This is a frequent topic of discussion for patients suffering from shoulder injuries as they look back on the wear-and-tear over the course of their work careers. The initial discussion often transitions to the potential “what ifs” (with respect to their shoulder) if they had in fact opted to choose another profession. This is a viable question, of course, with the unfortunate reality being that it should have been asked years if not decades prior. This is a topic on which many books have been written. In this article, I will touch on a few major points.
Microtrauma & Macrotrauma of the Shoulder
There is a lot of potential shoulder wear-and-tear (microtrauma: day to day wear-and-tear and macrotrauma: impact/torque/distractive trauma) in many “blue collar” environments, but the prevalence of microtrauma in the classic “white collar” environment is quite high as well. Some people are sitting in front of a computer screen up to 15 hours a day and the combinations of inefficient levels of arm/shoulder support with underlying mobility and strength deficits can lead to significant shoulder, neck and upper back issues.
Shoulder Injuries Among Industrial & Trade Workers
Let’s start with the industrial laborers and those in the trades. Basically, there is only so much “tread on the tire” and this in conjunction with normative regressions of functional mobility and strength leads to accelerated wear-and-tear on a number of joint structures about the body. Improvements in working materials and how they are applied in conjunction with safer work environments/requirements have certainly decreased the frequency and intensity of work injuries.
Nonetheless, it is basically impossible to fully adhere to work constraints and/or perfectly maintain proper ergonomics thus leading to excess levels of torque placed on joint structure. As one fatigues under the forces of the load, class one levers are created within the joint (think of a pole driven into the plant box with pole vaulting) to allow the worker to complete the required task/series of tasks.
Progressive Trauma to Soft Tissues
With recurring impacting events such as this within the joint, there is progressive trauma to soft tissues, cartilaginous and bony structures creating a slow cascade of joint injury. Ludewig et al reflects on this in the following paragraph:
Repetitive or sustained shoulder elevation during occupational tasks has been identified as a significant risk factor for shoulder tendonitis or non-specific shoulder pain. The evidence of occupational risk is strongest for combined exposure to multiple physical factors, such as holding a tool while working overhead. Construction workers in many trades, by the nature of their work, have substantial exposure to awkward postures, repetitive and forceful muscular contractions, and overhead work. However, not all workers exposed to these conditions develop shoulder symptoms, with prevalence rates in various construction trades ranging from 25% to 71%.” P M Ludewig, J D Borstad. “Effects of a home exercise programme on shoulder pain and functional status in construction workers”. Occup Environ Med 2003;60:841–849.
One often assumes that they are strong, as per sustained accomplishments with say a biceps curl. It is difficult to easily assess the magnitude of functional strength at motion extremes and even more challenging to exercise in this realm since the necessary exercise patterns fall well outside the norm of what classically occurs at the gym.
As one moves further into adulthood the extremes of available motion and strength are slowly lost (we don’t climb trees anymore). Thus the importance of being educated in mobility and functional strength exercises specific to one’s line of work to prevent excessive regression while minimizing potential injury. If injury does occur, allowing for complete healing while simultaneously restoring applicable mobility and strength again specific to one’s job. This can be accomplished successfully with the help of the physical therapist.