Shoulder, back problems a result of compensation?

By Dr. John Aronen

Dr. John Aronen dispenses advice at the nationals. He developed non-reversible changes to his left shoulder and low back due to his attempt to compensate for the pain and loss of motion he experienced from his arthritic right hip.

The Houston nationals marked the 22nd year of existence of the USHA Sports Medicine Team. For myself, Ray Chronister and Kevin Regan, it has been a most rewarding and memorable relationship.

Over these years, the vast majority of the players–in fact, 100 percent!–seem to have aged somewhat, with many of them suffering ailments common to aging athletes.

As with a car or a dog, as we get older parts start to wear out. The knee is the joint most likely to give players problems, followed by the hip and shoulder.

With some players, the wear and tear simply comes on as a result of the stresses placed on their joints by playing handball–a weight-bearing activity that requires upper-extremity involvement.

Many players participated in other athletic activities like football and basketball in high school or college before becoming involved in handball. Many brought a previous injury, most frequently to one or both of their knees, into the court. In this group, the combination of a previous knee injury followed by an active career in handball simply hastens the wear and tear on the knee.

Routinely at the nationals or in phone calls, players ask me if I still play handball, which I don’t because of an arthritic back and left shoulder. Though I never had a significant injury to my back or shoulder, I did have an interruption of the blood supply to my right hip at the age of 7 that resulted in non-reversible changes in the hip. Thus, at 7, I had to face the reality that my hip would only worsen in time, especially with weight-bearing activities.

I was already a seasoned swimmer at that age, so swimming, a non-weight-bearing sport, remained my primary sport through grade school, high school and college.

It was in high school when my future father-in-law introduced me to handball, a sport that was not only fun to play but also good for conditioning. Though I was aware that if I continued to participate in handball my hip would worsen more quickly than if I restricted my activities solely to swimming, the lure of the court and the camaraderie associated with handball was much more appealing than watching the bottom of the pool.

As I continued to play, the pain in my right hip gradually increased as the motion gradually decreased. Soon it got to a point where I would attempt to find ways to shoot that would result in the least discomfort in my hip.

I was compensating for my hip, and in doing so I used my lower back incorrectly and shot with my left shoulder incorrectly. I realized at the time that if I continued to compensate for my hip, I might develop non-reversible changes in my low back and left shoulder.

Rather than do the smart thing–stick to swimming only–I kept trying to play handball until I could play only right-side doubles once a week and required narcotics to sleep that evening. At 35, my low back and left shoulder bothered me as much as my hip.

Unfortunately, simply stopping handball did not alleviate the pain, for I had developed the non-reversible changes to these three areas to a significant degree.

Five years after I quit handball, I had a total right hip replacement. Though the operation resulted in a pain-free hip with full motion, I was unable to return to handball because of my chronic low back and left shoulder pain.

Handball is similar to tennis. The proper method of playing is to use the entire body–first get to the ball to properly position yourself to shoot, and then shoot with the entire body in one smooth motion, resulting in minimal stress on the shoulder and back. Players run into problems one of two ways.

The vast majority of handball players would rather play handball than spend the valuable time they could be on the court running or riding a bicycle to condition their legs. The ones who pay the price for this lack of adequate conditioning of their legs typically note the onset of sore shoulders or low back pain with tournament play, where they play harder and longer.

Years ago, Fred Lewis said, “When your legs go, your game goes.”

Thus, in many of these cases, the shoulder and low back problems are avoidable. These players end up shooting incorrectly simply due to lack of adequate conditioning of their legs.

Try staying up with Alan Sherrill, who rides his bicycle about 60 miles a week or more, in the court for a two-hour match. He and Jim Smith don’t outshoot their opponents at the national three-wall tournament each year. They outlast them by returning everything due to their superb conditioning, especially of their legs.

The moral of the story for these players is to get your legs and yourself in shape for the rigors of tournament play. You must get to the ball and properly position yourself to shoot with your entire body to avoid shoulder or low back problems.

Players who bring an old knee injury into the court or develop wear-and-tear changes to their knees or hips from the stress of handball will eventually be forced to compensate due to the discomfort experienced. Their altered style of play repeatedly places abnormal stresses on their shoulders and low back.

These are the individuals who are difficult to deal with medically, for even if their shoulder or low back problem can be managed successfully, as soon as they return to the court they will once again abuse their bodies with forced compensation. So the cause of the problem–the arthritic knee or hip–has not been addressed.

Obviously, the lucky players are the ones who have healthy wheels that are not adequately conditioned and shoulders and low back free from non-reversible problems, for all they need to do is get their legs in shape, strengthen their shoulder muscles, incorporate low back strengthening and stretching exercises into their daily routine and, in many cases, lose some of the excess baggage they’re carrying around the court. I don’t have to name the players who are, shall we say, a bit overweight, for you know who you are.

The players with arthritic (worn out or getting there) knees or hips need to realize that their bad knees or hips are the cause of their shoulder or low back problem. Thus, they will continue to have shoulder or low back problems until the cause of the problem–the worn-out knee or hip–is medically addressed.

Hopefully they will get a total knee or hip replacement before they develop non-reversible changes to their shoulders or lower back so they can return to the court without recurrent problems. While you are rehabilitating your new knee or hip, your reversible shoulder or lower back problem can be treated by your physical therapist and physician.

Why are players who are candidates for a knee or hip replacement reluctant to have the surgery? I don’t know. An excuse I routinely hear is, “I’m only 50, and the knee or hip replacement is only good for about 15 years, so I’ll need to have another replacement when I’m 65.” My answer: “If you have a slip of paper that guarantees that you’re going to live to be 65, let me know where you got it because I’d like to have that guarantee also.”

If you fall into this category and are considering a knee or hip replacement, why wait? All that can be done for you–such as medications, injections or having the knee surgically cleaned out–will only make you a little better for a short period of time.

Players who do get knee or hip replacements before developing non-reversible problems with their shoulders or low back are able to return to the court pain-free with no need to compensate. Don’t wait until you develop such severe problems. Remember, it is always best to do as I say and not as I do or did.

I encourage all players with knee or hip problems that are forcing them to compensate on the court to call me. We can discuss your future in handball, placing emphasis on your being able to continue to play The Perfect Game.

You can call me at 858-485-9488. Please don’t call before 9 a.m. Pacific time. If I’m not here, leave a short message stating your phone number clearly and slowly, and I’ll return your call.