3 Things You Should Never Do With Shoulder Pain

As a physical therapist for the US Olympic Team, I see shoulder pain, a lot of shoulder pain.  Most of it, in fact all of it is not the result of some accident that happened, it just started hurting.  In fact, shoulder pain, whether you are an Olympic athlete or not, comes on and the most common phrase I hear is, “I have no idea what I did.”

However, there are 3 very important things that you should NEVER do with your shoulder when it hurts.  Doing these things can lead to chronic pain, injections and surgeries.  

1. You should NEVER stop using it.

This one seems kind of counter intuitive but this is a number 1 reason that shoulders do not get better on their own.  This goes against what you’re going to want to do if your shoulder hurts.  For example, if your shoulder hurts when you lift it overhead, you don’t want to lift your arm overhead so you don’t.  Maybe you don’t lift as high overhead  or use the other arm to lift overhead, you make some variation not to move that arm into a position that hurts.

When your shoulder hurts you should continue to gently move it to all ranges of motion.  To see a video demonstration of this click here.  

Your body is going to want to move your shoulder out of the painful position.  So you will need to watch yourself in the mirror as you do this.  Make sure your arm doesn’t turn out or your shoulder doesn’t shrug.  You need to make sure that you are moving your arm in the correct fashion, nice and easy.

Click here for exercises you can do in the comfort of your own home to fix your shoulder pain.

2.  Have poor posture

Bad posture does not just effect your neck and back.  If you have bad posture, your shoulder is not going to heal, and in fact it will get worse.

The problem is, is that most times people have poor posture that effects their shoulders and they don’t even know it.  Here’s a quick test to see if your shoulders are in correct posture, try to push your shoulders down.  To see a video of this click here.  If you can move your shoulders at all in a downward movement then your shoulders are not in the correct posture and you are harming your shoulders.

Having your shoulders elevated are using mechanisms that are going to hurt you.

But you are also using a mechanism that can cause a decrease in blood flow to the shoulder.   With decreased blood flow comes decreased ability to fix pain or a problem in the shoulder.  If you’re shrugging your shoulders, if you’re leaning forward, you’re not going to be able to have enough blood flow to the shoulders to fix them.

To get your shoulders in a correct position, you’re going to roll them up back and then you’re going to drop them down.   Do not roll them up and back and then pin them all the way back holding them in that position as long as you can.  This will bring in other problems so you want to make sure you roll them up back and you simply drop them down.

This is not a 1 time exercise, this is not a 10 time exercise, you have to retrain your body on how to sit correctly and how to stand correctly.  This can take weeks and months.  Set reminders on your phone to help remind you to do this.   Click here for other tips and tricks that you could be doing at home to eliminate your shoulder pain.  

3.  Sleep on the shoulder

If you have a sore/achy/painful shoulder you should never sleep on that shoulder.  You want your shoulder in the correct position when you sleep for the maximum amount of healing time.

If you’re laying on it and you’re crushing all the structures in your shoulder.  You’re limiting the blood supply, you’re putting all the pressure on things that are already inflamed and sore.  If you are a side sleeper, you want to make sure that you lay on your opposite shoulder.

Finding the exact cause of your shoulder pain and performing a few exercises at home, is important for healing your shoulder also.  Click here for our FREE shoulder pain solutions book and find out what you can be doing at home to solve your shoulder pain.

Posture Correction Exercises

Changing posture is not going to happen overnight.

You’re going to need to change the things about your environment in order to make permanent posture changes.  You’re going to have to find a way to remind yourself to sit up straight or to walk correctly or to have your shoulders in correct position.

Your posture got this way over a matter of time, it didn’t happen overnight so it’s not going to change back overnight.  Don’t get frustrated if one minute you sit up straight and the next minute you’re back into your old posture habits.

Poor posture has come from years and years of practice and this has caused changes to your muscles and how they behave, they’re used to working in a certain and whether that’s a correct manner or not they’re still used to working in that capacity so when you try and change your posture you’re sending signals to your muscles to say hey! I need you to work a little bit differently.

If you don’t constantly send those signals, your muscles are going to go back to what they know, which is poor posture.  It takes a minimum of 6 weeks to make permanent changes to the muscle so it’s going to take you at least 6 weeks to be able to maintain certain aspects of your posture without having to constantly remind yourself otherwise.

Poor posture can lead to herniated discs in your neck and back which will cause numbness and tingling.  It can also cause you to lose some function in your hands, or your feet, if it goes on long enough. Poor posture can decrease the amount of air you breathe so if you’re not getting quality air in your lungs you feel tired and this can cause sleepiness and less productivity.   If you have poor posture when you sleep if it can keep you up all night.

Poor posture can just decrease the overall quality of life.

When I tell people to correct their poor posture they always sit up super straight. Overcorrection is just as bad as slouching.  People just jam their shoulder blades back together and try to hold that as long as they can.  Their muscles in their back start burning and they can’t hold that posture anymore.  This is just as bad as slouching.

How to stand properly

First you have to find something to remind you to stand up straight.  If you just rely on yourself to ‘remember’ it will happen one or two times a day and no real change will come.  For example, every time you walk through the doorway, say to yourself stand up straight.  It’s putting little reminders like that throughout your day that will create a constant way of remembering to stand up straight.  You will have to do this until it becomes a habit, it won’t be a habit without constant consistent practice.

For the shoulders you roll them up back and drop them down.  When I say drop them down, you literally let them drop, don’t try and control the motion on the way down.  The problem is that 5 minutes later you’re going to find that your shoulders are elevated and you need to drop them down again.

One of the biggest mistakes people make with their low back is they stick their butt out too far.  If you look in the mirror you will notice that there is a pronounced curve in their low back.  If you look in the mirror you will see a really pronounced curve in your lower back.

So to find out the best position for your low back, you want to stick your butt all the way out and arching your back.  Then you want to go to the complete opposite direction and tuck your pelvis under.  No repeat both of those motion, sticking your butt all the way out and then all the way under.  After doing this 10 times, find the middle between the two extremes and then hold it there.

It will feel completely unnatural until you practice standing like this and it becomes natural which will take a minimum of 6 weeks.

Sitting

When you’re sitting, you want to change your environment as much as possible to force you into the correct posture.  If your environment is not set up correctly and allows you to still be able to do your work, then you won’t be able to change.  For example, if you have your monitor off to the right and try keep your head straight ahead and just have your eyes look to the right, your head will follow where your eyes eventually and your head will turn to the right after awhile.   If your monitors are off or if your keyboard is off, your body is not going to be able to sit correctly.

When you sit at a desk you want to make sure you monitor is at eye level and directly in front of you.  If you use 2 monitors you want to put the monitor that you use the most in front of you with one a little bit off to the side.  If you use both equally you want to put them directly in front of you with them touching so you’re able to look right in front of you.  Having the monitor(s) off to the side even slightly, will cause your neck to have to turn.

Your arms should be at 90 degrees.   Roll your shoulders up, back and drop them down then bend your arms to 90 degrees.  Then do not adjust your arms or hands to meet the keyboard.  Bring the keyboard to meet your arms.   Your mouse should be right next to your keyboard.  Your knees should be below your hips.  This will help pull your back into the correct position.

One more note about this and a question I get asked a lot of questions about this, a standing desk.  You need a sit/stand desk that has a lever that can go from sitting to standing without any issue.   A standing desk all day too long and sitting this all day too long.  Every half hour you should be able to switch your desk from sitting to standing that’s the ideal desk position.

Sleep

Don’t sleep on your stomach.  Period.  This is a really really good way to cause a lot of problems.  People who are stomach sleepers are fiercely loyal to sleeping on their stomach.  If you want to do this you have to buy a pillow that has a cut out so your face can go into it so your neck is not turned one way or the other.  You’re going to have to put pillows underneath your chest and your stomach so that way your back is not in a poor position.

Sleeping on your back or on your side is the best.  If you sleep on your side, put a pillow between your knees and hug a pillow.  You should have only 1 pillow.  This is the biggest thing I find people do wrong when they sleep on their side, they stack pillows.   You need 1 thick pillow.  It doesn’t need to be a fancy pillow, it needs to fill the gap between your head and the bed.  Your head should not have to drop down to meet the pillow.

If you sleep on your back, you want to have your knees elevated.  You’re only going to need 1 pillow under your head when you’re sleeping on your back to support that curve in the back of your neck.

If you struggle with back pain as so many do, come to our FREE back pain workshop.  Click here to sign up or call our office at 215-997-9898 and ask to be added to the list!

Why does your back hurt?

People who suffer with back pain generally describe the same signs and symptoms as to why their back hurts.  while the cause may be different, how it presents is often the same for people.  Common signs and symptoms of back pain is pain in standing, pain with doing the dishes, raking, vacuuming or anything in the bending position.  There can be pain when you get up in the morning, pain that wakes you up at night, pain with driving or sitting too long, pain with activities like running or exercising, pain with sneezing, pain with going from sitting to standing and many more those are just some common ones.  The bottom line is that back pain can present in many different ways.

An important thing to understand is pain that is reproducible is reducible.

What that means is that pain, that you can cause, sit too long, stand too long anything that we described above, that pain that we can cause that we can reproduce, pain like that is reducible, meaning it can be fixed.  If your pain gets better or worse depending on the hour of the day, then that is pain that is fixable.  You may always have pain but if that pain gets better and worse with activities, then that pain is reducible.

This gives a lot of people hope, to know that not only is their back pain fixable but it is fixable without medications, drugs or injections.

There are 3 different categories on how people chose to handle back pain or any kind of pain.

  1. You ignore it
  2. You alter it or
  3. You handle it.

Most people fall on category 1 when the pain starts they just ignore it.  Oh, this is just a spasm it will go away.  I’m getting older I’m getting back pain.  My dad had back pain so I’m going to have back pain so I’m just going to ignore it.  Many of you may have said some variation of these things to yourself at any given time.

My rule is 2 weeks, if the pain doesn’t go away in 2 weeks then you see a doctor immediately to get it worked on, 2 weeks is enough time for something to resolve on it’s own.  And if the pain is not occurring on a daily basis but you notice that now instead of spasms once every couple months, you have spasms every other week.  This is a sign of a problem that is not going to go away on its own.

The second way people handle it is to alter it.  Altering it means taking drugs, whether if it’s an epidural shot, or an over the counter medication like Advil or some heavier prescription drugs you are altering it, you’re not handling it, you’re not ignoring it.   Now in altering it, you actually make everything much worse, because instead of ignoring it or handling it, you are changing the game.  Your back will begin to come up with new movement patterns that will cause even more pain because it is trying to alter the pain.  So the pain that was just in one spot, now grows to involved many other spots.

There are 4 main causes of back pain: 

  1. Herniated disc
  2. Stenosis,
  3. Sacro Iliac joint or SI joint/ Pelvic pain and
  4. Compensation.

Let’s first look at the Herniated Disc.  So a herniated disc is also a bulging disc or a slipped disc, this can also indicate sciatica but sciatica is usually a catch all term for just pain going down the leg but could be from any cause.  If there’s pain in your back, in your leg, pain in your butt, this is not a herniated disc.   A herniated disc doesn’t cause pain, a herniated disc causes numbness and tingling.  If I were to examine you and I touch spots on your back you won’t be able to feel anything, it wouldn’t irritate you if I was touching, it won’t bother you but you will still feel pain going down your leg.

This is common in the 40 year old category, who bends and picks up their kids the majority of the time.  Bending and picking things up off the floor is some of the highest pressure you could put your discs.

70% of people who get an MRI get herniated disc have a herniated disc show up on the MRI.  It doesn’t mean they have back pain, I have herniated discs I don’t have any back pain.  So don’t be so quick to think that just because you have a herniated disc that is causing your pain.

Stenosis, is a narrowing of the spinal canal.  The common sign of this is when you see someone who has to bend over the shopping cart or who has to bend over to walk because they relief.  They will get immediate relief if they bend over the shopping cart or they sit down.  I’m not talking about pain that gradually eases up the longer you sit or the more hunched over you are, I’m talking about instantaneous relief that occurs with sitting or bending over a shopping cart.

Stenosis usually involves pain that is going to shoot down both legs and it’s going to be pretty unrelenting so it will constantly be there unless you are sitting or hunched over a shopping cart.

SI joint or Pelvic Pain is one of the most common diagnosis people walk into my office with.  “I have a pain right here” is most often what is said and described.  This is not to be confused with “I have a pain in the butt” because a pain in a butt is different diagnosis.  There may be pain all over the back pain but there’s one point right on the lower back that really bothers them.  This is the SI joint.

With pain in the SI joint, nothing’s going to show up on an Xray or MRI or any blood test or any type of work up that you could do it’s going to diagnose this.  This has to be diagnosed by a physical therapist who knows exactly what they’re doing because it’s not a definitive test, it is several different tests that need to be done.

Compensation.  Compensation is not a direct reason that you have back pain it is not an actual diagnosis like stenosis or herniated disc but this is the number 1 people seek treatment for back pain and that’s because they’ve ignored it, altered it and now they’ve decided to handle it and by the time they’ve decided to handle it, the muscles have compensated for everything and now do not know how to function.

Compensation is when you allow your muscles to work differently.  When your body feels pain, some muscles are going to work harder and some muscles are going to work a little less, which is how your body is designed to work, for a little bit.  If it can stop you from feeling pain, then it will.  The problem is, is that if the body uses the muscles differently for too long, it thinks this is how the muscles are supposed to work.

They start recruiting other muscles to help them out and this is a snow ball and it keeps going and going until your muscles finally exhaust themselves, and say ‘hey we can’t compensate anymore we’re all done here’ and then the pain can no longer be hid or compensated for an the pain goes from just being every few months to every week to every day.   This is a very long process to get here and unfortunately a long process to reverse.  In order to treat compensation, you have to get the knots out of the muscles, you have to then retrain the muscles on how they’re supposed to work.

The Number 1 way to fix back pain is posture.

Some people hear that and sit up as straight as they can and jam their shoulders back.  And that lasts for about a minute and then it goes away until some random times a couple days later when something reminds them they should jam their shoulders back.  But this sitting up as straight as you can is incorrect also.

Most people don’t have correct posture because their environment doesn’t allow them to have correct posture. If you have a desk at work and your monitors are off to the side and it’s not on eye level or you work off a laptop, you can’t have good posture.  You have an environment that forces you to have poor posture.

If you work on a laptop you don’t have a way to have good posture, if you work on your smart phone for more that 15 minutes at a time, there’s no way you’ll have good posture, if you sit on your couch with your laptop at night and do your work, you can’t have good posture.  In all of these situations you’re herniating your disc, you’re causing yourself back pain.

Posture is not just standing up straight, posture is not just jamming your shoulder back as far as you can.  It is making your environment force you to have good posture.  You want to make sure your low back has support and you should roll your shoulders up, back and drop them down.  This is where your shoulders should sit.  If you have compensation going on, maintaining your shoulder posture will be difficult.  Within a minute or two of you intentionally dropping your shoulders you will find them creeping up towards your ears.  You need to constantly set a reminder either on your computer or on your phone, to drop your shoulders until your muscles relearn not to be up near your ears.

For more exercises that can be done for the back click here.

 

Cardio or Weight Training – Which is Better for Fat Loss?

When people want to lose fat, what is the first thing they think of doing? Cardio. Right? Most people don’t think of weight training to combat fat loss. But surprisingly, weight training is going to give you more bang for your buck and do more for you when losing fat is your goal.

I like to use this metaphor when I describe cardio in comparison to weight training. Cardio is like coffee. It gives you a temporary boost. It’ll spike your heart rate, quicken your metabolism, even give you a caloric after burn. But after that, it wears off. Even though it has wonderful benefits, it still falls second to weight training for fat loss.

Weight training however, burns fat longer than cardio. In fact, you could lose fat with weight training alone. No cardio needed. The reason why it trumps cardio is because it keeps burning calories LONG after you finished. It takes longer and more energy for your body to repair and build muscle than your short burst of caffeine from your cardio does. The metabolism is boosted for about 36 hours after training and can burn an extra 10 calories an hour. That doesn’t seem like much but you times that by 36 hours, you got yourself a lot of extra burned calories. Cardio on the other hand, you might get an extra 40-80 calories burned after a moderately paced, 60 minute workout. Additionally, the more muscle you have the more efficient your body becomes in burning fat. Finally, if you want your body to have shape, you need to lift some weights. Your shoulders aren’t going to round and your butt won’t lift until you lift some weights.

If I had to give you my best answer to which is best, you want to weight train 3-5 times a week supplementing with cardio and high intensity interval training. This combination will be your best defense when trying to lose fat.

Want to start losing fat today?  Sign up for our 2 week free training by clicking here!

I have pain going down my leg

Pain down your leg could present in many forms.  This could be a pain just go into your butt, this can be a pain that goes all the way down the back of your leg, back of your knee and even into your toes. Some of it might be numbness and tingling, some of it might be just some pain.

This is going to discuss why and how to resolve that pain that’s going down your leg.

The first thing to understand what is numbness and tingling is and understanding why you’re having numbness and tingling. Numbness and tingling means there’s a nerve that is involved.  When your leg falls asleep because you’ve been sitting on it too long, that’s a completely different story that is usually a circulation issue but any other time you have a numbness and tingling it means nerve involvement.

Nerves come out of the back and they’re going to go through the disc.  If the disc begins to bulge or herniate, the nerves will become affected.  You can picture a bulging disc as a jelly doughnut, when the inside begins to squirt out the hole, this is like a disc bulging or herniating.

The nerve can also be affected as muscles get tight.   As the muscles get tight they get shorter and as they get shorter they can start to compress that nerve.   As those muscles get tight they start to bother that nerve and can cause numbness and tingling going down the butt and into the legs and feet.

Just because you have a herniated disc doesn’t mean you’re going to have numbness and tingling and just because you have herniated disc and you have numbness and tingling that numbness and tingling may not be coming from the disc, it maybe coming from muscles that are actually tight.

If you’re experiencing numbness and tingling there has to be a nerve involved.  Numbness and tingling is a warning sign that you let things go on for too long it can eventually lead to loss of muscles strength and function.

Many times numbness and tingling starts off as intermittent numbness and tingling.  You can be sitting at work and you will get numbness and tingling into your feet, you stand up it goes away.  This can and will progress to numbness and tingling into the back of the knee and into the leg.  The numbness will also become more consistent and not just intermittent.  It will reach the point where a position change does not resolve the numbness and tingling.

Numbness and tingling can be caused by stenosis, muscle compensation or a herniated/bulging disc or a bulging disc. Muscle compensation is one of the greatest things that people ignore when they have herniated disc.  If there’s pain associated with the numbness and tingling, there’s something outside the nerve involvement.  This is what most commonly seen, a combination of a disc herniation and muscle compensation.  There’s numbness and tingling down the leg but there’s also back pain and leg pain and this pain is the muscle compensation not the herniated disc.  Many times once we relieve the muscle involvement, the numbness and tingling is completely resolved as is the pain.

A specific example of this is called piriformis syndrome and what people feel is a pain in my butt literally.  Many times after sitting for a long time people will feel a pain in the butt and they can put their finger right on it.  This pain will then lead to numbness and tingling down the leg.  Once we resolve the muscle tightness of the piriformis, the numbness and tingling and the pain will resolve.

It’s a snowball effect, and usually the snowball is a herniated disc and muscle compensation that goes hand and hand.  The numbness and the tingling will get worse and worse and the spasm will get worse, more frequent, more intense.  The main thing to understand with numbness and tingling is that if there’s muscle involvement it is treatable.  The better outcomes happens when people address it when it first starts to happen and not years later.

Muscle involvement and disc herniation can be completely resolved without medication, injections or surgery.

Most of the the time surgery, injections and medications fail because they do not address the problem.  They address the symptoms, just not the causes.  I see a lot of surgeries that fail and the person has the exact same pain before the surgery as they do after the surgery and the person gets frustrated and hopeless.  They can’t live a quality of life anymore.   The problem is before you have surgery you need to make sure that you address all the muscle involvement.

FYI 70% of all people have a herniated/bulging disc that shows up on an MRI.  Even people who have no back pain can have a bulging disc that shows up on an MRI.  So the fact that there is a disc herniation (or bulging disc, the words can be used interchangeably) does not necessarily mean that the pain is because of the disc.

Anti-inflammatories do not fix muscle compensation or herniated or bulging discs and only hides the compensation and pain and makes it worse.   If you’re popping an advil to help with the pain you did not solve anything.  Each time you take one you pack more and more onto the snowball making it harder and harder to actually heal from.  You are actually making your problem that much worse and eventually it’s going to catch up to you.  New studies have shown that conservative management like physical therapy is better results than any medication.

If you have spasms in your back, get pain when you’re sitting at your desk,  or if you get stiff while you drive, or you wake up and your back is sore you’re already started on the road to chronic pain.

So what you supposed to do?

First of all you’ve got to find out the correct diagnosis.  You need to make sure that you find out everything that is going on so that all the issues are addressed.  If we just take one piece (like just treating the disc for example) and ignore the others it’s not going to work.

One thing you can begin immediately is posture correction.  

Posture correction with low back pain is imperative.  If you want the magic pill like everybody does, making sure you have correct posture in sitting and standing is it and will get you on the road to correcting your back pain.  You have to do it over and over again so it becomes part of your everyday life.

Foam rolling is another way to treat back pain.  And it can also be another way to figure out the problems in the muscles.  If you hop on a foam roller for 5-10 minutes a day you get some pain, that is indicating that there is some muscle involvement.  You want to foam roll every day to try to reduce the muscle involvement by reducing the pain that you get with foam rolling.

Sleep is another posture habit that needs to be examined.  If  you do not sleep in the correct position you run the risk of having damage to your muscles or nerves.  Sleeping on your back or side is the best position to sleep in, stomach sleepers if you sleep on your stomach you are at a significant risk for herniating a disc and causing yourself neck pain.

If you want to find out more sign up for on of our FREE back pain and sciatica workshops by clicking here which will take place in either our North Wales or Hatfield, Pennsylvania locations.

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