‘Trucker’s Shoulder’: A Repetitive Strain Injury

Repetitive strain injury

‘Trucker’s shoulder’ is an injury that we see a lot with drivers who come into our office. It’s an injury that creeps up on a long distance truck driver over time. Pain is one of the last symptoms to show up. Pain may be felt in your upper arm, hand or fingers, as well as your shoulder, and can be quite distracting or even debilitating.

Because the symptoms may vary and many medical providers don’t understand the nature of an OTR driver’s work, this condition is often misdiagnosed, and the prescribed treatment does not address the cause.


So what causes ‘trucker’s shoulder’?

Long distance truck drivers know that U.S. highways have a built-in pitch to the right for water run-off. What very few people realize, is just how much effort it takes a driver to counteract this pitch to keep a vehicle on the road. Added to this is a tractor’s design to pull to the right as a safety factor in case the driver falls asleep at the wheel. A long distance driver has to constantly correct or pull the truck to the left to keep the rig in its lane.


Left shoulder repetitive motion

How much effort does it take?
Let’s say the average driver corrects for this road pitch once every second. And let’s say he exerts only 4 ounces of effort to make that correction. A driver will make that correction with “pull” effort, a lot more than with “push” effort. Here’s why – you have about 13 muscles to facilitate the “pull” versus 3 muscles to facilitate the “push”. So what happens is you’ll tend to pull the steering wheel with your left arm and shoulder, rather than push with your right arm, because it’s easier and takes less effort. And you drive for hours repeating this motion – hence developing repetitive motion or repetitive strain injury.

Let’s look at the cumulative effect of this repetitive strain over just one 70-hour work-week.

  • 4 ounces of “pull”, times 60 seconds, equals 240 ounces or 15 lbs per minute
  • An hour later you have pulled 900 lbs
  • At the end of an 11 hour day of driving you have pulled 9,900 lbs
  • At the end of a 70 hour work week you have pulled 63,000 lbs with your left shoulder

And you’ve been driving for how many weeks, months, years?

It’s just amazing that your body can take such a beating and keep on going. Until one day, your left shoulder says “Enough!” and the pain shows up. And you wonder why the darn thing hurts?

The repetitive strain on your left shoulder muscles and the muscle imbalance of working the left shoulder and not the right, causes your body to try to protect the stressed soft tissues in the region. For protection, it builds adhesive fibers between the muscle layers. The problem with this is these adhesions bind the muscles and other soft tissues, such as nerves, and prevent them from moving freely.

This is what you eventually experience as pain and restricted range of motion. It can also start to cause pain to radiate into your upper arm and may cause numbness in your hand, usually the thumb and first two fingers. If you don’t deal with this problem it will soon lead to a series of other dysfunctions in your back, neck, and arms.


What can you do to take care of this repetitive injury problem?

1. Prevention

There are four things that set up ‘trucker’s shoulder’, but only one of them can be changed during your normal driving time.

The four things that cause repetitive strain injury are: 1) The frequency of the motion, how many times the same motion is repeated in a minute.  2) How much tension is created in the muscle groups during the action, muscle stress.  3)  How much strength does it take to do the motion or action.  4)  How often the working muscle group gets a rest from the given motion or action.

The one thing you can do to take preventative measures while driving is rest. But not what you normally think of as rest. In this case ‘rest’ means relax the working muscles. When one group of muscles are pushing or pulling the opposite group of muscles must relax to allow for the movement. So when you’re busy pulling on the steering wheel, one group is working and the others are not.

If you can remember to take your left hand off the steering wheel every fifteen to twenty minutes and do anything else with it, the working muscles think this is a rest period. Doc Kenn’s advice to drivers: “Left hand off the steering wheel, reach for the ceiling, reach for the floor, scratch you knees, your tummy and your nose”. A thirty second break from steering, with movement of any group of muscles other than the ones you steer with, is seen as a rest period for the steering muscles.

2. Treatment

If you’ve been driving for months or years on end without taking preventative measures then a therapy session will go a long way to relieve pain, increase range of motion and improve muscle strength. Remember, pain only shows up when you already have a problem.

Doc Kenn uses a specialized soft tissue therapy called “active release technique” to release the muscles and nerves and allow them to move freely again. Addressing the soft tissue injury is just the first step. The next step is for you, the patient, to correct the muscle imbalance so the injury does not recur. Doc will recommend ways for you to improve your biomechanics to better support the problem area.


We see drivers in our office who’ve had this problem for a long time and it gets worse and worse. They’ve heard all sorts of diagnoses, from bursitis to arthritis to torn rotator cuff to old age, and yet no-one has addressed the cause.

It’s so nice to see a happy driver, who after just one session of active release technique, is amazed to see the difference - “I’ve got my arm back and my shoulder doesn’t hurt any more!” Once they understand about ‘driver’s shoulder’ they start talking with other drivers and find that many others are experiencing the same problem. Now they know “why the darn thing hurts” and what they can do about it.

15 ResponsesLeave one →

  1. Clyde McKinney Sr

     /  August 23, 2014

    I’ve come to learn from my years of experience of driving
    is that raising and lowering landing gear can cause a
    great deal of pain to the shoulders arms back and
    wrist.

  2. Trucker Doc

     /  June 16, 2014

    @truckerforever
    Best bet is to follow-up with your orthopedist and neurologist, until they have solid answers about your present condition.

  3. truckerforever

     /  June 13, 2014

    I found your site question i am injured as a result of trl coupling. MRI of wrist says i have ganglion cyst. however the pain feels much worst and have lack of function in right wrist and hand. any advice

  4. Trucker Doc

     /  April 29, 2014

    @Texas Angel
    Usually, right shoulder pain is something other than “trucker’s shoulder”.
    Old injury with scar tissue and adhesions is the first thing that comes to mind. And with that in mind, if you drive a manual in the city all day long, then it could be from excessive shifting. Best bet is to have a qualified physician check it out for you.
    Google “active release technique” for medical practitioners who provide specialist therapy with such conditions.

  5. Texas Angel

     /  April 28, 2014

    Mine is in my right shoulder. Could that be from the shifting all the time? Mine hurts so bad some times that it wakes me out of a dead sleep.

  6. Trucker Doc

     /  August 22, 2013

    @Graeme
    Let’s start by saying that in most cases there is usually more than one thing causing your problem. These issues must be addressed before you can tell anyone what to do to fix you. Just think of the people that you have seen so far and still haven’t found the solution to your problem.
    There is usually one of four things going on, or some combination of those four things. Only a truly proper evaluation can give you the answer.
    I would recommend that you start with a professional who is trained in SFMA and have them evaluate your condition to determine what the issue is and then you can get the answer you are looking for. Just google “SFMA” and find a practitioner close to you.
    Hope this helps. Thanks for the question. Trucker Doc

  7. Trucker Doc

     /  August 22, 2013

    @Carlos
    Thanks for the kind words.
    I would have an ART practitioner take a look at the shoulder. [go to ART website http://www.activerelease.com/ for providers]
    Most of the pain that I see in the driving industry is soft tissue related and no one does better work with this type of pain that a good ART doctor.
    Thanks again. Trucker Doc

  8. Trucker Doc

     /  August 22, 2013

    @Brian
    The main thing is to get the left hand and arm off the steering wheel for thirty seconds or so and do that three or four times an hour to reduce the repetitive stress injury. Your body needs a break from driving about every fifteen minutes, so do what you’re doing and it should be a real help.
    If the symptoms persist, then find some one in your area that does active release – Go to http://www.activerelease.com/ to find out who is near you – and have them do some work to reduce the effects of this injury.
    Thanks for the question. Trucker Doc

  9. Graeme

     /  August 19, 2013

    I am a salesman and a baseball player in Canada. I throw with my left arm, and since I’ve started hitting the road more often and for longer periods, shoulder pain has developed over the last few years. I’ve seen pitching experts, chiropractors, RMTs, acupuncture…you name it.

    What can I tell my therapists to start a program to strengthen these muscles?

  10. Brian

     /  August 18, 2013

    I just learned from my doctor last Monday that the repetition is me keeping my left arm elevated on the arm rest or on the window. The only relief that I have found is in making a boxing motion for a couple of minutes with that arm and it seems to loosen things up.

  11. Carlos P.

     /  August 17, 2013

    Thanks the Help on Drivers shoulder injury, One Md wanted to do surgery and one no need it needs time to rest and heal. Along with getting up in age our body as a trucker has took a toll over the years now I just want to take life Easy ( Thanks )

  12. Astraist

     /  April 26, 2013

    I instruct advanced driving, both for the advent of safe road driving and of motorsports. I am particularly interested in your comment about:

    “you have about 13 muscles to facilitate the “pull” versus 3 muscles to facilitate the “push”. So what happens is you’ll tend to pull the steering wheel with your left arm and shoulder, rather than push with your right arm, because it’s easier and takes less effort.”

    This is intersting since I have also learned that pulling the wheel facilitates more muscles, notably in the arm itself (compared to the shoulder and core when pushing) and mainly the forearm muscles, allowing for a smoother and more accurate operation. My limited understanding of anantomy and biomechanics helped me appreciate this point, but I admit I never fully understood it.

    So, which muscles are being activated in each movement? Also, do these muscles work similarly if you pull from across the wheel, instead of simply pulling down? (by placing the hand across the torso and wheel)

  13. Trucker Doc

     /  January 25, 2013

    @Dennis
    Only if you are driving the truck using these cross members would this be a problem. Holding the wheel at the 10 o’clock and 2 o”clock position would require grasping the wheel and have nothing to do with the cross members.
    Shoulder, arm and hand related problems are caused by over utilization with no rest period during the driving cycle. This is a repetitive stress injury.
    If you are using the cross members and they are in the incorrect position, I would have any mechanic correct the steering wheel alignment. Thanks for the question. Trucker Doc

  14. Dennis

     /  January 20, 2013

    Dear Sirs,

    How would an off-centered steering wheel (one where the 2 cross members holding the wheel to the steering column are 10, 15, or 20% higher or lower than the prescribed 3 o’clock and 9 o’clock position) affect the shoulder, arm and hands during continuous long distance transport truck driving? Continuous written requests for repair to this defect failed to have the proper corrections made.

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