3-2-1: Demystifying Shoulder Pain

By Holly Pennington, PT, DPT/Outpatient Physical Therapy

    Are you back in the pool after some time off this winter? Are you ramping up your yardage for race season? If so, you may be one of the 70% of people who experiences shoulder pain at some point during their lifetime. When a complex joint like the shoulder is injured, symptoms can be erratic and confusing. The glenohumeral joint (aka shoulder) is a ball and socket mechanism that allows for movement in all three planes and depends on four intricate rotator cuff muscles as well as a host of ligaments, tendons and nerves. The possible origins of pain range from the joint itself to tiny ligaments that connect the shoulder to the collarbone. All of this makes self-diagnosis – and deciding when to seek treatment - quite challenging.

    This simple guide will make knowing when to see your healthcare professional for shoulder pain related to swimming or other training activities as easy as 3-2-1.

    Most shoulder pain in athletes results from repetitive activities, such as swimming, throwing or lifting weights. Combine this with the fact that the longer pain from repetitive injuries persists, the harder it is to treat, and the message is: the earlier you get a diagnosis and treatment plan, the better. Further, recurring rates of shoulder pain are as high as 50%, meaning that if your shoulder pain goes away on its own, the chance of it returning is very high.

As a general rule of thumb, if you experience shoulder pain for three or more days, it is worth an evaluation by a healthcare provider* to get to the root of the problem, allow you to continue training, and prevent recurrence.

    Because of its ball and socket, shoulder joint movements are complex and require the interaction of many different anatomical structures. If your shoulder hurts when you move it in two or more directions, such as when you raise it out to the side and when you reach overhead, more than one muscle, tendon or ligament is most likely injured or irritated. While inflammation of multiple structures of the shoulder is not uncommon, it does require a comprehensive treatment plan that addresses each problem.

When you have pain with two or more movements of your arm, it’s time to get help!

    Finally, there is one shoulder symptom that always warrants a visit to the clinic for a professional evaluation: night pain. Upper arm pain that interrupts sleep is a common sign of rotator cuff tendinitis, rotator cuff tears, subacromial impingement, osteoarthritis and frozen shoulder. None of these will heal on their own!

If your shoulder pain affects your sleep, it’s time to get it checked out.

    Trying to figure out what is going on with your painful shoulder is daunting, but knowing when to seek help doesn’t have to be. Remember 3-2-1 and you’ll know when to go: Three (or more) days of pain, two (or more) painful motions, or one symptom (pain at night).

3 days of pain (or more)
2 painful movements (or more)
1 symptom: night pain

*Your “healthcare provider” could be a physical therapist - Physical Therapists at Outpatient Physical Therapy offer free pain and injury consultations (no prescription needed and no charge). If you have shoulder (or other) pain, call to make an appointment for a free consult at a location near you: www.outpatientpt.com

Sources:
Dong W, Goost H, Lin X-B, et al. Treatments for Shoulder Impingement Syndrome: A PRISMA Systematic Review and Network Meta-Analysis. Medicine. 2015;94(10):e510.
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Laslett M, Hing WA, McNair PJ and Coates MA. A prospective study of shoulder pain in primary care: Prevalence of imaged pathology and response to guided diagnostic blocks. BMC Musculoskeletal Disorders. 2011;12(119).

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