Have you ever been in the middle of an activity when you feel a little “twinge”? (Twinge: an instance of pain that may or may not have happened. Your body definitely felt something, but your head will not let you believe that there could possibly be anything wrong.) Then you go on with your life. Two days later, that twinge came back, only twice though. Two weeks later the twinge officially becomes predictable pain. This has officially entered the category of being an injury.
Fiddlesticks. Now your shoulder is stopping you from doing your daily swim; you are sitting out from volleyball at your own family picnic because you “did something” to your shoulder; you stopped your weight lifting routine and are just focusing on legs, but this gets old fast. After two weeks of rest you go back to trying a swim, after all, you rested it so it must be all good now! Twinge. Frustration. Pity Party. Eat. Lethargy.
I wish this was out of the ordinary, but I see this in practice all the time. We do not want to admit that we may have a rotator cuff tear, so we will avoid some fairly logical steps to make sure that it does not get worse. People get apprehensive of pain, but the truth is that:
PAIN IS GOOD!
It is situations like this that bother me a little bit. We live in a world with conservative care. What is conservative care? In my world, it is managing injuries (big or small) without using injections, surgery, or medication. A “twinge” is a great sign that you may need to incorporate something else into your weekly life to PREVENT AN INJURY FROM COMING! One month of rest and rehabilitation 3 times per week might be excessive for a twinge, but it could also be exactly what you need.
There is nothing to be afraid of.
My favorite part of being a sports physician is prescribing additional rehabilitative exercises as a supplement to an individual’s routine exercise program. This allows someone who is perfectly capable of learning one or two new exercises to care for his or her injury before it is actually considered an injury.
This is not scary for the individual because an action step was made once a weakness had become evident (Yes, the twinge is actually an indication of weakness or faulty movement). Sometimes adding in range-of-motion activities with some stability exercises will eliminate the twinge/weakness/faulty movement.
Here is an example of a recreational swimmer’s weekly routine with an added shoulder PREhabilitation. This was given after an examination to rule out anything major and we were able to prevent the regression of the injury:
Swims 1 mile 3 days per week (half freestyle, half back stroke)
Weight training 2 days per week (full body circuits)
Shoulder twinge PREhab prescribed:
Shoulder ROM 2 x 10/ movement
Contract/Relax mobility for 5 minutes prior to swim
Weight training days:
Raised surface child’s pose
External rotation 3 x 10 (light and easy, good form)
TGU light 2/side x 5
Shoulder setting with plank 10-30 sec holds x 3
These twinges just need a little love. Give it to them.