Having come across three people in the past two weeks with shoulder issues, ranging from one needing surgery and another daily medicine for pain, I got thinking about the number of times I’ve taken the shoulders for granted. Maybe I didn’t warm-up my shoulders enough before a push day in the gym, maybe I overused them during CrossFit? Am I stretching enough? The worry is justified: the shoulder seems to be quickly catching up with the knee when it comes to joint injuries and issues over time.
“Impingements, tears, unhealed injuries and trauma all eventually lead to bad shoulders over time,” says physiotherapist Drashti Shah, who has worked in Canada, USA, and India over the past two decades. Shah says that there are a huge amount of frozen shoulder issues related to diabetes as well. According to a 2016 study titled Diabetes and Shoulder Disorders, published in the Journal of Diabetes Investigation, diabetic patients might suffer from impaired microcirculation and joint stiffness. “The impaired circulation leads to tissue hypoxia, overproduction of free radicals, eventually leading to potential apoptosis. This collective damage might lead to joint tissue destruction and enhancement of degenerative changes,” the paper states.
A World Population Review article, which uses data from the International Diabetes Federation, states that an estimated 642 million people will be suffering from the disease by 2040. This fact warns us that the process of strengthening and making sure your shoulder is healthy starts now.
“I always ask people to assess how healthy their joints are before starting to exert them in any physical activity. Even a warm-up needs to be done with good form and in good health. If you’re not diabetic, and between the ages of 45-60 facing shoulder issues, then they are probably related to overuse of the shoulder over a period of time—whether it’s through overhead presses without mobilisation, sports without warm-up and stretching or even bad push up and plank form,” says Shah.
She uses the term “dynamic stability” to describe what the shoulder needs: stability during activity, not just while resting. Given that so many shoulder injuries are related to the rotator cuff, Shah suggests doing PNF (proprioceptive neuromuscular facilitation) exercises for a more dynamic drill.
PNF stretching is a technique that involves pushing against the targeted muscle for a few seconds before relaxing it for a few seconds in a static stretch. You might need a partner to push against the muscle while you’re resisting force, and also to aid the static stretch. A livehealthyarticle on PNF exercises says that this kind of routine will aid “flexion and extension, abduction and adduction, and internal and external rotations of the shoulder.” It is to be noted that PNF exercises should initially be done under supervision of a physiotherapist until the technique is learnt.
There are other ways to keep your shoulders healthy, and this means incorporating a few extra minutes of preparing it for stressful activity. Making sure the rotator cuff has gone through internal and external rotations, that the scapula is ready to contact and retract, and even doing a few light sets before going heavy on the weights will protect your shoulders. The other side of the coin includes stretching the upper body and doing enough mobility drills to make sure the shoulders don’t round forward. Saturno Movement’s 20-minute shoulder drill using just a yoga mat is perfect as a regular practice.
And here are AskDoctorJo’s 10 best exercises for more specific rotator cuff pain.
Shah says that a tight shoulder can lead to a lot of other issues in the upper body, given its connection with the chest and back. While building good looking shoulders is a high priority in the gym, she warns that it must be viewed as a joint as much as a muscle. “It’s like a door. If the hinges are bad, it doesn’t really matter how you paint it.”
Pulasta Dhar is a football commentator and writer.