Shoulder season refers to the travel periods between peak and off-peak seasons, typically spring and fall for most destinations. For example, in Europe, peak = summer (June–August) , when there are crowds, high prices, and hot weather (though Europe seems to be experiencing especially hot weather this spring as well). Off-peak = winter (November–February), when fewer tourists, it’s cheaper, and some attractions are closed. So, the “Shoulder Season” = April–May and September–October, or the sweet spot for travel there. The appeal is you get better prices and fewer crowds than summer, but the weather and operating hours are still good. For somewhere like the Rhine or Switzerland, where we are going in September, shoulder season is considered the best time to visit. The light is beautiful, the roads are quieter, the trains are less crowded, and accommodations are meaningfully cheaper.
But this week I am discovering the drawbacks of shoulder season. Tomorrow I fly from San Diego to Dulles to spend a day visiting friends Ann & Russ (to be joined by Debbie & Jay) in Annapolis, then go for two days to visit my son Roger and his wife Valene on the Delaware shore, then drive up to Philadelphia to lunch with Cliff & Linda (more college friends), on my way to Ithaca to go to my 50th business school reunion, stay with cousins Pete & Nancy, see my daughter Carolyn and her brood (celebrity birthdays for husband John and daughter Charlotte as we go), and seeing some old fraternity friends who will be reunioning with their classmates. It’s quite an action-packed week of travel and here’s the thing…the shoulder season weather situation has meant that as I’ve tried to keep an eye on the vagaries of the local weather in three eastern locations for the specific days I will be traveling in each, I have been seasonally whipsawed just enough to make my packing an ongoing challenge. Needless to say, this has been made even more difficult by my newly reduced size and wardrobe revisions. I started off thinking that the safe approach for a grown man of my age was to just go with long pants and collared shirts and be done with it. But then there was a sailboat on the Chesapeake, a beach and boardwalk in Delaware and the prospect of a hot day on campus with lots of walking from the designated parking areas during a crowded reunion event. Shorts and casual wear were on my mind and that meant different shoes and related paraphernalia. I went through several repacks and even a few quick visits to the men’s clothing store.
Just when I thought I had it right and had squeezed in everything I needed, Kim came home with some gift purchases which she wanted me to take to the kids. Well, I explained that the only way that would fit in my bag is with yet another repack and the required elimination of something I had thought I needed. As it turns out, the shoulder season kicked in again with the temperatures seeming to favor long pants again rather than shorts. What was needed to make it all work was to lose the extra pair of low sneakers that I had planned to wear with shorts and stay with the one pair of multi-purpose shoes I would be wearing. That, and the elimination of several added T-shirts would give me the room I needed for the gifts. I have chosen to bias towards cooler weather long-pants and yet take a pair of shorts just in case of a heat wave, and make do with my one pair of shoes. Traveling and packing isn’t supposed to be this hard. It never was in my working days and when I didn’t care so much about my appearance. Now that I’m sporting a new look, it all seems to be more complicated…especially thanks to this whole shoulder season thing.
I feel like I’m in another form of shoulder season as well right now. There are three parts of the body that seem to give people my age problems (besides and in addition to the ever-present back issues everyone suffers to one degree or another). The biggest problem seems to be with knees. Knee pain afflicts nearly 37% of adults 65 and older. Roughly 1 in 3 people over 65 have meaningful knee pain, and the number climbs steeply with age. Approximately 700,000 total knee replacements are performed annually in the US. The average age of a knee replacement patient is 67.2 years old, and women account for 58.5% of all procedures. Projected annual US knee replacements are expected to reach 850,000 by 2030 and 1.4 million by 2040. Hip pain comes in second but is considerably less common, the global incidence of hip osteoarthritis is roughly 3% in the adult population, though broader hip pain (including bursitis, tendinitis, fractures) runs somewhat higher. Hip replacements run about 450,000–500,000 per year, meaningfully fewer than knees (roughly 30–35% less volume than knees). The average age for hip replacement is about 65, with women accounting for roughly 60% of cases, a nearly identical profile to knee replacement patients. Hip replacement projections estimate 4 million US procedures by 2030, reflecting similar demographic tailwinds as knees. Knees are more commonly problematic and more frequently replaced, but hip replacement tends to be a more satisfying surgical outcome when it’s needed.
And then there is the shoulder joint. Shoulder pain is quite common generally with roughly 20–30% of adults experiencing it at some point, but glenohumeral (joint) osteoarthritis specifically showing radiographic evidence in about 32.8% of individuals over 60, though far fewer have symptoms severe enough to consider surgery. Shoulder replacements are estimated at roughly 175,000–350,000 procedures annually, making it a distant third behind knee and hip. It’s roughly half the volume of hip replacement. But as the population ages, shoulders are the fastest-growing segment of the joint problem universe. Shoulder arthroplasty procedures increased 1,373% between 1997 and 2016, and overall utilization is projected to increase another 122% by 2040. The main driver is the reverse total shoulder replacement (rTSA), a newer design specifically for rotator cuff tear arthropathy that has expanded the eligible patient pool significantly. rTSA surpassed anatomic shoulder replacement in procedure volume in 2014 and continues to grow at roughly 22% annually vs. 7% for the traditional design. Shoulder replacement surgery is less often about simple wear-and-tear and more often about rotator cuff failure combined with arthritis. That makes the surgical decision more complex and the patient population somewhat different.
Among my joints I always worried most about my knees, but they have both held up well and compared to many, mine are in great shape (strange, given the abuse I have inflicted on them…). Whatever hip issues I have had have been minor and have been largely sorted out by Stretch-U and the piriformis muscle stretching I do twice weekly. So that leaves the shoulders. While I’ve played my share of racket sports, I never figured to have shoulder problems and whatever aches and pains seem within the range of those weekly Stretch-U sessions. But side-sleepers like me are always messing with their shoulder joints. And add motorcycle riding to the equation and bingo…shoulder discomfort. Notice I call it discomfort rather than pain because I doubt it qualifies to be on Wong-Baker smiley-to-grimace pain index. But it bothers me enough that in conjunction with my recent hand dysfunction, I have tasked my trainer to focus on the upper body and back for the time being to help sort this out better. We use the stretch bands and all manner of floor calisthenics involving the arms and it all seems to make a difference.
Ecclesiastes (Old Testament) says, “To every thing there is a season, and a time to every purpose under the heaven.” The passage is essentially that life moves in cycles and human striving can’t alter the underlying rhythm of things. If you missed Sunday School, The Byrds said it again through Pete Seeger’s song “Turn! Turn! Turn!” adapting the text almost verbatim from Ecclesiastes. The shoulder is a ball joint, so how appropriate to think of time in cyclical terms where seasons, generations, and human fortunes repeat endlessly. Ecclesiastes uses it to argue for humility and presence, since striving against the seasons is futile, so go forth into the shoulder season and get on with it.