Shoulder pain in soccer players can occur due to trauma ie. a fall onto the outstretched hand or arm, a blow to the shoulder joint itself in a tackle, an overstretch (especially reaching above and overhead), or can occur for no apparent reason. The shoulder may become subluxed (partially out of position but spontaneously relocates) or dislocated.
After trauma the most likely cause of pain is a bursitis, torn rotator cuff muscle, capsulitis or even a fracture.
A bursa is a thin, lubricated cushion located at points of friction between the bones of the shoulder and the surrounding muscles , ligaments and tendons. After impact the bursa becomes swollen and can becomes compressed and painful during movements of the arm. This often leads to a painful arc of movement. Inflammation of the bursa is called bursitis.
The capsule is the loose lining of the shoulder joint which allows us such great range of movement in our shoulders. This can become inflamed or torn after being stretched, which is called capsulitis.
Many people will have heard of the term “frozen shoulder”. A frozen shoulder is when this capsule becomes very inflamed and fibrotic adhesions occur which limit the shoulder movements in all directions. Initially it is very painful and hard to diagnose. However if the stiffness gets gradually worse this is a good indication of the adhesive capsulitis. There often is no history of injury and the cause is not well understood (more on that later).
What should you do if you damage your shoulder? The first step use the usual RICE regime. REST - Do not totally stop using the arm but avoid painful positions. Put a rolled up towel under your back on the injured side to stop you rolling onto your painful shoulder. Do not carry things with this arm or reach overhead. ICE - Not heat on the area of pain. Ice can be continued until pain resolves (so even daily for a few weeks) COMPRESSION - Some taping or bandage may help. A sling may help with pain relief until seen by your physio. ELEVATION - Obviously you cannot elevate the shoulder joint but keep moving the hand and elbow to aid circulation.
Whilst some inflammation is a good sign our body is trying to heal, excessive pain and swelling should be reduced with anti inflammatories or pain relief. If unsure speak to your local Pharmacist or GP. However do not be too concerned as research shows that the amount of pain felt doesn’t relate to the size of the tear in the muscle.
Next arrange to see a physio The physio can look at all of your movement and perform special tests to see what function in the shoulder is lost and the best way to improve this. It may be that we need to:
Get your Rotator Cuff muscles to engage correctly and prior to movement, to stabilise the glenohumeral joint
Aid shoulder blade mechanics
Align your upper back and ribs
Engage lower limb mechanics to facilitate shoulder mechanics
Remove stiffness of muscles or ligaments.
Your Physio will design appropriate exercises using resistance bands , weight bearing exercises, postural corrections and stretches that suit your particular presenting symptoms. Massage to release over active muscles and dry needling may be used. Some mobilisations to surrounding ribs and vertebra and the shoulder joint are needed if stiffness is found.
Depending on the functional demands of your sport and lifestyle rehab is tailored to get your shoulder back to its full potential in all areas of speed, power, range and plyometrics (rebound training) and proprioception (position sense) and of course painfree. An X-Ray and/or ultrasound /MRI may be ordered by your GP or physio, however it is important to note that 96% of athletes without pain have abnormalities on ultrasound/MRI. In the Over 40’s bursa, labrum and rotator cuff abnormalities were found in 96% of people with or without pain. Over 60’s asymptomatic cuff tears are very common.
When you may need to see a surgeon If you are young (under 25) and dislocate your shoulder and tear rotator cuff or labrum (cartilage in shoulder), early surgical intervention is more supported in the literature. A GP can refer you for an opinion.
For the older population if there is considerable weakness and this cannot be improved by exercises surgery within 16 weeks has a good outcome.
For most shoulder injuries conservative management with rehab under the guidance of a physio is recommended and only if improvements are slower than expected is further investigation required. Sometimes a cortisone injection may be helpful for short term pain relief.
Next episode:, the painful shoulder without trauma.