Shoulder pain..The OUCH factor in winter..

Frozen shoulder is a nasty problem to deal with, especially for the elderly patients who have diabetes, particularly if u have an uncontrolled diabetes, There is a direct link between diabetes and shoulder pain The capsule surrounding the ball and socket joint of your shoulder becomes inflamed, stiff and thickened. This prevents most of the movement available in the shoulder.

Difficulty with general shoulder movement, in particular reaching above your head, reaching your back pocket or difficulty brushing your hair. There may also be pain when lying on the shoulder and the pain may be worse in the cold weather.

One of the most common problems to be seen in winter and is aggravated by being stiff at one place for a long period of time in winters leading to general muscular ache.

Why Joint Pain Increases In Winters or Cold Weather:

1. Due to Decrease in Barometric/ atmospheric/air pressure, the joints and tissues remain in contracted state and alignment. In winter this pressure decreases, tissue swells up and increases the surface area that impinches nerve endings leading to pain while as in summers the barometric pressure increases and maintain the tissue alignment.

For instance when we travel in plane above sea level, the barometric pressure decreases leading to joint swelling and uneasy ear pain.

As soon as the winter arrives in Kashmir, we look for a comfort and warm place to sit ideal for long period of time leading to stiffness and due to lack of mobility the tissue contraction that should happen isn’t happening the way it has to resulting in stiff and painful joint

2.Due to lack of mobility and exercises in winters.

In winters our weight bearing joints like knee joint and hip joint synovial fluid exchange and cartilage health has to be maintained by some weight bearing exercises. Gentle brisk walk by wearing warm clothes and some weight training exercise in warm room is must

These exercises will help in maintaining the hemodynamic and max out your more caloric burn with increased metabolism.

Hands and feet are cold in winter  as body needs to regulate heat on vital organs to keep them warm and with the movement of distal extremity the heat produced by muscle contraction is centralised by rerouting the blood flow.

Winter strategies to follow:   

1. Keep your body warm with loose layers of clothing. layers should be more in number.

2. Take vitamin- D from sunlight in winters.

3. Take food rich in vitamin C like oranges and lemon that are helpful for maintain joint cartilage and calcium production.

4. Increase movement and regular exercises.

5. Weight bearing exercises to protect joints.

Tips to Follow

If you are experiencing shoulder pain with some restriction in movement, it is always better to consult an internist or a shoulder expert. However, there are some tips that you can follow to protect yourself from the intensity of a stiff shoulder during winter.

1. Avoid going out in cold with less clothes as cold exposure can aggravate the pain with muscle stiffness.
2. Applying heat packs to the shoulder can help in relaxing muscles and improve blood flow. However, make sure that you do not use excessive heat as it can lead to skin burns or irritation in case if you are diabetic
3. Going for an early consultation can help you prevent your frozen shoulder complications. The Physician ask you to do an x-ray and other tests to make sure that there are no underlying issues. You may end up consulting a Physiotherapist for physical evaluation and checking your range of motion with further investigations like physical test and xray to analyse your situation and help you with a proper treatment plan
4. Diabetic control and thyroid check is a must.

Holistic approach for shoulder pain with Rehab medicine and pain management

A Physiotherapist is uniquely trained to create a well-structured rehabilitation program for patients with Shoulder pain. These treatments start with rest, modification of activities, and pain modalities and prescription of nutraceutical tabs.

Ultrasonic therapy: Therapeutic,promotes tissue healing and treating pain that works on the principle of peizo electric effect by modifying the tissue physiology

Interferential therapy: IFT helps to reduce inflammation, which can decrease the amount of pain that a person suffers. It can reduce pain associated with acute and chronic condition . IFT can also be part of a comprehensive rehabilitation program, which can help reduce pain and speed recovery time.

Laser (Light amplification by stimulated emission of radiation) treatment is a safe, painless, non-invasive, effective therapy to reduce pain and swelling to allow the body to restore damaged tissue. Red and infrared light is used for the relief of pain, speed up healing and decrease inflammation.

 Manual therapy

Orthopedic manual therapy is a specialized form of physical therapy that involves manual examination and treatment techniques. Gentle stretching and strengthening exercises, weight-bearing exercises, and resistance exercises focus on reducing pain and improving physical strength and functionality.

With the advancement of healthcare in Kashmir valley all these facilities are available in govt sector hospitals under different schemes like NCD NPCDCS and NRHM. Hospitals are timely upgraded to provide these facilities with the creation of physical medicine (physiotherapy department) in different institutes like SKIMS Soura and gmc baramulla.

By Dr Syed Sajid Geelani

Dr Syed Sajid Geelani, Physical Medicine, DH handwara