This time around we’re talking about another common problem that may affect people with spinal injuries (and other wheelchair users) – mechanical shoulder pain.
There are two main types of pain that may affect the shoulders – mechanical and neuropathic pain. For now we are focusing only on the mechanical pain, which may happen for several reasons.
The first of these is related to increased wear and tear:
ïƒ©Following a spinal cord injury your arms often take on a weight bearing role in most activities of daily living. During these activities, your arms have to support the weight of the body, resulting in increased and abnormal stresses being placed on the bones, joints and muscles of the arms.
ïƒ©Because you rely on your shoulders during transfers, for pushing your wheelchair and reaching above your head you place far greater demands on your shoulders compared to before your injury.
ïƒ©Your shoulder joint is not really designed to support your body weight, while pushing your wheelchair and lifting your body weight calls for significant strengthening of the muscles around the shoulder joint.
A second major cause is imbalance in the muscles around the shoulder joint:
The shoulder joint is held in position by four muscles which make up the “rotator cuff” – which are arranged around the joint to strap the shoulder into place, but leave it free to have a large range of movement. If the delicate balance between these muscles is lost pain may result as the shoulder becomes less stable.
In people with tetraplegia one or more of these muscles may be partially of completely paralysed.
ïƒ©Sometimes overuse of the muscles at the front of the shoulder may leave them strong and tight, while the muscles behind the shoulder may be weaker.
A third cause is overuse injury – as continuous and repetitive use of the shoulder muscles can affect the muscles, tendons or the joint itself and result in pain.
Shoulder pain may affect you in several ways:
It may make it harder to push your manual wheelchair.
It may be more difficult to transfer and leave you relying on others for assistance.
It may make it harder to lift your arms above your head and result in difficulty with tasks like dressing yourself, combing your hair, or reaching for things above your head.
It may make it more difficult for you to get comfortable in bed at night, and may make it hard for you to lie in certain positions and can cause problems with your pressure care.
If you do have shoulder pain you should seek advice early – talk to your doctor and/or your physio. They will be able to treat this pain if it does occur – but as always prevention is better than cure!
So here some tips on preventing shoulder pain:
Get your physio to teach you some strengthening and flexibility exercises to maintain the muscle balance around your shoulders.
Make sure you carry on with this programme - both for general strengthening and to exercise specific muscles to minimise the risk of shoulder pain.
Don’t ever suddenly increase your level of activity or exercise– your shoulders need time to get used to new activities or demands that you are placing on them.
Plan your day and consider minimising the number of transfers that you do in a day.
Warm-up and stretch your shoulders before transferring or pushing in the morning.
If you do play sport, be more careful not to overuse your shoulders. Build up your training slowly and use a variety of training activities.
Organise your home so that you can avoid lifting overhead repeatedly. Place frequently used items on shelves either at shoulder height or below.
Get treatment early if you have any shoulder or arm pain. Rest from the activity that is causing pain as much as possible. You may need to get help with transfers or pushing your wheelchair.
Make sure that your chair, backrest and cushion are set up correctly because poor posture can also contribute to shoulder pain.
Of course it is possible that after doing all of this, you may still have shoulder pain from time to time. If you do, see your doctor or physiotherapist as soon as possible. Treatment may be in the form of physiotherapy, rest, medication, injections into the shoulder or even surgery in the worst cases. Good, effective treatment exists – but you do need to take good care of your shoulders and prevent avoid wearing out this important joint and maintaining your independence.