Interview: Dr. Scott Trenhaile talks about shoulder strains and bad habits

Daniel Hopkins (DH): Is it possible with a shoulder strain to facilitate/cause an injury because you don’t rest, modify, etc.?

Dr. Scott Trenhaile (ST): It happens in varying degrees.  There are instances where you can develop, for lack of a better term, bad habits.  You develop these bad habits, and the bad habits continue, becoming a vicious cycle where you begin to spiral downward.  The posterior shoulder capsule becomes tight, you develop an internal rotation contracture, causing more impingement to occur, even though nothing has been structurally damaged.

Then the rotator cuff becomes weak, which causes more inflammation, which causes more pain, leading to guarding/protecting/going easy on that shoulder.  The more you do that, the less you use it, and the less you use it, the weaker and more dysfunctional it becomes.  It’s the vicious cycle.

DH: What happens when people like this come in to see you?

ST: Those folks who come in and often need an intervention beyond what can be accomplished at home independently.  Maybe they need therapy or prescription strength medication, or perhaps they will need a subacromial injection.

DH: Speaking of subacromial injections, it seems as though that’s what people think of when they think about serious pain relief for joint pain.  Is it a correct assumption that injections are mainly to relieve pain?

ST: No, not necessarily.  The subacromial injection does a lot more than relieve pain, though it certainly does that.  It’s like hitting the reset button on your computer.  It calms everything down, which allows the physical therapist to get everything back in the right position.  It decreases the inflammation and frees everything up, allowing it to move back in the right direction.

DH:  What actually happens when people try to push through the pain?

ST:  Those instances where people try to grind through the pain and try to tough it out can actually create a situation that was avoidable earlier on.
[quote]It’s not necessarily that they have torn anything, but lifestyle and habits of dealing with continued pain causes them to continuously get worse and worse.[/quote]
This is fairly common, especially at the age of 40.  When you are 18 years old, you can overdo it, and unless you have a specific event (link to sore shoulder article), the body is going to recover.  It has an innate ability to bounce back.  Things just get better, but as our bodies age, even active and fit people have to be more careful about how they train or work.  What you’re doing, how often you do it, and how much rest you give yourself becomes so much more important with age.

For those who exercise regularly, mix it up regularly.  Be more conscious and aware of how you stay active so that you can avoid nagging injuries that interrupt your way of life.

DH:  What types of activities/movements are you seeing that cause this nagging shoulder strain?

ST: I talk with patients who come in and are having trouble, and they are doing things that are very explosive in their mid to late 40s, and they get into trouble.  The same thing happens with those working in the trades as well: highly volatile motions cause cumulative trauma that changes quality of life in later years.

Fortunately with a little bit of work, these people can return to a highly active, functional lifestyle, but some things must be modified, and they must go through training in order to avoid what they did to get where they are in the first place.

DH: So you seemed to mention two different groups of people earlier.  Do you generally place people in either an aging athlete category or a career tradesperson?

ST: Yes, and no.  Those are certainly two of the largest groups that I see.  Yes, I see  aging athletes, people who have worked their whole careers in the trades, but I also see normal, average people who are just experiencing the “common cold” of the shoulder.  But to go back to the tradespeople; they often say that they have worked their bodies into the ground to the point where it is difficult to go to work every day.  Remember, they often begin working at 18 and don’t stop for the next 30-40 years.

DH: What do you tell the common-cold-of-the-shoulder group of patients?

ST: We really treat all three groups almost the same.  We test each person to see that they do not have any sort of anatomical problem, and honestly, most people respond extremely well to therapy, medication, and possibly a cortisone injection.

DH: Do you see a lot of repeat traffic for the cortisone injections as a result of overuse and bad habits formed over the years?

ST: Hopefully, it’s a one and done rather than a repeated event.  We don’t want people to have to come in every three months, four months for a shot.  We want them to get the injection, reset like we talked about earlier, and perform so well in therapy that they can return to a normal lifestyle.
[quote]So many people ask “How long will the shot last?”  That’s not my perspective.[/quote]
The injection is designed to reduce  the inflamed bursitis, which makes the environment of the shoulder less “hostile” so that they can now do exercises and activities in therapy that would normally be painful to perform.  See, that’s why therapy exists: to get your body functioning harmoniously again.

DH: Any last comments before we wrap this thing up?  I know we’ve covered a lot of ground here.

ST: I guess I would say that it’s important to remember that the shoulder is not a hinge like the elbow or knee.  It has numerous degrees of freedom.  It moves in the X, Y, and Z planes.   Many things need to come together for it to function properly.  When people just power through the pain or begin to baby a shoulder strain, they diminish the shoulder’s functionality.  That’s why it’s important to deal with problems before they dramatically affect your quality of life.