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Instep Dance Magazine Articles

Reprints of monthly column as first appearing in Instep Dance Magazine.

July 1999

Shoulder Injuries - Part 2 - Injury, Treatment and Prevention

By Rick Allen, DC

"Better health leads to better dancing."


 Normal Shoulder Diagram

Let's move on to the conservative treatment and prevention of common injuries of the rotator cuff muscles and tendons of the shoulder. These are most commonly caused by chronic overuse, but may also include additional acute trauma. Injuries that require surgical treatment are beyond the scope of this article.

Injury of the Rotator Cuff

As was pointed out last month, because rotator cuff muscles and their related tendons pass underneath the acromion, they may become pinched and irritated by that bone (compare the illustrations of normal and injured shoulders), causing rotator cuff tendinitis and related problems and even "frozen shoulder." The biceps tendon, because of its intimate involvement with the rotator cuff muscles, can also be irritated and, at times, can rupture. The subacromial bursa, which lies between the rotator cuff and the acromion, often becomes inflamed when the rotator cuff tendons are involved.

Dancers may develop rotator cuff tendinitis from frequently raising their arms to spin. This is especially a problem for women. Raising the arm places the places the rotator cuff in a position where it wears under the acromion. This chronic wear and tear frays the tendons, weakening them. When the dancer uses the arm vigorously again, the tendon may tear very slightly. This subsequently produces an inflammatory response. The bursa may then become involved. The process may be repeated in a worsening cycle. This often results in pain with virtually any activity; this pain may persist for a long time.

 Impinged Shoulder Diagram The common symptoms of rotator cuff tendinitis typically occur with overhead motions of the shoulder. They usually produce pain localized on the outside of the shoulder and sometimes go down the arm, but not past the elbow. Typically, the pain is worse at night while trying to sleep and certainly is exacerbated when the arm is raised above eye level. If the problem has persisted for a while, there may be stiffness of the shoulder, with limitation of motion. This "frozen shoulder" can be quite disabling.

Non-Surgical Treatment

Conservative, non-surgical treatment for such problems generally involves three phases: reducing inflammation, mobilization, and rehabilitative strengthening of the shoulder. Let's briefly examine each phase.

First, I suggest reducing inflammation with a combination of rest, anti-inflammatory herbs, and ice massage for a few days. Because of their well-documented negative side effects, I recommend patients avoid anti-inflammatory drugs, such as ibuprofen or steroid injections unless absolutely necessary.

Once the acute inflammation is under control, I start mobilizing the shoulder gently through various ranges of motion to prevent stiffness, but not moved so much as to aggravate the inflamed and slightly torn tendons. Almost universally, I will use special active release techniques to eliminate the fibrous adhesions that form under the shoulder blade in the subscapularis muscle. Oftentimes, I will work in concert with an acupuncturist who employs Chinese needling and soft tissue techniques to further release the muscles and connective tissue of the shoulder girdle. Since spinal problems often accompany shoulder injuries, I will massage and adjust the spine as well.

As the patient's range of motion is increased, I will start rehabilitative exercises to strengthen the injured tendons and muscles. All along, I encourage patients to continue alternative exercise that maintains their overall strength and aerobic capacity, but avoids aggravating the shoulder injury.

In my experience, shoulder injuries are often difficult to treat and subject to aggravation. The whole treatment process may take several weeks to several months, or even close to a whole year in the case of a severely frozen shoulder.

Prevention

Prevention is obviously the best strategy. Good stretching exercises for the arms and shoulders are recommended prior to participating in athletics, including dancing. Proper technique also helps prevent injury -- check with your dance instructor. Finally, if you start to develop significant shoulder pain, refrain from activity that causes the problem at least for a few days and try to do only stretching and strengthening exercises.

Next article: I'll save some real-life examples from our dance community for next month.

Dr. Rick Allen is a chiropractor, massage therapist and dance student who splits his time between Portland, Oregon and Trout Lake Washington. Dr. Rick welcomes your questions and suggestions for future articles. However, he cannot make specific diagnoses or treatment recommendations unless you visit him in person. He can be reached by phone at 503-257-1324 in Portland, 509-395-0024 in Trout Lake, or toll free at 1-888-247-3248, email or on the World Wide Web: www.CascadeWellnessClinic.com

DISCLAIMER: The information included in this website is meant to encourage thinking concerning choices of care for and insight pertaining to possible causes of various problems. It is not a prescription for or diagnosis of any disease or condition. Suggestions are based on the assumption by the writer that a thorough examination was done previously and the reader is under care by a healthcare professional. This information is not a substitute for a live doctor.

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