By Ross Hauser, MD, and Debra K. Brinker, RN

Island living embodies the pleasures of outdoor activities and sports. Southwest Florida’s climate is conducive to enjoying tennis, golf, swimming, cycling, fishing, kayaking and more. Some people even love the creativity of home improvements and gardening. These activities require mobile and flexible joints. The shoulder is one of the most flexible joints in the body, a ball and socket, with a huge range of motion. That mobility and flexibility are usually beneficial for engaging in the activities and sports we revel in.

At times, wear and tear from repetitive movements or previous injuries can cause the supporting ring of ligaments in the shoulder to become too loose, allowing for excessive movement in the shoulder, thus causing pain and susceptibility to further injury (see figure 1).  Ligaments are the connective tissue of joints that act like the hinge on a cabinet door. If the hinge becomes loose, the whole door becomes wobbly.

When ligaments get too loose, the joint becomes unstable. Subsequently, the muscles that move the shoulder, the rotator cuff muscles, are called upon to try and keep the shoulder stable. The muscles will eventually become chronically tight, sore or spasm from overuse, eventually fatiguing the rotator cuff and possibly leading to rotator cuff tears or injury to other shoulder structures.

Tips for Helping

If faced with a shoulder injury, you can take a number of steps to lessen the pain and aid in healing.

Stop extra activities that increase shoulder joint looseness. Discontinue passive stretching of the shoulder. This can increase the tendency toward shoulder instability.

Allow time for ligaments to tighten. Aggressive, repetitive use can cause ligaments to elongate. The ligaments need time to remodel and repair. For example, if a swimmer has shoulder pain, swimming training hours may be reduced or altered to allow for proper rest time between workouts (see figure 2).

Add appropriate strength training. Incorporate exercises that work all the shoulder muscles within a pain-free range, including the scapula stabilizers. Strength training causes muscles to tighten, which can have a protective effect on the shoulder.

Assess technique. For the sports enthusiast with a painful shoulder, certain techniques should be evaluated to ensure that excessive stress is not being placed on the shoulder during the swing or stroke.

Address contributing factors outside of the primary sport or activity. Sleeping on the bad shoulder can aggravate it. Computer usage may also stress the shoulder. If you have shoulder pain on your dominant side, simply switch to the opposite hand to control the computer mouse.

Note any shoulder clunking. When the shoulder becomes unstable, it can start making a clunking or clicking noise. When this occurs with every stroke or swing motion, it can indicate a more severe, multidirectional shoulder instability (see figure 3). Symptoms can include loss of shoulder strength and motion, in addition to increased pain and muscle spasms.

Stabilize the shoulder joint. Ligaments have poor blood supply and, once damaged, often need a treatment that restarts the repair cascade. Shoulder instability and pain can be successfully addressed with regenerative-medicine techniques such as prolotherapy, platelet-rich plasma or stem-cell therapy (see figure 4). These natural injection therapies can stimulate healing and provide a long-term strengthening of the joint, along with pain relief.

Make chronic shoulder pain and instability a thing of the past, and get back to the activities you love.

Ross Hauser, MD, is the medical director of Caring Medical Regenerative Medicine Clinics in Fort Myers and Chicagoland. Debra Brinker, RN, is a registered nurse and medical writer.