibly more so than you have had in recent memory, even before the injury. 

One of the common mistakes in this phase is simply stagnating or falling off the wagon. It takes consistent application over the long term to make these changes and you must continue to push yourself in order to make things change. For example, in Lara’s case, we will build in to some full range of motion Arnold Press, a form of deep full range shoulder press that’s much more dynamic than your typical option. This will need to be done with gradually increasing weights and it will take some significant effort as plateaus slow progress. The same is true for the lower back.

Too many times someone will build up to doing 10 squats and then continue to do 10 squats for the next 6 months just because the pain has gone, not realising they are more or less no better off than what they were 6 months prior, they haven’t built anything. Instead of this 10 squats with bodyweight might progress into 10 squats with a 15kg kettlebell… PROGRESS! 

Injuries are fundamentally very similar

Fundamentally we can only really injure so many things, the majority of joint injuries, lower back, shoulder, knee, affect the structures that provide stability to the joint, therefore weakening the joint and making it vulnerable and potentially dysfunctional. Movements central to this joint are then often problematic unless compensated for in the immediate aftermath. Understanding how these structures helps you understand how to limit the reoccurrence of flare ups in the short to medium term. 

Developing resilience in the long term comes to those who deserve it. Be someone who deserves it. This comes from consistent application of effort. Rebuilding your body, or rather giving your body the opportunity to rebuild itself. Recognise the marvel that is your own human body. You don’t do any of the strengthening, you merely provide the right stimulation direction, like a conductor directing an orchestra, and the body will do it’s thing, transforming your weaknesses into strengths.

Many of you will not have the ability to get the additional treatment that Lara has benefitted from, in the way she has, it’s one of the perks of the job, but you can do a tremendous job at home or with some professional support from time to time should your budget permit it. We get help fixing our cars, our sinks, doing our taxes, if you can, having additional support either academic or hands on along the way can prove to be helpful too!