Blog

Mar 13

With daylight saving time upon us and even a little tease of warmth this week, it might feel like Spring is in the air. While officially still a week away, Winter has certainly felt long enough. If you're anything like me, you're itching to open the windows or step outside and soak up some sunshine. Of course, these next few weeks also tend to be an important "on ramp" for most of us as our bodies might be a little stiffer or more likely to feel sore coming out of the Winter season, especially if our activity loads accelerate too fast. Add in heat acclimation, which is only a few weeks away, and it's easy to spot a reasonable risk trend on the horizon. Research findings from the last few decades support this idea. 

For example, in 2004, one study showed a clear preventive benefit for early-season injury rates among sub-elite athletes when pre-season training loads were dialed back and the "ramp" period was given proper respect. Another from around the same time period on US Army Cadets showed a much higher risk (1-3 times) of soft-tissue injuries during Summer Basic Training, even though overall loads were generally on par with Fall and Winter groups. The authors pointed to heat's effect as one possible cause. However, in my opinion, nothing could be more interesting than what we have (and haven't) learned from "The Boys of Summer" and their gnarled-looking but highly functioning shoulders.

Not surprisingly, in Major League Baseball, where money is less of an object, it started with the hope of using high tech to predict and ultimately prevent future injuries in elite-level athletes. I mean, it makes sense. Given the amount of money invested in those same shoulders, the cost of X-rays and MRIs didn't seem like much. Unfortunately, it didn't work all that well. Within a small study published in 2002, of the professional pitchers who were asymptomatic, meaning who had shoulders that felt and functioned fine, almost 80% showed clinically significant "damage" to the cartilage of the shoulder (labrum). 5 years later, another study searched for a correlation between "degenerative changes" and other abnormal X-ray findings of the shoulder and time spent on the disabled list for 50 pitchers from the St. Louis Cardinals organization. No significant correlation existed. Then, in 2022, another study on elite-level rock climbers yielded similar results: about 80% of normally functioning and pain-free shoulders had abnormal scans...which brings us to today and the question of whether non-athletes and otherwise everyday folks have similar findings.

 According to this study, published last month in the Journal of the American Medical Association, the answer is yes, and the rates are even higher. The research on approximately 600 Finnish adults aged 40 to 76 found that virtually all participants, regardless of symptoms, had abnormal findings. Specifically, almost all (96%) of those who had no pain or other symptoms, as well as almost all (98%) of those who did, had abnormal imaging findings. This was so impressive that the authors called into question the value of shoulder images for individuals over 40 years old in cases without significant physical trauma.

In the study's conclusion, they said it this way:

"In this population-based study, rotator cuff (RC) abnormalities were nearly universal after age 40 years and showed poor concordance with shoulder symptoms. These findings suggest that RC abnormalities often represent normal age-related changes rather than disease and call into question the clinical value of routine imaging for atraumatic shoulder pain."

There are more layers to peel back on this one but for now, much like what we've learned about other stiff and achey joints (and what works best to help them), when there's no major or obvious cause of the pain we feel, scary images and the negative worries they produce might not be high (or even on) the list.

Call us if you need to dive deeper.

Have a great weekend,

Mike E.