How to Wear a Shoulder Sling Correctly to Prevent Neck & Upper Back Pain

If you're reading this, chances are you or someone you care for is in a shoulder sling. Whether it's for a collarbone fracture, rotator cuff repair, a dislocation, or even an elbow or wrist injury, the sling can play a crucial role in supporting early healing. However, as a physiotherapist, I often see that the period of immobilisation, while sometimes necessary, can be the starting point for a secondary set of problems - most commonly in the neck and upper back.

This doesn't have to be an inevitable trade-off. In the video below, I walk through the subtle details of fitting a standard shoulder sling with a posture-first approach. The goal is to help you support your injury effectively while also protecting the surrounding areas from new aches and dysfunctions that could complicate your recovery later on.

The Core Principle: It Starts with Your Posture

The most common mistake I see is putting the sling on while standing in a relaxed, potentially slouched posture. The sling then locks this position in, and for weeks, the weight of your arm constantly pulls on the muscles of your neck and upper back. This can lead to significant stiffness and pain that feels entirely separate from your original injury.

Before you even put the sling on:

1. Consciously roll your shoulders back and down. Think about standing tall.
2. If your injury allows, you can use your other hand to passively position your affected arm so it is supported closer to the centre of your body, not pulled across your chest.

This "shoulders-back" posture is the foundation. The sling's job is to support and maintain this position, not to create it.

A Step-by-Step Guide to Fitting Your Sling

While sling designs vary, the principles remain the same. Follow these steps to apply your sling over that good postural base:

1. Prepare the Sling: Before you start, detangle all the straps. Having them stuck together makes the process much harder, especially when you're doing it one-handed.
2. Insert Your Hand First: Place your hand into the wrist cuff or the bottom of the sling first. Trying to put your elbow in first makes it very difficult to then get your hand positioned correctly.
3. Secure the Elbow: Slide your elbow back into the deepest part of the elbow cradle for solid support.
4. Attach the Straps Loosely: Connect the main body strap and the horizontal strap across your back loosely at first. Don't worry about tightness yet.
5. Fine-Tune the Position: This is the critical step. Ensure your shoulders are still back and your hand is resting near the centre of your chest, not over by your opposite shoulder. A hand pulled across the body encourages that rounded posture we want to avoid.
6. Secure and Check: Tighten the straps enough so the sling feels supportive and your arm feels comfortably cradled. When you relax your muscles, the supported position should not change.

For Elbow, Wrist, or Hand Injuries

If your sling is for an injury below the shoulder, an additional key point is elevation. Ensure your forearm and hand are positioned slightly above the level of your elbow to help minimise swelling in your hand and fingers.

Managing the Inevitable Stiffness: A Simple Self-Help Tool

Even with perfect sling posture, spending weeks in a supported position can lead to general stiffness in the upper back and neck. A fantastic way to manage this is with a simple self-massage tool.

Using a lacrosse ball or tennis ball, you can target the muscular tension in your upper back (on the non-injured side and carefully around the injured side, avoiding any surgical incisions).

• You can do this standing against a wall, sitting in a chair, or even lying on the floor - choose what feels safest and most comfortable for your injury.
• Place the ball between your back and the wall/floor and gently lean into it.
• Slowly manoeuvre to find spots that feel particularly tight or tender.
• When you find a stiff area, simply relax and let the pressure of the ball work for 30-60 seconds. There's no need to aggressively roll around.

This can be a great way to down-regulate discomfort, improve local tissue mobility, and make your time in the sling more tolerable. It's a proactive step to maintain what function you can during immobilisation.

The Goal: Smoother, More Efficient Recovery

Rehabilitation after a shoulder or arm injury can be a lengthy process. The thinking behind this detailed approach to sling fitting is to make that journey as efficient as possible. By optimising your posture in the sling, you are actively working to:

• Protect the Healing Tissues: A neutral, supported position may help minimise stress on surgical repairs or healing fractures.
• Prevent New Problems: By reducing strain on the neck and upper back, you might avoid a secondary layer of pain and stiffness that needs its own treatment later.
• Set a Stronger Foundation: When the time comes to start active rehab, your body is in a better starting position, potentially allowing you to focus solely on the original injury.

Remember, this information is a general guide. Your individual case may have specific requirements. Always prioritise the advice of your treating clinician, and use these tips to have a more informed conversation with them about your comfort and recovery.

– Grant

Need Personalised Guidance?

If you'd like help trying to uncover the underlying cause of your pain or dysfunction, consider booking an online Telehealth consultation with Grant here!