One Joint Shoulders a Heavy Load

Multiply stress and bad habits over a couple of decades, add poor posture and a decline in blood flow associated with aging, and the shoulder becomes a breeding ground for aches and pains.

Fortunately, rotator cuff injuries do not typically involve the type of full tears that baseball pitchers or other athletes suffer (or that might occur in a severe weight room trauma), and therefore don't require surgery. Instead they can be treated with an assortment of rehabilitation strategies.

In my second session with physical therapist Patrick Kennelly, he was able to massage and loosen the muscle beneath the shoulder blade, and it made an immediate difference once that part of the body could move more freely.

He also recommended shoulder and upper-back exercises, some of which seemed to be taken straight from the yoga playbook; a sequence done with the knees and one hand on the ground, for example, that involved extending the arm in front of the head, threading it under the body and then lifting it to the sky.

"Yoga is our enemy," Kennelly said jokingly. "It keeps people out of here." Yoga teachers, in fact, frequently note that joints do not have a dedicated blood supply and are nourished when motion causes the secretion of synovial fluid -- hence all the twisting and contortions of a standard yoga session.

The concept is important, but local medical experts say it is often lost on people who are having trouble. The intuitive response is more like "if it hurts, leave it alone." In fact, in the case of joint problems and arthritis, motion and activity are critical.

"Biomechanically it can only get worse," said Jay Greenstein, head of the local Sport and Spine Rehab clinics. "If you feel the pain and don't do the activity, you are losing out. It is going to catch up with you. It won't be [while you're] lifting weights at the gym; it will be getting something out of the cupboard."

The recommended exercises are, however, painstaking and tedious -- not ones that will leave you spent and feeling as if you've pushed your body to its limits. Quite the contrary, they involve light weights and potentially dozens of repetitions. The rotator cuff is not meant to bear heavy loads but is "always active" and needs to be trained for endurance, said T. Moorman, the head of sports medicine at Duke University Medical School.

The sequence that Kennelly provided me involved using resistance bands to strengthen the cuff and stretches to loosen the upper back. More rotation in the back means more help supporting the shoulder and arm when you reach out or across the body.

In my case, this is all to fix a problem. The same types of exercises can (should!) be done by anyone who is healthy to make sure their cuff stays strong and injury-free. Upper-back exercises, yoga -- there is much else that can help.

And, just like your mother told you, stand up straight.