Why are shoulder injuries so prevalent in nursing?
During pandemic, I am honored that I was given an opportunity to be part of a hospital’s employee wellness program.
The primary objective is to aid injured frontline workers to return to work safely and educate them about injury prevention.
I soon recognized an alarming trend of shoulder injuries, almost all nurse practitioners came to my treatment rooms with shoulder problem...
Many of them suffer from various level of rotator cuff tears and shoulder impingements. They are typically prescribed with many shoulder strengthening exercises, but they usually report those exercises are not helping or even causing more pain...
More interestingly, the injured shoulder is often the non-dominant arm!
One question popped up in my head immediately, “Is the shoulder injury really caused by the shoulder itself?”
Most shoulder injuries in nurses coincidentally fall into the same dysfunctional pattern in the musculoskeletal system. In observation, many nurses are demonstrating forward head posture with significant thoracic kyphosis. This creates a biomechanical disadvantage to their shoulder blade (scapula). Their scapula tends to tilt anteriorly and laterally, and thus their rotator cuffs tendons are constantly being compressed due to the anomaly of the scapula.
Then it leads to a deeper question, why are their posture so bad?
Upon examination, I have noticed a lot of the nurses are also having apical breathing patterns. They have a very limited rib movement and a weak diaphragm.
They cannot breathe properly!
This explains why they also suffering from chronic neck discomfort due to hypertonic scalene muscles.
In the hospital settings, staff who provide direct patient care are required to wear a properly fitted N95 respirator. N95 respirator is highly effective on sealing the face to provide the best protection of viral and bacterial filtration. However, it also makes breathing more challenging for nurses. Wearing a N95 respirator inevitably encourages them to become a mouth breather. In order to breathe deeply through the mouth, they have to get into a head tilt- chin lift position to open the airway- that’s why forward head posture will be the best choice to make it happen.
This is when all the biomechanical flaws prevail and lead to injury.
Needless to say, nurses are required to work 12 hours shift and their job is highly physical e.g. providing bedside care in awkward posture and positioning heavy patients.
But the origional issue was shoulder pain, how did we get here? And what now?
Now we have a better understanding that shoulder injury is not merely a shoulder problem.
To tackle this complex issue, we need various tools to complement our treatment effort.
Firstly, we would suggest the nurses to wear the posture bra/ shirt to reduce postural stress. We found that it’s extremely difficult to ask any individual to stay in perfect posture for 12 hours long shift. Therefore, posture shirts are able to reduce fatigue and desensitize the hypertonic muscles.
Secondly, they will need posture arch- easy to use tool- to improve the thoracic mobility.
Lastly, in some cases, some individuals will need the power breather to strengthen the diaphragm to reverse the apical breathing pattern.
Once the root cause of the issue is identified and corrected, nurses will start to see major improvements in their symptoms as the biomechanical obstacles are removed, so now we have created a proper physical environemt for all shoulder strengthening exercises to be effective!
Are you a nurse experiencing these issues?
Book a visit with Simon in our Aurora or Markham clinics by clicking the links below.
Still unsure if this is right for you? Email Simon, he would love to hear from you!
Written by: SIMON CHOW
Registered Massage Therapist + Certified Athletic Therapist
BKin. RMT. CAT(C). R. Kin.