Shoulder Pain, Ice and Needles

Have you ever noticed how long the needle is when you get inoculated for something like tetanus? If you have even the slightest needle phobia, you might pass out. The needles are long - about 1.5 inches.

Injections delivered into your upper arm must penetrate into the muscle belly of the Deltoid muscle. There is a considerable amount of research on just how long a needle needs to be to penetrate most adults' Deltoid muscle. The average needle is between 1.0 and 1.5 inches long. Remember this. You will need it later.

I was watching a major league baseball game recently and happened to notice a pitcher sitting in the dugout with what looked like a small mountain of ice strapped to his shoulder. A few questions came to mind. Why do we use ice for a sore shoulder? How much ice do you really need? Is a thick pile of ice better than one of those gel ice packs you store in your freezer? How long should you use ice? And, how deeply does the cold penetrate? Does it get to the tissue that supposedly needs it?

Ice is probably the most commonly used physical agent in the sports injury world. When a baseball pitcher injures his shoulder, in most cases, the injured tissue is the rotator cuff muscle group. These small muscles (four in total - Supraspinatus, Infraspinatus, Teres Minor and Subscapularis), buried deep in the shoulder, control the finer motions of the shoulder. They blend together to form a large tendon that anchors to the top part of your arm. When you throw too hard, too long or too much, you strain the tendon and develop a deep, aching soreness. This can lead to rotator cuff tendonitis or tendonopathy (a weakness of the tendon).

Ice is often used as treatment for rotator cuff tendonitis. So, for the cold to work it must actually reach the tendon (how it helps or does not help tendonitis is for another time). Cold penetrates about 1 cm or slightly less than 1/2 inch. The rotator cuff is buried under your Deltoid muscle. Remember the needle length for injections? It was over 1 inch to get into the Deltoid. If the rotator cuff is under the Deltoid, and the cold of ice only penetrates 1/2 inch after a thirty minute exposure, how does the rotator cuff ever benefit from the ice? It doesn't. While the baseball pitcher sits with a pile of ice strapped to his shoulder, he is nicely cooling his Deltoid while his rotator cuff remains toasty warm.

Cold is cold. A pile of ice is not any better than a gel ice pack other than perhaps it will stay colder for a longer period of time. Ice helps reduce the pain of a sore shoulder, but if you think it helps prevent or treat rotator cuff tendonitis, you're wrong. The cold never gets there.

If your shoulder is sore, ice it if you want to temporarily reduce the pain. Perhaps a better choice is to figure out why you have a sore shoulder and what you can do to prevent it. Want to know more? Sign up for our June 14th free seminar on this very subject "Shoulder Pain: Why You Still Cannot Throw, Swim or Hit" and for all of the clinicians out there, reserve a spot in our upcoming professional seminar on August 4th-5th at Sports Center entitled "The Shoulder: Rehab for Rotator Cuff Tendonitis, Tendonosis, and Repair".

Ice is OK. Knowledge is better.

Make today count.

Doug Kelsey
Author. Speaker. Therapist.

P.S. I promised I would share with you some of the comments from our inaugural graduating class from Sports Center.  Click here to read their amazing comments.

References:
Chiodini J (2000) Vaccine administration. Nursing Standard. 14, 43, 38-42. April 2000.

Enwemeka, C. S., C. Allen, et al. (2002). "Soft tissue thermodynamics before, during, and after cold pack therapy." Med Sci Sports Exerc 34(1): 45-50.

Otte, J. W., M. A. Merrick, et al. (2002). "Subcutaneous adipose tissue thickness alters cooling time during cryotherapy." Arch Phys Med Rehabil 83(11): 1501-5.