Backpack Safety for Back to School

backpackIt’s back to school season it’s time to clean out those backpacks to make room for the new school year! 

Sure, you may have some items that should have been thrown out from the previous school year, but now, you need to make room for those new books and supplies to get you through the next school year.

Did you know that according to the Consumer Product Safety Commission, injuries from heavy backpacks result in more than 7,000 emergency room visits per year? Sprains, strains, and “overuse” injuries were among the top complaints.

Safety Tips

OSS would like to offer some basic safety tips for you:

  • Your backpack should weigh only 15% – 20% of your total weight
  • Backpack straps should be wide and padded
  • Make sure the backpack has two shoulder straps
  • The backpack should have a padded back
  • Adjust the bottom of a full backpack and make sure it is not more than four inches below your waistline.
  • Consider using a rolling backpack, an air backpack or a light-weight backpack
  • Periodically check the contents and weight of your backpack; you may be amazed at the amount of unneeded items you are carrying

Prevent injury when using a backpack, do the following:

  • Use both shoulder straps to keep the weight of the backpack better distributed
  • Tighten the straps to keep the load closer to the back
  • Organize items and pack heavier things low and towards the center
  • Remove items if the backpack is too heavy and only carry items necessary for the day
  • Lift properly by bending at the knees when picking up a backpack

Here’s a great tip from Dr. Shapiro, “Take the time to lift your kids backpack. What could they leave behind to lighten their heavy load?”

If you believe you are suffering from a backpack-related injury and need specialized orthopedic care, Orthopedic Specialists of Seattle provide excellent treatment options available for you.  Please feel free to contact OSS at (206) 633-8100 to schedule an appointment.

Shoulder Dislocation and Treatment


Here in the Pacific Northwest outdoor activities are a way of life. From lumberjacks to the most experienced kayaker, healthy joints are important to perform various tasks and activities that involved upper body strength involving our shoulders.

The shoulder is the most mobile joint in the human body. To accomplish this, the shoulder requires a balance of stability and strength.

Shoulder Dislocation

Shoulder dislocation is a fairly common injury sustained by people of all age ranges. It is generally a sudden onset type of injury, which is caused by trauma to the shoulder region. There are many causes of this type of injury, from athletics to falling from a ladder. Most dislocations occur as the arm is outstretched to the side or overhead in conjunction with a force pushing the arm backward.

Dislocated shoulder signs and symptoms may include:

  • A visibly deformed or out of place shoulder
  • Swelling or discoloration (bruising)
  • Intense pain
  • Inability to move the joint

Shoulder dislocation may also cause numbness, weakness or tingling near the injury such as in your neck or down your arm. The muscles in your shoulder may be in spasm from the disruption, often increasing the intensity of your pain.

When the shoulder dislocates, the ligaments in the front of the shoulder tear causing pain and at least some loss of function in the affected arm. Although the ligaments may heal, the result is a shoulder that has even more laxity and instability than prior to the injury. Many athletes and active individuals will experience multiple occurrences of dislocation after the first event due to the increasingly unstable shoulder.

Successive dislocations, because of the increased amount of instability in the joint, often take significantly less force to occur. Whereas the first dislocation is usually the result of a traumatic force upon the shoulder, subsequent dislocations could result from ordinary, athletic or heavy use of the arm.

A common condition that may exist with shoulder dislocation is a SLAP tear, which is a tear to a structure in the shoulder known as the glenoid labrum. The labrum is a cartilage rim, similar to an O-ring, which covers the outside edge of the shoulder socket. This acts to deepen the socket and give the shoulder some extra stability. But under the extreme force of a shoulder dislocation, the labrum can be torn from the bone, creating a painful injury with reduced motion and strength of the arm.

Labral tears often produce a clicking or popping with shoulder motion, along with apprehension in the overhead ranges. Because these cartilaginous structures do not have a great blood supply, they often do not heal on their own and may require surgical intervention to re-attach the labrum to the bone.

Shoulder Dislocation Treatment

According to Dr. Shapiro, “A consistent strengthening program is often the key to shoulder stability.” There are many treatment options available for these types of shoulder injuries. Some are non-surgical such as physical therapy, while more extensive injuries may require surgical repair.

Dr. Joel Shapiro, MD, specializes in surgical and non-surgical treatment of shoulder injuries at Orthopedic Specialists of Seattle and uses the latest technologies and research studies to aid in the diagnostic process and treatment of your injury.

A good physical therapy program can help protect against instability. While this cannot help everyone, a diligent therapy program is always the first step. After evaluating your shoulder, a customized therapy program will be created.

If you believe you are suffering from a shoulder injury, Orthopedic Specialists of Seattle is here to help.

Softball Pitchers’ Windmill Delivery Can Cause Injury

Softball pitching subjects the biceps to high forces and torques when the player’s arm swings around to release the ball. Published in the March 2009 issue of the American Journal of Sports Medicine, the study of the “windmill” pitching motion appears to explain the high incidence of anterior shoulder pain observed in female softball players.

In the study, seven women — three collegiate and four professional pitchers — underwent motion analysis and surface electromyography to evaluate the muscle firing pattern of their biceps in the course of a windmill pitch. Electromyography detects electrical potential generated by muscle cells when they contract.

The researchers found that even though the upper arm movement in both baseball and fast-pitch softball gives the ball about the same velocity, the muscle force during the windmill pitch was much higher, according to the press release.

Moreover, the maximum force, or maximum contraction, occurred not when the arm was cocked, as in baseball’s overhand pitching, but when the arm circled around from the 9 o’clock position (i.e. almost fully extended back) to the 6 o’clock position (i.e. perpendicular with the ground), completing the windmill motion with the release the ball.

In one case, a pitcher had ruptured her tendon during play, which implicated the long head of the biceps tendon as the source of stress. Female softball pitchers are prone to overuse injury not only because of windmill pitching dynamics, but also because they pitch so many games.

Common Softball Injuries

Common injuries in softball players include tendonitis, rotator cuff and tendon strain, and ulnar nerve damage, but there are also plaguing lower body injuries that affect softball pitchers. So what is the source of injury? In simplest terms, the hips provide the platform for the scapula, and the scapula is the platform for the shoulder. If there is dysfunction in that system, this leads to injury. If a pitcher complains of shoulder pain, the shoulder may not be at fault for the pain, but rather faulty mechanics in the lower body.

Many times, softball pitchers experience upper body injuries that may be a result of faulty lower body mechanics. Force is produced in the ground, transfers through the legs and torso, and finishes in the upper body. If something along those lines isn’t functioning properly, injury will present itself.

Anterior shoulder pain is one of the most common complaints among windmill pitchers. A typical overhand pitch sees around 108 degrees of motion, whereas the windmill pitch has around 360 degrees of motion; which is an increase in the eccentric action of the biceps.

Strength and conditioning for softball pitchers takes on a significant meaning because all of the energy is transferred from the ground up to the hand (the final point of contact with the ball) and pitch from a flat surface vs. baseball players who pitch off of a mound; this means that a softball pitcher would need to train in ground reaction-force, emphasizing gluteal exercises. Strong glutes will provide a strong base for the pelvis, then transferring energy through the core to the upper body.

When considering training regimens for windmill softball pitchers, much of the conditioning should focus on strengthening the lower extremity and lumbopelvic-hip complex. The lower extremities and lumbopelvic-hip musculature can often be addressed in the same exercises. Ideally, the lumbopelvic-hip complex should be addressed first in the training cycle in order to maintain a base of stability throughout all the conditioning exercises.

Dr. Shapiro states, “Warming up prior to the game and using the proper technique while playing will reduce the opportunity for injury; however, if you are experiencing pain this may be from overuse or an acute injury. It is best to seek medical attention and be evaluated by an Orthopedic and Sports Medicine Specialist.”

If you believe you are suffering from a softball-related injury and need specialized orthopedic care, Orthopedic Specialists of Seattle provide excellent treatment options available for you.

Your Handbag could be the Cause of Shoulder Pain, a Stiff Neck and Back Pain

The holiday rush to get all your shopping done means being pretty efficient of how you want them packed and carried out of a store. Enter your handbag, big, bulky and up to the task. Unfortunately, that bag, if filled to capacity, will probably give you a sore shoulder, stiff neck and quite possibly back pain.The frenzy of the holiday season and your busy lifestyle warrants that you talk on your cell phone in one hand and carry that big, bulky purse on the other hand is actually intensifying a big problem; you are unevenly distributing weight on one side of your body.

What Can Be Done to Minimize the Damage?

Instead of carrying your bag on the same side, switch back and forth, or carry the bag in front of you. Understandably, it doesn’t look glamorous, but at the end of heavy shopping day, you can prevent your shoulders from aching. The prolonged effect of constantly carrying a heavy bag is like a strenuous workout; you overtax the muscles and induce joint pain if your bag is too heavy. By maintaining the correct form of carrying your bag and keeping the bulk of your purse toward the center of your body, it will help alleviate shoulder and neck pain.

Just remember these helpful tips:

1) A bigger bag doesn’t mean you have to fill it. Keep things to a minimum – a weight of no more than 5-8lbs is recommended.

2) Swap shoulders – this takes some getting used to but it is possible.

3) The wider the shoulder strap, the better the dispersal of weight.

4) Think about the material of the jacket you are wearing; slippery fabric will cause you to hunch your shoulder even more.

5) Watch your posture: are you leaning to one side to help balance the weight?

6) Stretch your neck and shoulder muscles.

According to Dr. Shapiro, “To protect your shoulders from an overuse injury like bursitis, don’t carry a heavy load of bags on one arm. It is best to switch shoulders or carry an even load of bags to distribute the weight safely.” If you are experiencing neck, hand, shoulder or back pain, call Orthopedic Specialists and make an appointment with one of our expert, orthopedic doctors at (206) 633-8100.

Rotator Cuff Tears and Repairs

Rotator Cuff Tears and Repairs

In the world of orthopedic surgery, there are few body parts as notorious as the rotator cuff. It’s one of those medical terms that has become a household name, and usually comes with a wince and a sympathetic nod when we hear it. Most people know of someone, a friend or family member, who has injured this particular part of the shoulder. We also see it in the sports news quite often.

In fact, now that football season is in full swing, we may hear more about Seattle Seahawks defensive lineman Michael Bennett who was diagnosed with a rotator cuff tear earlier this year. He played through the injury last season and plans to do it again this year, although he will likely need surgery in the off-season.

The rotator cuff is a group of four small muscles and tendons that surround the head of the shoulder. Their job is not so much to move the arm through space, but to provide dynamic stability to the shoulder. This means that as the larger muscles of the chest and shoulder create arm movement, the smaller rotator cuff muscles pull the upper arm into the shoulder socket. This design allows the ligaments of the shoulder to be relatively loose so that we can enjoy a vast degree of mobility, being able to reach in a near three hundred and sixty degree range of motion.

Tearing of the rotator cuff can happen in two ways. An acute tear happens suddenly, such as when you fall on an outstretched hand, or lifting a heavy object. There is generally the sudden onset of pain and a corresponding loss of function of the arm, to varying degrees.Tears can also happen slowly over time. As we age, the tendons of the rotator cuff become weaker and gradually fray. This is particularly so with the supraspinatous tendon, located on the top of the shoulder blade.

This muscle and tendon tends to get pinched between the shoulder blade and the arm bone, especially if theother rotator cuff muscles are weak. The supraspinatous also has poor blood supply, sotears often do not heal on their own, making surgical repair necessary to restore function.-1

Symptoms of a Rotator Cuff Tear

Symptoms of a rotator cuff tear include pain with movement of the shoulder and tenderness to touch. Inability to lift even household objects out to the side or overhead is also typical. Sometimes a person will not be able to actively lift the arm overhead due to abnormal movement within the joint itself.

Another indicator is a prior history of shoulder tendonitis or bursitis as this would point to excessive stress on the rotator cuff over time.

Treatment can be conservative for some tears, including physical therapy to improve shoulder mobility and progressively strengthen the cuff muscles. However, the majority of tears will likely require surgery if function of the shoulder is to be restored. Rotator cuff surgery has come a long ways in recent years, with many surgeries being arthroscopic.

This is a minimally invasive technique where the surgeon inserts a camera and surgical tools through small incisions in the shoulder. The instruments are only about a centimeter in diameter and can burrow through layers of muscle on top of the rotator cuff, whereas in past years these muscles had to be cut, making for longer recovery times.

During thesurgery, the torn rotator cuff tendon will be sutured together. The surgeon will also clean away any bone spurs that may have contributed to a degenerative tear.

If the tear is complex or involves additional procedures such as tendon transfers due to excessive degeneration of the rotator cuff tendon, then the surgeon may need to open the shoulder with a slightly longer incision. It involves more cutting of shoulder musculature and may slightly lengthen recovery time; however, from time to time it is necessary.

Fortunately, most repairs will not require this technique.Recovery is generally a four to six month process, involving four phases:

  • Phase 1 (protection): Lasting from day one to four weeks, this stage of healing involves protecting the surgery. You will be required to wear a sling during most parts of the day. Gentle mobility exercises may be prescribed.
  • Phase 2 (passive motion): Lasting until the sixth week, you will be prescribed physical therapy and begin moving the shoulder with assistance within a prescribed range of motion.
  • Phase 3 (active motion): From weeks six through twelve, the focus will be on moving the arm and shoulder on your own, increasing the active range of motion.
  • Phase 4 (strengthening): You should have improved mobility at this time, allowing you to focus on building full strength and function of the arm.

Undergoing a rotator cuff repair can be a lengthy process. The amount of time that you will be required to be away from work will vary depending on the physical demands of your job. This will all be discussed in depth during pre-operative visits so that you may plan accordingly.

However, if surgery is recommended, you should not delay for long, as the torn tissue becomes weak and shortened over time, making a successful repair more difficult.If you are experiencing persistent shoulder pain, please feel free to contact my office to arrange a consultation.