Shoulder and knee treatments

You may be able to dismiss a little niggling pain in your shoulders during your workout - after all, "no pain, no gain" - but you have to admit there's a problem when you can barely raise your arms overhead to blow-dry your hair. And if even thinking about training your delts makes you cringe in pain, you definitely need help. 

Maybe your shoulders are fine, but your knees ache if you sit too long at your desk. Perhaps running or bicycling has become a painful ordeal. How can you stick with the cardio component of your training program if you can't count on your knees? 

The day may come when you'll need medical help to solve these common problems. But before heading off to your doctor's appointment, you can brush up on the inner workings of your shoulders and knees so you'll know the lingo and understand some of the ways your physician might want you to rehab your injury. Our primer can also help you avoid common shoulder and knee problems in the first place!

Shoulders: All About Impingement
Do you feel pain or hear clicking from the top and front of your shoulders during arm movements? One of the most common causes of these symptoms is shoulder impingement syndrome, which occurs when the rotator-cuff tendons and bursa sacs become inflamed and swollen, essentially becoming trapped in the joint capsule. The causes are typically many - muscular weakness, overuse and/or degeneration - and one problem frequently leads to another. The shape of the acromioclavicular joint and shoulder-capsule tightness or laxity can also play a role.
Poor posture with a forward head and rounded shoulders will close off the small space within the joint capsule and cause rubbing of the tendons and bursa, sometimes resulting in bursitis. Excessive overhead use of the shoulder joint without strengthening and stretching can also cause pain.

Treatment Tips
The primary goal of shoulder rehabilitation is to reduce the compression and friction that lead to pain and dysfunction. In acute impingement syndrome, rest, ice and nonsteroidal anti-inflammatory drugs, along with strengthening and flexibility, are beneficial and may reverse the syndrome. If these tactics don't work, consult an orthopedic sports-medicine physician.

A rehabilitation program should focus on the reason for the impingement. If it's an overuse syndrome, rest and lifestyle changes are needed. If muscle weakness or imbalance is the problem, specific exercises (shown on the following pages) should target strengthening of the rotator cuff and other stabilizer muscles. 

Knees: The Grind Line
Knee pain, or patellofemoral (PF) pain, is one of the most common disorders that orthopedic and sports-medicine physicians evaluate. The whys and hows of PF pain are still a subject of debate. One popular theory blames PF pain on abnormal patellar (kneecap) movement, a faulty movement pattern that increases the stress between the patella and femur (thigh bone) and wears out the cartilage on the underside of the patella. Although the cartilage itself has no pain receptors, the bone underneath does. 

The cause of knee dysfunction is really an individualized issue. In some cases, a congenital malalignment of the lower body may be the culprit. In others, tight and/or weak muscles may be to blame. Overuse of a bodypart is always going to cause inflammation, pain and weakness. Knees can also become painful as a result of injuries that stretch or tear ligaments or bruise the patella. Whatever the cause, the signs and symptoms are generally the same: They run the gamut from swelling, loss of range of motion and a sense of instability to pain with prolonged sitting, squatting, and walking up and down stairs.

Treatment tips
If your knees are already hurting, your first course of action is to treat the symptoms with rest and ice until the pain lessens or stops. If this is a chronic problem, or if the ice and rest don't decrease your pain, your next step is to visit an orthopedic surgeon who specializes in sports medicine. 

Once the painful symptoms are reduced, the cause of the problem can be tackled. Strengthening and flexibility of the entire lower extremity from the hip to the foot is important. Strong legs and hips can help decrease stress on the PF joint (see "Top Knee Pre- and Rehabilitation Exercises"). When the entire quadriceps group is strengthened, it may help change the contact areas between the patella and femur and redistribute the pressures. This, in turn, can relieve painful areas of worn cartilage. Remember, the rule of thumb is that all exercises are performed pain-free. 

Strength & Flexibility are Key
Most shoulder and knee problems are definitely preventable and easily treated. The key is to train smart in the gym and analyze your exercise program to determine if you're setting yourself up for an injury or if your program contributes to your pain.

Keith Meister, MD, orthopedic surgeon and team physician for the University of Florida (Gainesville) women's sports teams, says women can prevent many injuries by simply incorporating some weight training and stretching into their cardio programs. "I see so many women in my gym spending hours grinding their knees away in Spinning classes or raising their arms overhead in aerobics classes and never spending any time with weights," he explains. "It doesn't surprise me when they come to my office with knee and shoulder pain. They haven't prepared their joints with proper strengthening for these stresses." To treat your joints with the respect they deserve, he recommends acquiring a base of strength and a degree of flexibility to lessen the damage that constant repetitive motions can cause.