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Dr. Dan Richmond M.D.
Orthopaedic Surgeon: Sports Medicine Specialist
Certified NRA Pistol Instructor
Range Safety Officer
Orthopaedic Surgeon: Sports Medicine Specialist
Certified NRA Pistol Instructor
Range Safety Officer
| Graphics and pictures below to assist you in shooting exercises. |
| More: Orthpaedic Info |
Over the past few years there has been rise in gun ownership and a surge in popularity of all types of shooting sports. As with all types of new physical activities people can sometimes experience the aches and pains associated with overuse. Overuse injuries in shooting, as with any other sport, occur when you do too much, too soon relative to your level of conditioning. Whether breaking clays with your 12 gauge shotgun, practicing for competitive pistol shooting, or just plinking at the range all day, shooters can experience overuse symptoms. These symptoms usually affect the muscles and joints in the upper extremity from the hand and forearm to the shoulder and neck. There are several factors which contribute to musculoskeletal pain in shooting enthusiasts including improper gun selection and fit, improper shooting technique, or the presence of underlying orthopaedic conditions. Fortunately these symptoms are often preventable and usually very easily treated with simple exercises. Why can shooting lead to musculoskeletal symptoms? Well any time any firearm is fired there is a creation of energy which projects the bullet forward. Laws of physics tell us that any time energy or momentum is created in one direction there is an equal amount created in the opposite direction. This backward momentum is called recoil and it equals the forward momentum of the projectile. When shooting non mounted firearms, this momentum is in partly absorbed by the body. What parts of the upper extremities are commonly affected by repetitive shooting? Well this depends on what are you shooting. With long guns the recoil or kick is felt typically in the shoulder area since the butt of the stock is supported by the shoulder. These contusion type injuries usually result in soreness to the muscles in the front part of the shoulder. These problems are common with shotgunners who participate in clay sports simply due to the number of rounds that are shot. There are some factors specific to the type of shotgun and the ammo which can affect the perceived recoil. This is very important in the decision of what type of gun to use. The first thing to consider is the overall size and gauge of the gun. The load of a larger gauge will generate more energy, but on the other hand a heavier gun will help absorb the backwards force of the shot. It is wise to determine if you are physically strong enough to feel comfortable with supporting and absorbing recoil of a particular shotgun. Many shotguns, and rifles for that matter, have built recoil reduction systems or gel pads to lessen the kick. Pads can also be worn on clothing to absorb some of the recoil. Autoloading shotguns also can have less recoil than break open guns. Finally and maybe most important are proper gun mount and positioning. The shooter should have a comfortable well balanced stance with a slight forward lean and the gun should be held in a comfortable position. The butt of the stock needs to brought into in the natural pocket of the anterior shoulder muscles and not on the upper arm itself. The cheek also needs to be positioned properly against the comb to help stabilize the stock. The gun should be held in a comfortable position. Proper gun fit is an essential part of mounting a shotgun properly and minimizing repetitive trauma associated with recoil. Shooting a shotgun with a stock that is too long can result in the butt being positioned in the upper arm area. This part of the shoulder is not suited to absorb recoil and can lead to contusion injury. Shooting a shotgun with a stock that is too short can lead to the butt of the stock not being firmly positioned against shoulder which will cause the butt to repetitively strike the shoulder. A proper mount with a tight fit of the butt against the natural pocket of muscles in the shoulder with prevent this. Finally proper ammo selection is also important. A heavier ammo load will increase recoil so if you are spending the day shooting clays use the lighter target loads not the heavier magnum or game loads. Although shooting per se is usually not thought to cause rotator cuff injuries, rotator cuff problems are common in people over forty years old and this can influence their ability to shoot. The rotator cuff consists of four tendons that insert next to and cover the ball part of the shoulder called the humeral head. These tendons arise from muscles and their function is to help stabilize the shoulder joint and assist the larger muscles like the deltoids and pecs to move the shoulder properly. The rotator cuff can be acutely injured in the form of a strain with repetitive lifting or overhead use. The cuff tendons can be fully or partially torn with a more significant injury such as a fall. Bursitis or “impingement syndrome” can occur when the rotator cuff muscles are weak and don’t function properly leading to a pinching of the rotator cuff and bursal tissue on bone spurs with repetitive activities or overhead activities. Arthritis, which is a degenerative condition of the joint cartilage, can also occur in the shoulder. These painful conditions can be made worse with repetitive shooting. Recoil can aggravate conditions of the dominant side shoulder. On the other hand, a shotgunner with problems in the opposite side shoulder can have discomfort during gun mounting, swing and support of the shotgun. Patients with offhand problems should consider shooting lighter guns because they are easier to support. Shoulder problems can often be prevented by maintaining shoulder strength with the properly performed shoulder exercises. The treatment of mild shoulder pain due to inflammation secondary to bursitis or arthritis generally consists of a short period of rest, ice, and over the counter anti-inflammatory medications such as Advil or Aleve. After the initial inflammation decreases it is very important to gradually strengthen the muscles around the shoulder with exercises using light weights or an exercise band. If symptoms persist it is recommended that you consult your physician who may obtain x-rays, start formal physical therapy or even give you a cortisone injection. In some cases which are slow to improve an MRI can be obtained and arthroscopic surgery may be indicated. If surgery is necessary it may be at least 3-6 months before full shooting activities can be resumed. Therefore once again, the best treatment is prevention in the form of simple strengthening and stretching exercises. This conditioning will allow you to get the most out of shooting. Pistol shooters can also experience overuse problems. Although the guns are usually lighter and associated with less recoil, the shooter does not support the stock against his or her body, but has to support the gun with their hands around the grip of the pistol. With pistol shooting, injury is not purely caused by the absorbed recoil, but by the forearm and hand muscles attempt to maintain the grip and control the recoil. This repetitive tight gripping initially causes strain to the muscles in the hand and forearms. Once again stretching and strengthening of the muscles can prevent overuse injuries to these muscles. This is done by grabbing your hand with the other and flexing and extending the wrist maximally. This will stretch the forearm muscles. Strengthening exercises can be performed with light weights, with a grip device, or even a tennis ball. Proper gun fit, shooting technique and shooting a gun appropriate to the shooters level of strength and conditioning are also very important in minimizing overuse problems. One of the first steps in choosing a pistol is finding one that feels comfortable in your hand. An inherently comfortable grip is based on finding a pistol that fits the size and shape of your hand. Utilizing the proper grip technique is important for several reasons. Firstly, improper technique can lead to acute injury from the slide in a semi-automatic pistol or from the expelled gasses in a revolver. Secondly proper grip allows the shooter to control recoil in the most efficient manner and minimize stresses on the joints and tendons in the hand and wrist. Choosing a gun of a caliber that is appropriate to the shooters strength and conditioning is also important. A heavy framed gun will help absorb recoil, however it is important that the shooter is strong enough to properly grip and support the gun. Once again overuse problems arise from the cumulative effects of shooting. Even with the properly fitted gun and proper technique, it is still possible to overdo it. So it is important maintain strong upper extremity muscles and gradually increase the amount rounds shot at a caliber that you are comfortable with. It is important to let pain be your guide. If your develop pain then take a break and stretch out your forearm muscles. It is also important to drink plenty of water on the range as muscles can cramp when they are dehydrated. If you develop soreness in your arms and it is persisting or getting worse, then it is time to stop. Failure to listen to your body can lead to strain injuries becoming more serious and developing into tendonitis or epicondylitis. Tendonitis is an inflammation of the tendons and can occur in the hands or around the wrist. Epicondylitis results from inflammation and injury to origin of the forearm muscles near the elbow. Commonly known as “tennis elbow”, lateral epicondylitis can occur with more chronic injury to the forearm muscles that extend the wrist. “Golfers elbow” occurs at the medial epicondyle and is associated with chronic overuse of the forearm muscles that flex the wrist. These tendon injuries can take longer to resolve. Treatment generally includes a period of activity restriction in which activity is kept under the pain threshold. Another ways to say this is, “if it hurts don’t do it”. Part of the activity which may contribute to persistent tendon pain is carrying heavy objects by grasping them. Around the range this may mean heavy ammo boxes or range bags. In addition to activity restriction, ice, anti-inflammatory medications, cortisone injections and formal physical therapy may be indicated. Although rarely necessary, if these problems persist for several months, there are surgical treatment options as well. In addition to injuries that may develop with shooting activities, people can develop degenerative arthritic problems in the hands and wrist as they get older. These underlying problems may force an older shooter to use lighter ammo loads or switch to a less powerful caliber pistol in order to reduce recoil and minimize aggravation of these conditions. As shooters we are all taught and hopefully strictly adhere to rules of gun safety to prevent injury from and accidental discharge of a firearm. What we are not typically taught is how to minimize and treat overuse problems from the routine and planned discharge of our firearms that can occur with repetitive shooting. Following the guidelines of proper gun selection, gun fit and shooting technique, as well as, maintaining good strength and flexibility is important to minimize overuse. However keep in mind that everyone can overdo it, so listen to your body and let pain be your guide as to when to take a break. Finally if symptoms persist, it is important get an orthopedic evaluation as there may be a simple treatment or modification that can help you get back in action. |
