Author: Dr. Spencer Lindholm
Anyone who has suffered a shoulder injury can tell you that they are not fun to deal with and (if left untreated) tend to linger far longer than most other injuries. The most common classification of shoulder injury seen with strength and conditioning is shoulder tendinopathy. This can involve any of the muscles that encompass the shoulder joint complex, but most commonly involved are the biceps tendon and rotator cuff tendon.
There are several sub-classifications of tendinopathy including tendinitis and tendinosis. Tendinitis refers to an acute tendon injury which is accompanied by inflammation. Tendinosis refers to a chronic tendon injury with degeneration at the cellular level and not accompanied by inflammation. If left untreated, shoulder tendinopathy can often lead to a tear of the involved tendon as well as degenerative calcific tendinosis with various factors leading to this slow progressive change. The most common cause of shoulder injury is the result of repeated overuse, or micro-trauma. Shoulder injuries typically do not occur as a result of one trauma, as many assume. The more severe and more frequent injury occurs directly affects the resulting progression, worsening and degeneration.
Four separate muscles make up the rotator cuff group in the shoulder. Rotator cuff injuries commonly result from poor mechanics/movement in the shoulder and overall weakness. Injury to this group often causes local swelling, tenderness and pain on the top, side, and back of the shoulder. Pain and stiffness is common when lifting your arm. Over time, overuse and minor rotator cuff injuries can lead to tears or even degenerative changes leading to rupture or tearing of the muscle or tendon. Bicipital tendinopathy commonly occurs as a result of rapid and repetitive eccentric (lengthening) loading of the biceps causing increased tension and strain on the proximal tendon where it attaches at the shoulder. This can occur from high repetition pull-ups with poor technique as well as progressing too quickly with the olympic lifts, namely snatches, which places the biceps tendon under an enormous amount of tension in the overhead position.
Shoulder tendonitis commonly involves the following symptoms:
- Shoulder clicking when your arm is about shoulder height
- Shoulder and upper arm pain when lifting
- Shoulder pain when lifting something with a straight arm
- Shoulder pain or clicking when your hand is behind your back or head
Degenerative calcific tendinosis commonly involves:
- Calcium deposits formed in the tendons
- Repetitive injury over time along with normal wear and tear
- Lack of oxygen and blood flow to the injured tissues
- Pressure on the tendons
In many cases, torn shoulder tendons begin by fraying. As the damage progresses, the weakened tendon can completely tear. This can happen without even lifting a heavy object. This makes early intervention and treatment of shoulder injuries that much more crucial. There are different types of tears. The more common type of tear is a partial tear, which is an incomplete tear and results in significant damage to the tendon, but does not completely sever it. A full-thickness tear is also called a complete tear. This involves separating the tendon from the bone. With a full-thickness tear surgery is usually required to repair the torn tissue.
- Rub and roll to increase blood flow and oxygen as well as break up any myofascial adhesions
- Stretch the tightened/affected tissues
- Cross-over symmetry or comparable banded resistance exercises
Professional treatment options:
- Physical therapy
- Orthopedic medicine
The bottom-line: Most shoulder injuries are not benign or nothing to worry about. Especially if the symptoms started slowly and have progressed. Depending on the severity of the injury, most can be resolved with RICE (Rest, Ice, Compression, Elevation) and a combination of the self-treatment options listed above. Professional treatment is always recommended, and the techniques used to treat injuries of this nature can vary widely. However, the most common professions that deal with musculoskeletal and sports-based injuries are listed above. Addressing deficiencies and weaknesses as soon as they are identified as the best preventative measure as well as focusing on proper mobility required for the movements in your program. If you do suffer a shoulder injury, begin treatment immediately and don’t just brush it off and expect it to go away on its own. Early intervention is key with all injuries, but you’ll be especially happy that you took care of that shoulder injury before it turned into a chronic and nagging problem.