Health – Shoulder or Upper Arm Pain [21]

By Nick Gill

Introduction

Having moved to Canberra in August last year I joined the NSW Sea Kayaking Club and attended the October Rock ‘N Roll weekend as my first club event. From that time I started paddling regularly, either on the coast on weekends, or on Lake Burley Griffin. Although I had had my kayak for a couple of years I had never used it to the extent that I now was. I quickly began to build up paddling speed and endurance and was feeling very pleased with myself – and having a great time.

I was therefore understandably annoyed when I began to develop a good deal of pain and discomfort around my right shoulder and upper arm in March this year. This problem has severely curtailed my paddling, restricting me to relatively short forays and forcing me to miss a number of club events and assessment weekends. The problem is still with me (in late July), although I am starting to get on top of it. Other paddlers I know have also had such problems to a minor extent, and it has been described in Sea Kayaker a few years ago. It is also common amongst rock climbers and tennis players. I want to describe what causes the problem and enable others to recognise it when it occurs, for unless one undertakes remedial training the problem is unlikely to disappear by itself.

The Problem

The problem generally manifests itself as pain on the upper arm, where it joins the shoulder. The pain may be in various places, depending upon the exact nature of one’s problem. In my case, the tendons in question are those to the front of the arm. The problem arises due to the nature of kayaking and the muscles that are exercised when paddling. Paddling a kayak seems to particularly exercise the pectoralis major (‘pecs’ – chest), the upper trapezius (‘traps’ – neck and upper shoulder) and the latissimus dorsi (‘lats’). I certainly noticed that these muscles were developing as I paddled more and more. Unfortunately, the strengthening of these muscles can set up imbalances with other muscles, causing changes in posture and movement. These changes can precipitate what is known as ‘impingement’ of the tendons that are found in the shoulder and upper arm.

The imbalance that develops is between the muscles mentioned above and a set of muscles known as the ‘rotator cuff’ (RC) muscles. These muscles are the supraspinatus, infra-spinatus, teres minor and subscapularis. These muscles are found in the upper back and they play an important role in stabilising the shoulder joint. Most importantly these RC muscles act to rotate our shoulders outwards and to stabilise the movement of the shoulder blade, protecting the tendons that pass through the shoulder area to the upper arm.

By strengthening and shortening our lats, pecs and traps we cause them to both pull the arm forward and turn it inward, and also to pull the shoulder forward. This has the effect of decreasing the space in the shoulder joint through which the tendons run. The result, during movement, is ‘impingement’, or squashing of the tendons. This can cause inflammation and swelling. Once the tendons are swollen they will be further squashed. The space through which the tendons run will be at its smallest when our arms are raised, for example when paddling, or even, as I am now doing, typing.

The problem can be hard to shake as strengthening and shortening of the lats, traps and pecs has the corollary effect of stretching and weakening the RC muscles, compounding the problem. The positive feedback of ever more swollen and aggravated tendons also makes the problem hard to remove. It is quite possible to reach a situation in which even everyday activities will cause impingement.

Unless you are lucky and the problem sorts itself out, the remedy is basically strengthening of the RC muscles and stretching of the pecs, lats and traps. The precise mix of this will be dictated by one’s particular circumstances and professional advice is worth getting. In my case, the exact nature of the problem has changed and has required different exercises over time. I am currently using a mix of strengthening and stetching exercises from my physiotherapist and from yoga.

Are You At Risk?

If you have pain as described above, it is possibly due to problems with your RC muscles. Of course, if you do have pain in your shoulder area don’t rely on a necessarily accurate diagnosis from me. If it’s a continuing problem get professional advice. If you don’t have such pain it is worth checking to see if you are at risk of developing impingement. The most obvious sign of risk is the ‘gorilla’ posture. This is evidenced by; rounded upper back; shoulders forward; arms inwardly rotated so that one’s palms are facing backwards or resting on one’s thighs.

Other signs include; prominent upper trapezius muscles (‘bull’ neck); hollows above and below the middle of the shoulder blade (indicating wasted RC muscles); wasting of the lower traps between the shoulder blades, shoulder blades that sit far away from the spine; shoulder blades that lift away from the back when you raise your arm; tight lats.

As for me, I’m starting to get on top of the problem by dint of regular stretching and strengthening exercises. I’ve recently begun to do more than potter about in my kayak again, although I’m still taking things easy and not pushing myself.

In an attempt to reduce stress on my shoulder I have also modified my paddling technique in two ways. First, I have switched from a long, full-bladed paddle to a slightly shorter, narrow-bladed paddle. Second, whereas I once paddled with my arms held up and out in front of me, I now paddle in a more relaxed fashion, holding my arms down and closer to my body. These changes seem to have helped, particularly the narrower blade, although only time will tell.

Acknowledgments: Although I had an understanding of the impingement problem from my physiotherapist, an article in the Jan-Jun 1994 edition of Rock, by physiotherapist M. Sleeman was of great help in finding the necessary words.

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