Shouldering the Burden
Of all the joints in my body associated with the dreaded RA flare, by far, the most painful for me, are my shoulders. When I first stared exhibiting symptoms of RA, over 20 years ago now, I remember thinking that I would sell my soul if only my shoulders would stop hurting. I was unable to wash my hair, let alone brush or comb or style it. I could barely lift my fork to eat, let alone cook or clean. I could barely type on the computer, let alone do other work-related tasks. I could not even hug my family members which may have been the cruelest of all at a time when that support and love meant the most. I think that is why when I get even the slightest twinge in my shoulder(s) to this day, it is often accompanied by anxiety and panic at the mere thought of what is in store if a full-blown flare develops.
RA shoulder pain
I recently mentioned this to my rheumatologist and he admitted that shoulder flare pain is the most stubborn to treat because there are so many joints within the shoulder and directing the treatment can be difficult at best. I am not a good candidate for prescription pain medications for relief as they do not agree with me systemically. So, I have to rely on OTC medications and homeopathic treatments like heat and massage. They generally work to a degree, but when my shoulders are in full flare mode, there is nothing that gives me significant relief. To make matters worse, sleeping with shoulder pain is essentially impossible. No matter how you attempt to assume a sleep posture, the shoulder is impacted. Therefore, when said shoulder is painful, sleep alludes you. If I am lucky, I might get an hour of uninterrupted sleep when I have shoulder pain. Generally, that is not the case. I just have to wait out the flare and hope I do not lose my mind in the meantime.
Some ways to avoid shoulder flares
So, over the years I have figured out a few things that have helped me to avoid shoulder flares as much as possible within the context of the chaos of RA. First of all, I am exceptionally tuned in to the sensations in my shoulders these days. What I mean by that is every morning and throughout the day, I do some level of range of motion in my shoulders to “check in” and see how they are doing. If I even feel the slightest bit of pre-pain (fatigue or stiffness) I scale back on any activity that might involve the use of my shoulders.
In addition, I have a list of movements I can no longer do that are sure to trigger shoulder pain. Some are obvious, like shoveling, while others were not so easy to determine. For instance, I can not carry grocery bags at my side anymore. I have to carry them from underneath. If I forget and carry a bag by it’s handles, at my side, I pay a price within a few hours! To this day, I still forget and sometimes lift bags that way only to pay a stiff fine later. I think it is because it is hard to remember not to do something when there is no pain in the joint in that moment. But it is a habit I continue to try to nurture.
I also believe that strengthening the muscles and tendons in my shoulders has helped me a great deal. The trick there is doing it in such a way that you do not bring on the very pain you are trying to prevent. I cannot, under any circumstances, do strength training exercises in the traditional way. But I can do them in the water, a joint neutral environment. I do 15 different strength training exercises in the water with aqua weights and I have no doubt it has helped to strengthen my shoulder muscles, tendons, etc. providing support to the joints.
I am also a firm believer in massage. I go to an amazing therapist who uses hot stones and is very in tune with how to massage RA patients. She is a blessing I am most grateful for.
If we manage what we can with regard to our shoulders we can lessen the burden to them and hopefully have fewer shoulder flares in the future.