So far, we’ve been primarily focusing on repetitive strain injuries (RSIs) that result from performing the same movements regularly in one’s occupation. But sports—both as a profession and a recreational activity—typically require certain motions to be repeated as well, meaning they are yet another potential contributor to RSIs. For golfer’s, one of the most common issues is golfer’s elbow, which leads to a nagging pain on the inside of the elbow that can seriously derail a player’s game.

The medial epicondyle is a piece of bone located on the inside of the elbow that protrudes out from the humerus (upper arm bone). It contains a group of tendons and muscles, all of which allow the forearm, wrist, and hand to bend and move in several directions. When this area becomes irritated or inflamed, the result is medial epicondylitis, or golfer’s elbow.

Golfer’s elbow results from repeated bending of the wrist, which damages the muscles and tendons of the medial epicondyle and eventually leads to inflammation. The condition is especially common in golfer’s because gripping or swinging clubs incorrectly or with too much force can take a toll on these structures over time. But golfer’s elbow can also occur in other sports and from activities that strain the elbow in a similar manner, such as racquet sports, throwing sports, weight training, and even certain occupations that involve lots of bending of the wrist or elbow.

The clearest indication of golfer’s elbow is pain on the inside of the elbow that’s most noticeable when performing any type of gripping activities. Other symptoms include general weakness in the wrist and forearm when gripping, tenderness and swelling on the inside of the forearm, and elbow stiffness or numbness that radiates down from the elbow into the hand. As a result, many basic activities that require gripping or grasping can become challenging.

What a comprehensive physical therapy program can do for your elbow pain

If you start to notice elbow pain or any other signs of golfer’s elbow—especially if you golf or do any of these activities regularly—we strongly recommend visiting a physical therapist as soon as possible. Failing to address this condition early can lead to further complications down the road such as a torn tendon, which is a much more serious problem. A physical therapist will address your condition immediately by evaluating your symptoms and then developing a personalized treatment program based on your abilities, preferences, and goals. A typical treatment program for golfer’s elbow will consist of the following:

• Pain–relieving modalities ice, heat, and massage to reduce your pain levels
• Manual therapy: this type of therapy involves the physical therapist performing a series of mobilizations and manipulations to the forearm and wrist to help the muscles in that region regain their full range of motion
• Stretching exercises: since muscles will generally lose their flexibility from lack of movement, these exercises will target those areas and address any impairments present
• Strengthening exercises: weakened muscles are another consequence of golfer’s elbow, and these exercises will work to build back strength in the muscles of the forearm, elbow, arm, and hand; eccentric exercises—or negative strengthening exercises—are especially helpful for this condition
• Sport–specific functional training: for golfers and other athletes, these exercises will work specifically on the movements involved in your sport, so that you can return to the course or field more quickly and confidently

In our final post, we’ll discuss a related condition called tennis elbow, which occurs due to similar mechanisms in tennis athletes and other individuals who overuse the lower arm and elbow.

Our hands are the main tools that we use to navigate the world around us. Most—if not all—professions require some use of the hands to complete the task, whether that’s grooming dogs, typing at a computer, or trimming trees. Unfortunately, these repetitive motions can irritate and damage certain structures of the hand and wrist, as we explored in our last post. Over time, this can lead to the development of a repetitive strain injury (RSI), which can cause a variety of symptoms in the hand and wrist that will interfere with hand function and make it a challenge to perform tasks normally. Some common RSIs involve irritation of nerves as they pass through the wrist, and we’re going to discuss each of those below.

Carpal tunnel syndrome

The carpal tunnel is a space at the base of the palm that contains several tendons and the median nerve, which provides sensation to most of our fingers. If these tendons and soft tissue thicken or any other swelling occurs in the area, the tunnel narrows, which puts pressure on the median nerve and leads to carpal tunnel syndrome. Symptoms usually start with a burning or tingling sensation, but eventually pain, weakness, and/or numbness develop in the hand and wrist, and then radiate up the arm. As carpal tunnel syndrome progresses, symptoms usually get worse when holding certain items, and the weakness and numbness may occur more frequently if pressure on the nerve persists.

Carpal tunnel syndrome affects about 5% of the population, and the greatest risk factor is performing any task that requires repetitive hand motions, awkward hand positions, strong gripping, mechanical stress on the palms, or vibration. Although office work and repetitive typing may be a potential cause, the professions most frequently associated with carpal tunnel syndrome are those that involve sewing, baking, cleaning, or assembly–line work.

Cubital tunnel syndrome

The ulnar nerve is a major nerve that travels from the neck down to the hand, where it provides sensation to the little finger and half of the ring finger. This nerve can become compressed—or squeezed—by nearby structures at any point along the way. But the most common place this compression occurs is behind the inside of the elbow at the cubital tunnel, a narrow passageway for the ulnar nerve.

The result of this ulnar nerve compression is cubital tunnel syndrome, which is the second most common nerve compression syndrome of the arm after carpal tunnel syndrome. Symptoms are also similar, as pain, numbness, tingling, and weakness in the arm and hand—especially in the ring and little fingers—are most common. Cubital tunnel syndrome is also caused by daily habits like leaning on the elbow for long periods of time, sleeping with the arms bent, or from direct trauma to the ulnar nerve, like hitting your “funny bone.”

Guyon canal syndrome

The Guyon canal is another “tunnel” for the ulnar nerve that is formed by two bones in the wrist (the pisiform and hamate). When the ulnar nerve is compressed at this location, the resulting condition is called Guyon canal syndrome—or ulnar tunnel syndrome—which is far less common than carpal tunnel syndrome; however, both conditions will occur at the same time in some cases.

Guyon canal syndrome often develops due to overuse, particularly from activities like heavy gripping, twisting, and other repeated hand and wrist motions. Repetitive work with the hand bent down and outward and repeated pressure on the hand—such as in cyclists, weightlifters, and with regular use of a jackhammer—can also cause pressure or irritation of the ulnar nerve at the Guyon canal. Symptoms include pins and needles in the ring and little fingers, which may progress to a burning pain, decreased sensation, weakness, and difficulty spreading the fingers and pinching.

Physical therapy and nerve mobilization exercises can effectively alleviate symptoms

If you notice symptoms that sound like any of these conditions, your first step should be to evaluate your daily habits and behaviors to detect any repetitive movements that could be contributing factors. The tips we provided in our last post can be used to treat as well as prevent overuse injuries like carpal tunnel syndrome, cubital tunnel syndrome, and Guyon canal syndrome, but they may not provide you with adequate relief on their own.

In these cases, a course of physical therapy may be needed to manage your condition. A typical physical therapy treatment program will include bracing or splinting, modalities like ultrasound and electrical stimulation, and advice on how to make modifications to your lifestyle and posture. But the central component of most programs for these nerve–related conditions is targeted exercises that help to move the affected nerve away from the compression forces. Nerve mobilization exercises are designed to help glide or mobilize the ulnar nerve and encourage normal movement through the cubital tunnel or Guyon canal, which can effectively alleviate pain and other symptoms. A similar approach is also recommended for carpal tunnel syndrome, as specific exercises can decrease swelling and adhesion in the carpal tunnel, thereby mobilizing the median nerve and reducing pain levels in the process. Below are a few examples of nerve mobilization exercises for each of these conditions:

Carpal tunnel syndrome

• Median nerve mobilization
• Nerve gliding exercise

Cubital tunnel syndrome

• Elbow flexion and wrist extension
• Head tilt
• Arm flexion in front of body
• A–OK

Guyon canal syndrome

• Wrist flexion and extension exercise
• Side wrist flexion exercise

In our next two posts, we’ll explore how RSIs can also result from overtraining in sports like golf and tennis.

Throughout a typical day, you use your hands, wrists, and elbows almost constantly. From vigorously brushing your teeth in the morning, to switching the lights off before bed, and during just about every other action in between, these joints are frequently in a state of movement. But over time, performing certain tasks on a repetitive basis can lead to damage and injury.

Certain professions are associated with higher risks for pain

Occupational overuse syndrome, also known as repetitive strain injury (RSI), is a potentially disabling condition that results from overusing a region of the body–usually the hands, wrists, or elbows–through repetition of similar movements. As the name suggests, workplace habits and behaviors are some of the most common culprits of occupational overuse syndrome because they require repeating certain movements to complete the job at hand. Nearly any occupation that involves the hands and wrists can contribute to occupational overuse syndrome, but certain activities and equipment are more likely to increase the risk, such as the following:

• Vibrating equipment
• Working in a cold environment
• Carrying heavy loads
• Working with furniture, tools, or equipment that is not ergonomically designed (doesn’t comfortably conform to one’s body)
• Working long hours without breaks
• Holding the same posture or position for prolonged periods
• Working with machinery that is too fast for user comfort

As a result, some of the most at-risk occupations are those that involve office work (ie, any job performed on a computer), process work (eg, assembly line and packing), piece work (eg, sewing), and manual work (eg, bricklaying and carpentry). Professionals who use vibrating tools—like hairdressers and tattoo artists—as well as musicians, mail workers, kitchen workers, and cleaners all tend to have an elevated risk for RSIs as well. But this doesn’t mean that someone must work in a particular field to develop this type of condition. Various sports, as well as leisure and recreational activities like playing video games, scrolling on a cellphone, and gardening can lead to strain and painful symptoms, too.

A wide range of conditions fall under the umbrella of occupation overuse syndrome or RSIs, including bursitis, tendonitis, carpal tunnel syndrome, cubital tunnel syndrome, Guyon canal syndrome, golfer’s elbow, tennis elbow, Dupuytren’s contracture, and trigger finger (we will discuss several of these conditions in the next few posts). Symptoms vary depending on the specific condition present, but some of the more general symptoms are:

• Tenderness or a burning, aching, or shooting pain in the affected muscle or joint
• A throbbing or pulsating sensation in the affected area
• Tingling (especially the hand or arm)
• Loss of sensation/numbness or clumsiness
• Fatigue or weakness that makes it difficult to perform basic tasks

Tips to reduce your risk at the workplace

Since many of these conditions result from activities that one must perform in their occupation, the best way to prevent occupation overuse syndrome from occurring is by modifying certain movements and activities to reduce the strain placed on the body. Here are a few helpful tips to reduce your risk:

• Adjust your posture and the positioning of your hands and wrists
  • Try to keep your shoulders square rather than rolled forward when sitting, standing, and walking
  • Try to perform tasks with the arms at a comfortable distance from the body (not too close and not too far)
  • Keep your wrists in a neutral position that’s parallel to the ground, or slightly bent downwards towards the keyboard; avoid flexing your wrists and angling them upwards to reach the keyboard

• Try to avoid repetitive straining movements
  • Pay attention to how you use your hands when performing tasks at work and elsewhere, especially those that are done repeatedly
  • Avoid tasks that require constant bending or twisting of your hands; if these movements are part of your profession, try to take frequent short breaks, switch hands, and rotate tasks whenever possible

• Modify your workstation positioning and habits
  • Make sure your forearms are level and wrists are not flexed and in a neutral position when you type
  • Don’t rest your wrists on the table surface
  • Try to avoid reaching too far on the keyboard with one hand
  • Change your hand positions often and take frequent breaks

Physical therapy is an ideal approach for occupation overuse syndrome

If occupation overuse syndrome develops, it’s best to take a hands-on approach and see a physical therapist. The first step of every encounter with a physical therapist is a detailed interview about any factors that could be contributing to a patient’s symptoms. If the physical therapist then determines that the patient’s profession is likely to be responsible for their symptoms, he or she will offer specific recommendations to reduce the amount of stress and strain on the injured region(s) of the body, which may include the use of ergonomic tools and equipment. The therapist will also create a personalized treatment program designed to alleviate pain and improve physical function with carefully selected interventions, such as stretching exercises, strengthening exercises, posture training, passive modalities, and manual (hands-on) therapy.

In our next post, we’ll take a closer look at three RSIs: carpal tunnel syndrome, cubital tunnel syndrome, and Guyon canal syndrome.

By now, the many ways in which posture can influence the body and the importance of practicing good posture should be abundantly clear. If you’re interested in taking more control over your own posture, performing the exercises and techniques described in our last post is a great place to start, but they may not solve your issues independently.

Correcting one’s posture—especially if it’s been particularly poor for a long while—is hard work that doesn’t take place overnight. Truly improving posture usually requires a more sustained and hands–on approach, which is best provided by physical therapy. Physical therapists are perfectly positioned to correct posture, since their practice is based on evaluating the body’s mechanics—which directly contribute to posture—and then determining the best way to address any impairments or imbalances.

Whether a patient has a specific postural problem or a painful condition that may be related to a postural deficit, the physical therapist’s first step is always to perform a thorough screening examination. This involves the patient performing several everyday movements while the therapist observes the position of the spine, head, shoulders, and various other body parts in relation to one another. From there, the therapist will create a personalized treatment plan that focuses on correcting any postural faults and/or painful conditions present, which may include the following:

• Strengthening exercises that target the muscles that attach to the shoulder blades and core muscles
• Stretching exercises to increase the flexibility of the head, neck, and shoulders
• Manual (or hands–on) therapy, especially if any neck, back, or shoulder pain is present
• Posture tips and recommendations, such as setting frequent alarms to remind you to change your posture, working in front of a mirror, or using a foam roller

Evidence supporting physical therapy for posture correction

Research on the use of physical therapy for posture is not abundant, but there are some key examples in the literature. In one high–quality study called a randomized–controlled trial, 99 adults aged 60 years and older with hyperkyphosis were randomly assigned to either a treatment group or a control group. The treatment group participated in three hour–long exercise sessions each week for six months. These sessions were led by a physical therapist and included various exercises that targeted muscle impairments that were known to be associated with hyperkyphosis, with a particular focus on strengthening and improving the flexibility of certain back muscles. These patients were also given training to help improve their posture. Patients in the control group attended an education session every month for four months and did not undergo any physical therapy.

Results showed that patients who followed the physical therapist–led exercise program experienced several significant improvements compared to the control group. Most importantly, the angle of the curvature of the spine reduced by an average of 3.3° in the treatment group, compared to only 0.3° in the control group. In addition, the treatment group reported better self–image and satisfaction with their appearance after completing their treatment. These findings suggest that a treatment program consisting of spine strengthening exercises and posture training can lead to physical improvements in older patients with hyperkyphosis, which in turn appears to boost their confidence.

Contact a physical therapist for any posture issue or pain you’re dealing with

So if you’ve noticed that your posture is less than optimal or if you’ve been bogged down by pain that could be related to your posture, we strongly encourage you to see a physical therapist, preferably sooner rather than later. Doing so will help you address any issues before they progress further and reduce the risk for long–term complications

In our first post, we briefly mentioned how bad posture, neck pain, and respiratory function are all related. This relationship is worth a closer examination, too, as improving the way you breath is a key to better posture, reduced pain, and less stress.

A brief overview of breathing and posture

At first glance, posture and breathing may seem like separate bodily functions of the body. But when you understand how each one works, you can see that they are deeply interconnected, and that the health of one function can directly impact the other.

The diaphragm is the main muscle of respiration. It’s a dome–shaped muscle located between the chest and abdomen that contracts and relaxes during different points of the breathing cycle. When you take a breath in, the diaphragm contracts until it becomes flat to create room in the chest cavity for the lungs to expand, which lifts the ribs outward. Intercostal muscles, located between the ribs, also assist the diaphragm by elevating the ribcage to allow more air into your lungs. When you exhale, the diaphragm relaxes and assumes its full dome shape, while the ribcage contracts and returns to its original resting state.

Poor posture, especially when seated, keeps the diaphragm compressed and prevents it from opening fully when breathing. Similarly, rounded shoulders and a forward head posture can cause the muscles around the chest to tighten. This limits the ribcage from expanding completely and causes people to take more rapid, shallow breaths.

There is also potential for a vicious cycle to develop between posture and breathing. Breathing from the chest relies on secondary muscles in the neck and collarbone instead of the diaphragm, and when this breathing pattern occurs along with poor posture, it can weaken many muscles in the upper body and prevent them from functioning properly. Having weak core and upper back muscles makes it more difficult to practice good posture, and these two forces continue to impact one another in a cyclical fashion. Over time, this can lead to the development of many of the painful conditions we’ve described, such as neck, back, or shoulder pain.

Deep breathing and other techniques to improve breathing patterns

Since breathing and posture are so closely intertwined, taking steps to improve one of these functions will likely have a positive impact on the others and lead to several other benefits as well. Keeping a slow, steady breathing pattern has been found to enhance core stability, improve tolerance to high–intensity exercise, and reduce the risk for muscle fatigue and injury. Paying more attention to your breath may also improve sleep habits and alleviate stress and anxiety, since breath focus is considered a common feature in several techniques intended to put one in a state of calm. Below are a few examples of breathing techniques and other exercises that can help you take better control of your breath and posture:

• Deep breathing: sit somewhere comfortable, relax your shoulders and inhale slowly to fill your lungs completely; then exhale slowly, emptying the lungs completely
• Pursed lip breathing: breathe in through the nose, then breathe out through the mouth with pursed lips while making the exhaled breath twice as long as the inhaled breath
• Box breathing: breathe in through the nose for four seconds, filling the lungs, then hold the breath in the lungs for another four seconds; next, breathe out slowly through the mouth for four seconds, emptying the lungs fully, then wait another four seconds before breathing in again
• Flexibility and resistance exercises: these exercises help realign posture and train the body to breathe better
• Traditional quadriceps stretch: bend your right knee and reach behind to grab your right foot with your right hand and bring it to your buttocks; try to keep your knees aligned throughout this stretch
• Head–to–hand neck release: in cross–legged position, bring your right ear toward the right shoulder, then lift your left arm to your shoulders and spread your fingers with palms facing up; place your right hand lightly on top of your head and apply slight pressure; retract the left shoulder blade toward the spine and hold the posture; repeat on the other side
• Wall chest stretch: face a wall and place your hands on the wall at shoulder height; walk your feet and push your hips back so your torso is parallel to the floor; keep the toes pointed forward and the feet under the pelvis; you should feel a stretch in the back of the legs and chest muscles

In our next and final post, we’ll show you why physical therapy may be necessary to if you want to commit to improving your posture.

In our last post, we introduced you to the concept of posture, explained what is meant by good versus poor posture, and offered a few examples of painful conditions and other dysfunctions that may be related to poor posture. But since this was only the introduction to the topic, there’s a great deal more to discuss when it comes to posture, pain, and how the two might influence one other.

To dive a bit deeper, in this post we take a closer look at posture by answering some of the most frequently asked questions about the topic.

Q: How common is forward head posture?

A: As we explained previously, forward head posture is when the head is positioned in front of the shoulders—by more than one inch—instead of directly over the shoulders. Also referred to as “text neck” due to its relationship with staring down at one’s phone too frequently, forward head posture is the most common of all postural faults, affecting between 66% and 90% of the population.

Q: How does forward head posture affect the body?

A: Forward head posture forces the muscles of the neck to work harder to hold up the head, and the further forward it’s positioned, the harder these muscles must work. Over time, overworking these muscles can lead to muscle imbalances as the body tries to adapt while figuring out other ways to hold the head up straight. Excessive forward head posture may also lead to reduced flexibility of the neck—particularly when rotating and flexing the neck—and have a negative impact on balance.

Q: What is hyperkyphosis?

A: Recall that the spine has three curves. The first curve (at the neck) and third curve (in the lower back) are forward curves called lordosis. The second curve, which runs from the shoulders to the bottom of the ribcage, is a backward curve called kyphosis. All these curves are necessary in the normal spine to balance the trunk and head over the pelvis, but in some cases, they can curve too far inward or outward. The normal angle of the second curve is between 20-40°, but when it increases beyond 40°, the condition is called hyperkyphosis, which is more common in older adults but can also occur in children and adolescents. Poor posture and excessive slouching are the biggest contributors to hyperkyphosis, and over time, it can cause a noticeable hunching forward of the back.

Q: What other painful conditions may be related to poor posture?

A: We already listed several examples of painful conditions that may result from or cause poor posture in the medical literature. Here are a few more:

• Pain between the shoulder blades (interscapular pain), which can result from muscle strain due to leaning forward with prolonged sitting or standing
• Shoulder impingement, which is the painful pinching of the shoulder’s muscles against surrounding bone from repetitive shoulder movements; slouching or hunching over can narrow an important space in the shoulder and cause tendons to become pinched and rub against other structures
• Tight hamstrings: when the hamstrings are too tight, it rotates the pelvis backward, which can flatten the natural curvature of the back and cause poor posture while seated or standing
• Tight hip flexor muscles can pull on the spine and lead to bad posture

Q: Do all experts agree that poor posture directly causes pain?

A: In short, no. Although there is an abundance of research that supports a connection between poor posture and various painful conditions—as we’ve shown—there is also ample evidence to show that there is no association between these factors, or that the association is not very important. For example, a powerful review called a systematic review analyzed 54 studies and found no evidence of a relationship between excessive curvature of the spine and health issues, including neck or back pain. However, it should be noted that the general quality of the studies included in this review was rated as low.

In our next post, we’ll explore how your breath affects your posture, and why working on improving one could also improve the other.

Osteoarthritis affects up to 31 million Americans, making it one of the most common conditions in the nation. The resulting joint pain can be devastating for these individuals, and the longer osteoarthritis progresses, the greater the disability becomes. It’s no surprise, then, that there is a plethora of treatments, medications, and products available that claim to alleviate pain related to osteoarthritis or even prevent it from progressing.

Over the past 20 years, glucosamine and chondroitin sulfate have emerged as two of the more popular products that claim to resolve osteoarthritis–related issues. But what are glucosamine and chondroitin sulfate, and what does the research say about their effectiveness? In this post, we try to answer these questions and help guide you towards an informed decision about whether taking these is right for you.

Nutritional supplements are not FDA–regulated

Glucosamine and chondroitin sulfate are naturally occurring substances that make up many connective tissues throughout the body, including the cartilage that protects the ends of bones in joints. Glucosamine is a major building block of large compounds called proteoglycans, which contributes to the elasticity of cartilage, while chondroitin sulfate is a larger molecule that also plays a key role in the elasticity and function of cartilage. Either of these chemicals can be extracted from the tissue of certain animals and then packaged in pill form—either individually or combined—to be taken as a treatment for joint pain related to osteoarthritis. The typical dose is about 1500 mg for glucosamine and 1200 mg for chondroitin sulfate, taken once daily.

However, it’s important to note that products containing glucosamine and/or chondroitin sulfate are labeled as nutritional (or dietary) supplements rather than approved medications. Status as a nutritional supplement means that these products are not subjected to the same aggressive regulations as prescription medications and claims regarding their indication or effectiveness have not been evaluated by the U.S. Food and Drug Administration (FDA). Glucosamine and chondroitin sulfate supplements typically claim to alleviate joint pain from osteoarthritis and help to slow or prevent the breakdown of joint cartilage, which is the major underlying cause of osteoarthritis pain. But do they deliver on these supposed benefits?

Loads of research both for and against

The short answer: possibly, but it’s difficult to say with certainty. Evidence to support glucosamine and chondroitin sulfate supplements for osteoarthritis has been mixed, with some studies suggesting that one or both chemicals can relieve pain and others identifying no clear benefits.

For example, a key analysis of multiple studies published in 2010 called a meta–analysis concluded that glucosamine and chondroitin—both independently and in combined formulations—did not reduce joint pain or have any impact on the narrowing of joint space. Another study published in 2016 that administered combined glucosamine and chondroitin sulfate to half the patients and placebo to the other half had to be stopped early because those taking the supplement reported worse symptoms than those taking placebo.

On the other hand, a 2008 study found no statistically significant improvements in knee pain overall for patients with knee osteoarthritis taking glucosamine and chondroitin sulfate supplements, but a group of patients with moderate–to–severe knee pain did experience some improvements. A 2014 review concluded that these supplements may lead to a small but significant reduction in joint space narrowing, while another key 2018 meta–analysis found that chondroitin sulfate alone was more effective than placebo for relieving pain and improving function in knee and/or hip osteoarthritis, and glucosamine was found to reduce stiffness.

Although most guidelines from professional societies do not currently recommend glucosamine and/or chondroitin sulfate for osteoarthritis, some experts believe that newer supportive research could lead to some future changes in these guidelines. But as you can see, the jury is still out on these supplements. It’s possible that the evidence is so mixed because some patients do truly experience benefits—possibly from the placebo effect, which is a real benefit nonetheless—while others do not.

Consult your doctor before making a decision

Therefore, a clear–cut answer on the therapeutic value of glucosamine and chondroitin sulfate for osteoarthritis may be difficult to reach, but should you still consider taking these supplements? Since answering this question is out of our scope as physical therapists, we strongly recommend talking to your doctor and evaluating the potential benefits compared to the risks involved. These supplements are generally considered to be safe, but some side effects have been reported, including diarrhea, abdominal pain, heartburn, drowsiness, and headaches. If you and your doctor agree that the benefits outweigh the risks, it’s probably best to try a short trial of one or both supplements, and if you don’t experience any notable improvements after a designated period, consider discontinuing their use. And as always, keep realistic expectations and understand that these supplements can only go so far. Proper care for osteoarthritis also requires regular movement and exercise, and as physical therapists, we can help you get there with a comprehensive, customized treatment program.

As we explained in our last post, there are several steps you can take to reduce your risk for shoulder pain, but even if you follow these measures to a T, pain may still develop for reasons that are partially out of your control. If you do begin noticing pain in your shoulder or start struggling to perform certain overhead activities, you might be wondering what to do next.

For frequent episodes of pain that interfere with how you function in daily life, we strongly recommend taking a proactive approach and seeing a physical therapist as soon as possible. Physical therapists are movement experts whose goal is to guide patients back to full strength and function with a multifaceted, evidence–based approach. Rather than wait and see if the pain progresses or improves on its own, physical therapists teach patients how to modify their movements and engage in behaviors that reduce strain on the shoulder right away, which will ultimately reduce their pain levels.

Typical physical therapy treatment programs for common shoulder conditions

Most treatment programs will involve some combination of pain–relieving interventions, flexibility and strengthening exercises, manual (hands–on) techniques administered by the physical therapist, and education on how to avoid future shoulder issues. The specific approach used will vary depending on what condition is present, its severity, and the patient’s abilities and goals, but most treatment plans for shoulder pain share several features in common. Below are a some of the more frequently used interventions for various shoulder conditions:

• Rotator cuff/shoulder tendinitis
  • Stretching and strengthening exercises, including external and internal rotation, forward flexion shoulder raises, pendulum exercises, and scapular squeezes
  • Education on how to improve posture and avoid habits that will further aggravate the shoulder
• Rotator cuff tear
  • Passive treatment like ice, heat, and ultrasound to alleviate pain
  • Strengthening exercises that target the pectoral and upper back muscles
  • Education on how to avoid positions and movements that can further aggravate the shoulder, like sleeping on the side and carrying heavy loads
• Shoulder impingement syndrome
  • Stretching and strengthening exercises that target the rotator cuff and scapular muscles
  • Manual (hands–on) therapy, which typically includes soft–tissue massage
• Shoulder bursitis
  • Stretching exercises like Codman’s pendulum swings and active range of motion exercises
  • Strengthening exercises that target the scapular and core muscles
  • Ultrasound and other pain–relieving modalities
  • Posture education
• Frozen shoulder
  • Treatment for frozen shoulder depends on the current stage of the condition, from stage 1 (pre–freezing) to stage 2 (freezing), stage 3 (frozen), and stage 4 (thawing)
  • The bulk of treatment consists of manual therapy and stretching and strengthening exercises, which increase in
  • intensity with further stages of the condition; activity–specific training is usually added at stage 4

There is an abundance of research showing that these interventions are effective for many shoulder conditions. For example, a recent review of studies called a systematic review found that stretching exercises, strengthening exercises, mobilization, and several other physical therapy techniques were found to reduce pain and improve range of motion and functional status in patients with frozen shoulder. A 2018 systematic review identified moderately strong evidence to support the use of exercise therapy for full–thickness rotator cuff tears, while a 2015 systematic review and meta–analysis concluded that surgery was no more effective than conservative treatment for shoulder impingement. Similarly, a 2019 guideline recommended that patients with a shoulder condition shoulder impingement avoid surgery and instead pursue nonsurgical treatments like physical therapy.

So if you’re dealing with a new case of shoulder pain or a lingering problem that just won’t seem to improve, physical therapy may be your best bet for a safe and successful outcome. Contact us today to learn more or schedule an appointment.

Shoulder pain can be an extremely bothersome issue to deal with. Although you may not realize it, you use your shoulder on a frequent basis throughout most days, since it permits many of the movements that involves your arms. So if a problem arises that leads to pain and prevents your shoulder from moving normally, it can become a major burden to your daily life.

As we discussed in our last post, there are many conditions that can produce shoulder pain. In some cases, the cause may be a single, traumatic event like a hard fall to the ground or sports-related injury (eg, rotator cuff and SLAP tears). Other patients will experience a gradual onset of shoulder pain due to repeated damage from overhead activities, which is often the case in rotator cuff tendinitis, shoulder impingement syndrome, shoulder instability, and bursitis.

If you’re concerned that you may develop shoulder pain—perhaps because you play an overhead sport or have a job that involves overhead movements—you may be wondering if there’s anything you can do to reduce your risk. The good news is that yes, it may be possible to avoid some types of shoulder pain. There is no single, foolproof way to stop all shoulder pain from occurring because many variables are involved, but there are several steps you can take that will lower your chances. Each tip addresses a different aspect of shoulder use, but the underlying message is that you should modify and improve how you move your shoulder to reduce potential stress and strain.

4 Tips To Prevent Shoulder Pain

1. Modify your workstation: working at a desk may not sound like a big risk factor, but you could be aggravating your shoulder if your workstation is not set up properly; below are some important ways you can modify and improve your workstation ergonomics to reduce shoulder strain
   • Use proper posture: sit with your feet flat on the ground or on a footrest, with your lower back supported, shoulders relaxed, and hands and wrist in line with your forearms
   • Take regular breaks: aim for a 30 second “micro-break” about every 30 minutes to shake out your arms and hands, plus longer breaks to give your shoulder a rest every few hours
   • Rearrange your desk: keep supplies that you use regularly within easy reach, so you don’t have to twist or stretch to reach them
   • Invest in a headset: if you’re on the phone frequently, strongly consider adding a headset
2. Limit overhead activities and/or improve your form
   • If your profession does not involve regular overhead movements, try to avoid performing these types of activities too frequently in your spare time; when you do, be aware of how you move your shoulder and try not to overreach regularly
   • If your profession does involve lots of overhead movements, learn to use proper form during these activities (your physical therapist can help with this), take frequent breaks throughout the day, and switch your arms as often as possible so that the load is more evenly distributed; also try to avoid straining your shoulder when reaching for objects
3. Increase shoulder strength: strengthening the muscles that support the shoulder will increase its stability and reduce the risk for pain; below are two helpful examples of shoulder strengthening exercises
   • Scapular stabilizing exercise: lie face down with a pillow under your stomach and place your forearms on the floor with your elbows bent at 90°; slowly raise your arms up off the floor as high as possible and hold for 5-10 seconds; slowly return to the starting position; repeat up to 10x
   • Doorway stretch: stand in an open doorway and spread your arms out to your side; grip the sides of the doorway at shoulder height, and while maintaining your grip, lean forward until you feel a light stretch in the front of your shoulder; slowly return to starting position; repeat up to 10x
4. Improve shoulder flexibility: the more you stretch your shoulder, the better its range of motion will become, and keeping these muscles flexible will in turn help you avoid pain and injury; below is one great shoulder stretch example
   • Sleeper stretch: lie on a firm surface on your side with your shoulder under you and your arm extended out; bend the extended arm up into a 90° angle with your fist in the air; use the other arm to push the bent arm down (forearm towards the floor) and stop pressing down when you feel a stretch in the back of your shoulder; hold this position for 30 seconds, then relax your arm for 30 seconds; repeat 4 times, 3x/day

Although following these tips is likely to help, shoulder pain can still develop for a variety of reasons. In our next post, we’ll show you why seeing a physical therapist is the best decision you can make in these situations for safe and quick relief.

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The shoulder doesn’t always get the recognition it deserves. As the only major joint that can rotate a full 360°, the shoulder is the most mobile and flexible joint in the body. This flexibility allows you do things like throw a baseball, reach for faraway objects, drive a car, hoist a child above your head, and complete countless other complex movements. This wide range of motion, however, also makes the shoulder one of the most common locations for pain.

Shoulder pain ranks only behind back pain and knee pain as third most common site for pain in the body. Some studies have found the annual prevalence to be as high as 47% and the lifetime prevalence to be as high as 67%. There are many conditions that can lead to shoulder pain and disability. Read on for some of the most common shoulder pain FAQs.

Q: Is the shoulder a single joint?

A: Although the shoulder is often referred to as one joint, it technically consists of four joints. The acromioclavicular and glenohumeral joints are most important for movement. The acromioclavicular joint is a gliding joint where a part of the shoulder blade and the collarbone meet. It allows forces to be transmitted from the arm to the clavicle. The glenohumeral joint is what most people think of when visualizing the shoulder, and it’s responsible for the shoulder’s extremely wide range of motion. It is a ball-and-socket joint consisting of the head of the upper arm bone (humerus) as the ball and the glenoid, a shallow cuplike part of the scapula, as the socket.

Q: What other structures make up the shoulder?

A: Connecting the bones and muscles of the shoulder are several ligaments, tendons, plus several other important structures, including the following:

• Rotator cuff: a group of four muscles that run from the humerus to the scapula. The tendons of these muscles form a cuff around the head of the humerus, and all the muscles work together to allow movement and stabilize the shoulder
• Deltoid: the largest and strongest muscle of the shoulder, which provides the strength to lift the arm
• Bursa: a fluid-filled sac that acts as a cushion between tendons and other structures of the shoulder
• Labrum: a ring of cartilage surrounding the glenoid that creates a deeper socket for the ball to stabilize the joint
• Joint capsule: a fibrous sheath the encloses the structures of the shoulder joint

Q: What’s the difference between rotator cuff tendinitis, shoulder impingement, and a rotator cuff tear?

A: Any of these structures can be damaged in an acute or overuse injury. Most shoulder conditions about 85%  involve the rotator cuff. Of these, rotator cuff tendinitis, shoulder impingement, and rotator cuff tears are most common.

• Rotator cuff tendinitis (shoulder tendinitis): the most common cause of shoulder pain, this condition results from irritation or inflammation of any of the rotator cuff tendons occurring gradually over time. The main symptoms are pain and swelling in the front of the shoulder and side of the arm, usually while raising or lowering the arm
• Shoulder impingement syndrome: a condition in which the bursa or any rotator tendons are trapped (or impinged) by the humerus and the acromion, which is usually due to an outgrowth of bone (bone spur). Symptoms include shoulder pain and weakness, and difficulty reaching up behind the back
• Rotator cuff tear: a tear results when one of the rotator cuff tendons detaches from the bone, either partially or completely. These injuries can occur either traumatically due to a single incident, or gradually over time, which is usually the case in older patients.The most common symptom is pain that is most noticeable when lying on the shoulder or lifting or lowering the arm

Q: What is a SLAP tear?

A: A SLAP tear, which stands for superior labrum, anterior to posterior, is a common injury to the labrum. More specifically, the top (superior) part of the labrum is torn from front (anterior) to back (posterior). SLAP tears can result from a single incident, such as falling on an outstretched arm or shoulder, or from regularly doing lots of overhead activities. Sports like baseball and tennis, and professions that involve lifting heavy objects can all increase the likelihood of a SLAP tear. Typical symptoms include a sensation of locking, popping, or catching, pain with many movements of the shoulder, especially lifting heavy objects overhead, and reduced shoulder strength and range of motion.

Q: Which other shoulder diagnoses are common?

A: Here are four other common causes of shoulder pain:

• Shoulder bursitis: a bursa is a fluid-filled sac that acts as a cushion to prevent structures from rubbing against each other; the subacromial bursa in the shoulder is the largest bursa in the body, and when it becomes inflamed, often from regularly performing too many overhead activities, he result is shoulder bursitis; the most common symptom is pain at the top, front, and outside of the shoulder that gets worse with sleeping and overhead activity
• Frozen shoulder: a condition that occurs when scar tissue forms within the shoulder capsule, another structure that helps to keep the shoulder stable.This causes the shoulder capsule to thicken and tighten around the shoulder joint, which means there is less room for the shoulder to move normally, eventually causing it to freeze.  Symptoms include pain and stiffness that makes it difficult or impossible to move the shoulder
• Shoulder dislocation: an injury in which the humerus pops out of the glenoid. This is typically due to a forceful motion, and the dislocation can be either partial or complete; symptoms include pain, swelling, and difficulty moving the shoulder
• Calcific tendinitis: a condition in which small deposits of calcium form within the tendons of the rotator cuff. Calcific tendinitis is most often seen in individuals between the ages of 30 – 60. The reasons it occurs are not entirely understood. In most cases it does not cause symptoms, but can lead to severe pain if the calcium deposits get bigger or become inflamed

Q: Am I at risk for frozen shoulder?

A: Frozen shoulder affects up to 5% of the population, but it’s not completely clear why it develops. Certain factors may increase your risk. They include not moving your shoulder for a long period of time, a recent injury, surgery, or pain. Other factors may also contribute, like being between ages of 40 and 60, female, or having arthritis, diabetes, or cardiovascular disease.  Therefore, your risk could be higher if you fit into any of these categories, but predicting whether you will get frozen shoulder is difficult.

In our next post, we’ll provide some simple strategies you can follow to reduce your risk for all causes of shoulder pain.

Q: Who can I speak to if I have more questions?

A: Contact us to speak to a physical therapist.