Monday 23 July 2018

Dear Dr Nina: Do I need to quit the gym after shoulder surgery?

Shoulder pain
Shoulder pain

Nina Byrnes

I was lifting weights in the gym recently and suddenly experienced a sharp pain. An MRI showed a torn labrum, which my doctor says was the cartilage around the joint. I had surgery to fix it andI feel like my shoulder has returned to normal function - there's only an occasional twinge. My problem is that my GP says that I should stop lifting weights as I've increased the likelihood of dislocating my shoulder. Surely though weights would only strengthen the joint? I also play a lot of tennis and I don't want to give it up. The surgeon made no such recommendations so I'm wondering if I should just carry on as I was before. What do you think?

Dr Nina replies: The humerus (arm bone) attaches to the scapula (shoulder blade) at a place called the glenoid. The labrum is a piece of cartilage found in the shoulder joint.

It has two main functions - namely deepening the socket, helping the ball stay in place, and acting as an attachment for the ligaments the join the ball to the socket. It is an important piece of cartilage.

Injuries to the labrum may occur due to a sudden shoulder injury or due to repeated episodes of strain. Things like falling onto an outstretched arm, a direct blow to the shoulder, forceful overhead motion or sudden pulling, such as occurs when lifting a heavy object, may all tear or damage the labrum pulling it off the rim of bone. Tears may occur at the top, middle or bottom of the labrum.

More complicated injuries may involve the biceps tendon or be associated with a partial or complete shoulder dislocation.

Minor injuries may be managed with rest, slinging and anti-inflammatories, but more extensive injury requires surgery. The surgery may involve removing torn cartilage, reattaching ligaments and repairing damaged tendons.

Recovery from any surgery takes time. The shoulder is usually in a sling for three to four weeks. The goals in the first few weeks are to ensure the wound is healing, protect the surgical repair, control pain and swelling, prevent stiffness and regain a very gentle range of motion.

Gentle strengthening of the shoulder joint and increasing the range of motion can start from week five after surgery. From this time the arm can be used for most normal daily activities.

It is important at this stage to still avoid lifting anything that weighs over one kilo. Forceful pushing or pulling, or reaching your hand behind your head, should still be avoided at this stage.

From eight weeks, raising the arm for activities such as washing and dressing are OK, but even up to 12 weeks forceful pushing or pulling activities can upset the healing of the shoulder joint

You should not return to weight training unless cleared to do so by your doctor or physiotherapist. This should not be attempted in the first three months post-op.

Before weight training, the shoulder joint needs to be assessed to ensure you have regained a full range of motion of the joint.

When training resumes, certain exercises such as pulls downs, bench presses, lateral deltoid raise and shoulder press overheads need to be done with caution.

It is great that your surgery went well and you feel you have recovered, but it sounds like your GP gave good advice.

You should only return to weight training under the guidance or observation of a physiotherapist or doctor experienced in treating those who have had labral tears.

Q. I’m breastfeeding my three-month-old baby but I’ve put my back out and I’d usually just take Nurofen until it improves. Now I’m worried that they’ll hurt the baby. Are they safe?

Dr Nina replies: Back pain is a common reason for many people to go to their GP. The pain itself can be quite severe, making simple things like turning, dressing or sneezing very painful and difficult. 

Pain may be felt in the lower back or radiate into the buttocks, hips or down the legs. You may notice numbness, pins and needles or sharp shooting pains if there is any pressure. You may also have reduced flexibility in your back and simple things like trying to put on socks or shoes can be excruciating or near impossible.

Simple back strain is usually treated with a combination of painkillers and physiotherapy sessions. X-rays or scans are not usually necessary.  Ibuprofen (Nurofen is one brand available) can be very effective. Minimal levels of ibuprofen pass into breast milk so this is considered safe during breastfeeding and would be the medication of choice in your case. It is not known to cause any harm to the baby.

Physiotherapy is another treatment option. In mild strain it may provide as much relief as medication.

If your physiotherapist advises exercises, this is like a prescription from your doctor and doing these exercises daily is essential to your recovery. Be careful leaning into the cot and lifting the baby as this will hurt.

Simple exercises like walking or swimming can be beneficial and exercise that focuses on strengthening the muscles of the abdomen and lower back will help support the spine. If there is a lot of muscle spasm, applying ice or heat packs or having a warm bath may also provide relief and help ease pain.

If you have any health queries for Dr Nina Byrnes, please email drnina@independent.ie. Please note that Dr Nina cannot enter into individual correspondence

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