Unfortunately, shoulder pain is quite a prevalent issue in the over 55 population due to conditions such as osteoarthritis and rotator cuff problems. These conditions are often very limiting and prevent people from being active and doing the things they enjoy. We thought we would clarify some common misconceptions around shoulder pain and what the best approach is to improve symptoms and function.
I can’t lift my arms overhead so I shouldn’t do any exercises where I have to lift my arms above shoulder height?
There are several conditions that can cause shoulder pain when lifting your hands over head – which can make tasks like hanging out the washing or putting away crockery very frustrating and challenging. Regardless of the condition, avoiding the overhead movements will not help you improve your capacity to lift overhead. Just like a student who fails a maths test, the best way to prepare for the next test is to study. The same principle applies here – we need to better prepare the shoulder for overhead tasks by building its capacity.
That makes sense, but I get pain whenever I use my arms, doesn’t that mean I’m causing damage?
Pain is not an accurate measure of the health of our tissues. In the case of shoulder pain with overhead movements, it’s likely that the load we are placing on the shoulders is beyond the capacity of the tissues to manage. So to reduce pain, we need to increase the capacity of these tissues so they can handle more load.
Pain during exercise does not mean we are doing more damage – just that we are putting load through structures that may be sensitive. If you experience pain during exercise, you should continue as long as it's tolerable for you. This means we can gradually build up the tissue tolerance and reduce symptoms.
I have a complete tear in my rotator cuff, exercise won’t fix that?
A couple of things regarding the rotator cuff– a small group of muscles that act on the shoulder. Rotator cuff tears are common and their prevalence increases with age. You can think of rotator cuff tears as an age related change, just like skin wrinkles or grey hair. The other thing to consider is that a lot of rotator cuff tears are asymptomatic. In fact, research has shown that for people in their 50s, asymptomatic tears accounted for half of all rotator cuff tears, and this number rises to two-thirds of tears in people over the age of 60.
Now the rotator cuff tendon is quite broad, and most tears that occur can be thought of as more like a hole in a blanket as opposed to a torn rope. This means that the tendon is still useful, just like a blanket with a hole! We can still make the surrounding tendon tissue stronger and more resilient by challenging it with exercise.
There is no cartilage left in my shoulder from wear and tear. There is no way to improve it except a shoulder replacement.
We used to think of joints in our bodies like the joints in a car – if they get enough use, eventually they will need to be replaced. However, we now realise that our bodies are incredibly adaptable and that exercise is actually very important for joint and cartilage health. Cartilage doesn’t have a blood supply like muscles and bones, so it gets its nutrients from the surrounding synovial fluid. You can think of this process like a sponge – when we exercise, the fluid is squeezed out of the sponge, but as we recover, the sponge expands and draws in the nutrients from the synovial fluid.
We also know that X-Ray findings don’t give us much information about symptoms either. Lots of people with no symptoms have low amounts of cartilage, and equally, lots of people with severe pain have good amounts of cartilage in their shoulder. This means that even if your X-Ray looks bad, there is still plenty of scope to improve your symptoms by means other than joint replacement. There is good evidence that we can improve shoulder symptoms through exercise that increases the capacity of the muscles and the shoulder joint itself!
I’ve had a shoulder replacement/rotator cuff repair and my Surgeon told me I shouldn’t lift anything over 10kg ever again. How can I do resistance exercise?
Surgeons commonly give lifting restrictions following operations to allow the affected structures time to heal. Unfortunately, a lot of surgeons unnecessarily extend these guidelines beyond the healing time of the tissues. The reality is that at some point, deliberately or not, you are going to exceed the lifting restrictions set by the surgeon. The best way to prepare for this eventuality is to build the capacity of the tissues so that they can tolerate these events. We understand that this can be daunting – which is why we strongly encourage our clients to follow the principle of progressive overload. This means that we start resistance training well below what the shoulder can tolerate and very slowly and gradually build up over time. If we do this, the structures in the shoulder have time to adapt and there is a low risk of reinjury.
For more information check out our Video on Shoulder Pain in the Bonus Videos section of the course!