The Approach to Shoulder Pain
"Improvise, adapt, and overcome…"
The unofficial mantra of the United States Marine Corps and an important mindset for anyone looking to overcome an obstacle….and certainly applicable to getting past pain and injury.
Let's dive into an understanding of what's needed to overcome a shoulder problem, specifically when surgery is not an option, or the last resort.
The Initial Step to Healing
It shouldn't be a surprise that continuing to hammer the same painful movements is not an effective solution for pain.
Therefore, the fundamental first step is to deload the painful tissue…best known as rest!
Although rest by itself actually a poor solution to pain!
That's because it doesn't support the most difficult part of the healing process— fighting the urge to return to max effort as soon as possible.
There's not an athlete in the world who wants to sit back while their injury heals! Watching their hard work and effort go to waste! Any effective shoulder fix must address this and get away from the mindset of rest.
Instead create compensations to maintain activity levels.
These things keep performance moving forward, while lessening the engagement of painful tissues. This facilitates both physical and psychological success to get past the shoulder pain.
Examples of compensations are:
- Movement modifications,
- Taping techniques,
- Avoiding specific painful stimuli and positions,
- and workload modifications
For more information on this, take a look at our shoulder scaling guide. It provides many effective ways to train the shoulder despite injury limitations.
Creating a Cure
As much we would like to profess to the magical band powers of Crossover Symmetry, healing is largely a natural process.
Demonstrated in a 2004 study in the Journal of Shoulder & Elbow Surgery (ref), which showed wearing a brace with activity modification was as effective as many weekly physical therapy sessions for treating shoulder impingement syndrome.
Despite this evidence, sitting back with a brace is far from the most effective healing plan. It does not address the strength, mobility, and coordination problems that may have led to the original injury.
Another look at the previous research reveals a short term study only considering pain levels, and not return to function, recurrence rates, or life satisfaction.
Thus, the next consideration for healing is remediation— derived from the latin word remediare, meaning to heal or cure.
Remediation first addresses impairments underlying shoulder issues. Correcting things like poor cuff strength, scapula control, and thoracic mobility creates a better environment for healing to happen and is essential to preventing pain from returning.
Remediation also involves gradually introducing load to painful tissue in a controlled manner. This builds the capacity to withstand the previous activity demands, beneficial to both meeting performance goals and avoiding shoulder pain recurrence.
Even structures that do not heal (e.g.-labrum, some rotator cuff tears, ligament tears) can return to full capacity through remediation. By improving strength and dynamic control of the shoulder, it removes loads and stress on the damaged area.
Many athletes can cover up their issues and continue to perform at high level despite permanent structural changes. For example, research shows up to 80% of major league baseball players continue to compete with a torn labrum (ref).
To further support this, we've seen many Crossover Symmetry users cancel their surgery and remain pain-free, despite things like rotator cuff and labrum tears.
Showing that a comprehensive plan of both compensation and remediation, known as relative rest, can alleviate most pain and keep a person moving towards their goals long term.
Healing Without A Cure
Unfortunately, some issues are beyond remediation and compensation.
A clear example would be a spinal cord injury, resulting in paralysis.
No amount of training can overcome this injury, yet adapting to the disability can restore life activities that bring joy and satisfaction.
Thus, despite a cure, adaptation is a form of healing.
Not all adaptive situations are this limiting or permanent either. For example, there are plenty of workarounds for dealing with an arthritic shoulder, or severe tendinosis which can take up to 9 months to completely resolve.
Ultimately it requires being smart with training and activities to continue pursuing goals. Whether it be adaptations around permanent limitations, or short term adaptations to stay invigorated while long term healing runs its course.
For example, it's very possible to be strong, athletic, and look great naked without doing squat snatches or muscle ups. You can go out and enjoy 18 holes of golf (and for most shoot the same score), without full swings off the tee box. And even for something as shoulder intensive as swimming, a great swimmer can be made by drilling mechanics, body position, and carefully prescribing volume.
If adapting or avoiding these movements is not an option for life enjoyment, it may be time for a surgical consult. No doubt there are situations when surgery is the best solution. It often has remarkable results that completely resolve pain and limitation.
Although surgery does have many drawbacks, it's not the solution for everyone, and should ultimately be the final approach. We get more in-depth on the decision making for surgery here: Important Considerations Before Going Under the Knife.
How to Approach Shoulder Pain
In dealing with shoulder pain, use the healing strategies outlined above.
Compensation- Find a Work Around
Remediation- Find a Cure
Adaptation- Find an Alternative
Start by creating a plan of relative rest, using a combination of compensation and remediation.
If you are following the Crossover Symmetry Shoulder Program, we help guide this in our training and education on the Training Zone.
And you can learn more about our plan here: 30 Day Shoulder Fix.
Then after 30 days reevaluate how things have improved. If pain is gone or continuing to improve keep moving forward!
If things are not getting better, this will require some self analysis to understand what's most important to you. It may be time for more advanced medical procedures, or to create adaptations to satisfy activity cravings, without wrecking your shoulders in the process.
All the best on your road to recovery, however long that may be! And if you ever need help along the way, please reach out to us at
support@crossoversymmetry.com.
