Shouldering Your Responsibility as a Sailor
Ok, so what is a baseball picture doing on a nautical health blog? Well there’s a story of course. In 1995, a friend and I went to Phillies Dream Week, an adult fantasy camp for middle aged baseball wannabes and retired major leaguers who were there for love and /or money. I usually played the infield in my youth and so I signed up for second base. By the end of the first day, the “kid” who was playing centerfield – and who was only 29 years old (the lower cut-off was 30 so he was really too young) – threw out his right shoulder and could not play the outfield for the remainder of the week. I volunteered and played error-free center field! Fast forward two years to 1997 when I began to have right shoulder pain. An MRI scan revealed “tendinosis” of the supraspinatus muscle, one of the “rotator cuff” muscles (see below). I had heard of “tendinitis” – an inflammation of the tendon – but was not familiar with the term “tendinosis”. When the radiologist informed me that it was a degenerative condition of the tendon frequent with increased age, I informed him that I was only 49.
So, I rehabbed the shoulder, and all was well until 10 years ago when my left shoulder began to act up. I didn’t bother obtaining an MRI but began rehabbing both shoulders and have never stopped for the past 10 years. Working on my shoulders has been part of my workout regimen ever since.
This is an illustration of “tendinosis” with the irregular tendon fibers compared with the nice neat regular tendon fibers to the right.
Shoulder injuries and damage are extremely frequent in a nautical environment; just look through any discussion thread on sites concerned with boating, sailing, fishing, racing and sailboarding. And if an operation is required, the downtime is measured in many months which could spell the end of the season.
Why are shoulder injuries so common? The shoulder joint (technically the glenohumeral joint) is the most flexible joint in the body. You can move your shoulder in all different directions. However, to achieve such a high level of flexibility what is sacrificed is stability. So, when you think of shoulders, think high flexibility = high instability. This unstable ball and socket joint is often described as the equivalent of a golf ball (head of the humerus) sitting atop a golf tee (the glenoid socket). This is very different from the hip joint where the ball sits well within the socket.
To maintain stability there are both static and active stabilizers. The static stabilizers are: 1. the so-called glenoid labrum, a ring of fibrous tissue which increases (somewhat) the depth of the socket and 2. Several ligaments which prevent the humeral head from going too far forward or backwards and dislocating.
The active stabilizers are the “rotator cuff muscles” principally the supraspinatus (one of the more common rotator cuff muscles to be injured – see my story above), infraspinatus, teres minor, and subscapularis. In this picture from the book (Figure 11.8) it is impossible to see all the rotator muscle in one view. In the view to the right, which is looking at the right shoulder from behind you can see 3 of the muscles but not the subscapularis which is underneath the shoulder blade (scapula) and can only be seen on a front view (the left illustration) once the chest and lungs are removed. However, it is usually not injured.
This illustration better illustrates the arrangement of the muscles. Both illustrations demonstrate just how unstable the joint is.
Some of the common injuries to the shoulder:
Rotator Cuff Injuries: There may be “tendinosis” (as discussed above) or there may be partial or even complete tears of one of the 4 rotator cuff muscles. Sometimes a biceps injury can be confused with a rotator cuff injury. The biceps is not one of the rotator muscles but as you can see from the diagram above it attaches to the shoulder joint and may certainly cause shoulder pain.
Impingement: A confusing syndrome due to both overuse and sometimes bone spurs rubbing on tendon or muscle.
Bursitis: A bursa is a fluid filled sac that cushions tendons and muscles and when swollen with inflammation (often due to overuse) can cause pain and impingement. It often responds to an injection of corticosteroids. Look at the bursa right beneath the acromion.
Injury to the joint (glenoid labrum): May be acute or chronic from overuse and may cause instability.
Dislocations and Fractures: Usually acute injuries requiring orthopedic care
Adhesive Capsulitis: “Frozen shoulder” is usually due to chronic repetitive trauma in youth and often due to nerve or other injuries in adulthood.
If you have shoulder pain or limitation of range of motion, see an orthopedist / sports medicine specialist. Get diagnosed and properly treated including physical therapy and be sure that the therapist provides you with an exercise program to continue after formal PT. This discussion should not take the place of treatment. It is meant for educational purposes and to help those of you who:
A. Have mild symptoms and want to avoid further damage
B. Wish to be proactive and avoid future problems
Here are some tips on getting started for proper care and feeding of your shoulders from the Rothman Orthopaedic Institute website, here in Philadelphia:
Apply heat to shoulder muscles before exercise. Heat prepares muscles and tendons for exercise.
Keep your arm below shoulder height while doing stretches for the shoulder.
Gradually increase movements—big circles, across-body movements, trunk twists, shoulder blade rolls and forward and backward squeezes—during shoulder warm-up.
Pendulum stretching exercises relieve pressure on the rotator cuff. While sitting or standing, keep arm vertical and close to the body. Allow arm to swing back and forth in a small diameter (about 1 inch). As symptoms improve, the diameter of swing may be increased. Initially perform the exercise with just the weight of your arm. As shoulder pain improves, progressively add more weight—5 to 10 pounds (a filled gallon container weighs 8 pounds). Perform exercise for 5 minutes once or twice a day.
Muscle-strengthening exercises can be performed about 1 to 2 weeks after doing pendulum stretching exercises. Use elastic exercise bands for a variety of arm exercises.
Once you are developing your program you should think of the 3 shoulder “S”s:
Strength – you want to strengthen the muscles especially the rotator cuff muscles and the biceps
Stretch – you will want to stretch those shoulder muscles
Range of motion –you will want to improve range of motion; OK, it really is 2S’s and 1R although we could substitute “Stability in all directions” for range of motion to get that third “S”!
The best way to strengthen the shoulder muscles –especially for boaters and sailors—is the use of Resistance Bands. They are relatively inexpensive, take up little space, and can be used anywhere. They come in 2 major types: Resistance Bands and Resistance Tubes. There are advantages to both, and they are widely available. Some companies package both (see below), giving you the option of seeing which agrees with your program. I should mention that these can be used for strengthening muscles other than the shoulder and the main limitation for general use is that there is a limit to the resistance; you cannot approach the amount of weight that advanced lifters and body builders require.
Top row is tubes and the middle row is bands.
Here are just a few of the exercises you can do to strengthen your shoulder with resistance bands:
The second “S” is stretching and there are numerous stretching routines for the arms and shoulders. Below are some of the common stretching exercises for the shoulder girdle. Remember, it is always better to stretch a warm muscle rather than a cold one, so it makes little sense to start a workout with stretching. Warm up first.
Finally, we come to Range of Motion. It is certainly possible to maintain or increase shoulder range of motion with the resistance bands using lesser weight. Another approach which is also cost effective on the water is the use of a pulley which fits over the door. Below is the inexpensive unit I have, but there are many other units to choose from including those with an over-the-door metal bracket. None are expensive and I have found them very useful for range of motion.
I think you get the idea. If you were here, I could demonstrate my preserved right shoulder range of motion, by making the throw from centerfield. On second thought, at this point in my life, maybe I should stay in the infield!