You may not realize how often you use your shoulder until you begin feeling pain. When simple tasks like reaching up into a cupboard, brushing your hair, or reaching over to fasten your seat belt cause you pain, it begins to affect your daily life. And for athletes, the pain can put a quick stop to your training program.
Issues with the rotator cuff and tissues that surround it are the most common causes of shoulder pain in people over the age of 40. Rotator cuff tendinitis occurs when a shoulder tendon (a bundle of fibers connecting muscle to bone) is irritated and becomes sore. With continued irritation, the tendon can begin to break down, causing tendinosis, which is a more chronic condition. Every time you move your shoulder you’re using your rotator cuff to stabilize and help move the joint. People who perform repetitive or overhead arm movements, such as weight lifters, athletes, and manual laborers, are most at risk for developing issues within their rotator cuff.
How does it feel to have tendonitis in your rotator cuff?
Typically you’ll experience shoulder pain that can occur gradually over time or start quite suddenly. The pain occurs in the shoulder area and can radiate into your upper arm. It doesn’t usually go past the elbow region, however, in some cases it can. You may not experience any pain or discomfort when you’re at rest, but once you move the arm the pain can be moderate to severe. Reaching behind your body or doing overhead activities, such as throwing, swimming, reaching into a cabinet, or combing your hair can be very painful. The pain can get worse at night, especially when rolling over or sleeping on the painful side. If the condition is left untreated, it could get worse and the pain could move to other parts of the body, such as your neck.
Doing proper exercises can help to avoid a rotator cuff injury because it’s possible for your shoulder to become inflamed pretty quickly. Many people with rotator cuff issues can manage their symptoms and return to daily activities with physical therapy exercises that improve flexibility and strength of the muscles surrounding the shoulder joint.
Our team has put together a series of rotator cuff exercises that you can do a few times each week to strengthen the shoulder region and avoid pain and injury.
How is a rotator cuff injury diagnosed?
A physical therapist can assess your pain by performing an evaluation (you may even be eligible for a free consultation, call and ask for details), which may include strength and motion tests on your shoulder. They’ll talk about your job duties and hobbies, evaluate your posture, and check for any muscle imbalances and weakness that can occur in the shoulder region. Your physical therapist will then gently touch your shoulder in specific areas to determine which tendon(s) are inflamed, and may perform other special tests to detect rotator cuff tendinopathy. Generally, a physical examination is all that’s needed to diagnose rotator cuff tendinopathy. If the symptoms do not resolve with physical therapy, imaging (eg, MRI) may be considered, to help determine any possible underlying condition that could be affecting the shoulder.
How can a physical therapist help with rotator cuff pain?
It’s important to get proper treatment for tendinitis as soon as it occurs because over time, a degenerated tendon that is not treated can begin to tear, leading to a more serious condition. Physical therapy can be very successful in treating rotator cuff tendinitis, tendinosis, and shoulder impingement syndrome. Depending on your specific condition and goals, your personal treatment program may include:
Pain management. Your physical therapist will help you identify and avoid painful movements to allow the inflamed tendon to heal. Ice, massage, or moist heat may be applied for pain management.
Patient education. Posture education is an important part of rehabilitation. For example, if you sit at a computer all day you may have a tendency to roll your shoulders forward, causing the tendons in the front of the shoulder to become pinched. We may suggest adjustments to your workstation and work habits to reduce the discomfort. We may also go over certain sitting, standing, and sleeping positions to help alleviate symptoms. Finally, your physical therapist may suggest different ways to perform currently painful activities and show you movements to avoid while you’re experiencing shoulder pain.
Manual therapy. Your physical therapist may use manual techniques, such as gentle joint movements, soft-tissue massage, and shoulder stretches, to get your shoulder moving in a manner which is pain-free.
Range-of-motion exercises. You will learn exercises and stretches to help your shoulder and shoulder blade move properly, so you can return to reaching and lifting without pain.
Strengthening exercises. Your physical therapist will determine which strengthening exercises are right for you, depending on your specific condition. You may use weights, medicine balls, resistance bands, and other types of resistance training to challenge your weaker muscles. You will receive a home-exercise program, so you can continue rotator-cuff and shoulder-blade strengthening long after you have completed your formal physical therapy.
Functional training. As your symptoms improve, your physical therapist will help you return to your previous level of function, which may include household chores, job duties, and sports-related activities. Functional training can include working on lifting a glass into a cupboard or throwing a ball using proper shoulder mechanics. Speak with your physical therapist so they know what your goals are, and can get you back to your prior level of functioning as soon as possible.
Can a rotator cuff injury be prevented?
The likelihood of developing rotator cuff tendinopathy can be reduced by:
- Being aware of repetitive movements that may lead to pain—especially over your head, across your body, or behind your back—and modifying your activity if there are any symptoms of discomfort.
- Maintaining ideal shoulder and spinal posture during daily activities, including sitting at a computer. This can be accomplished by performing daily stretches to the shoulder and upper back to maintain normal movement. Tightness in the upper back, or a rounded shoulder posture will decrease the ability to move your torso, and that makes the shoulder have to work harder to perform everyday activities, such as reaching for objects.
- Keeping your upper body strong, including the upper back and shoulder-blade muscles, will help prevent tendinitis. Many people work the muscles in their chest, arms, and shoulders, but it is also important to work the muscles around the shoulder blade and upper back. These muscles provide a strong foundation for your shoulder function. Without a strong foundation, muscle imbalances occur and put the shoulder at risk for injury.
If you have any questions about a rotator cuff injury or shoulder pain, feel free to contact us. You may be eligible for a free consultation where you’ll meet one-on-one with a physical therapist to discuss your concerns.
Northern Physical Therapy is part of the Ivy Rehab Network, learn more at www.ivyrehab.com.