Shoulder pain can be a real nightmare, especially if you get pain when trying to hang up the laundry, take off a jumper, or pick up the kettle to make a cup of tea. We rely on our shoulders and arms for almost everything in our daily life, and dealing with shoulder pain can severely limit our daily living. If you experience pain in your shoulder or upper arm, which worsens during overhead movements or heavy lifting, you may be suffering from a condition known as Rotator Cuff Tendinopathy.
Rotator cuff tendinopathy makes up 80% of shoulder pain in Australia, and can become a persistent and limiting problem, as it often does not resolve on its own. Studies have shown that up to 40% of sufferers can still experience pain up to 12 months later.
What is the rotator cuff?
The rotator cuff is a group of 4 muscles that start at the shoulder blade and attach onto the arm. There are three muscles that wrap around the back of the arm, and one that attaches on the front. As they wrap around the arm, the tendon of each muscle attaches onto bone and forms a protective cuff for the shoulder joint.
These muscles are important for maintaining stability and control, acting as the core muscles of the shoulder, while the larger muscles in your chest and back generate the force required to carry heavy objects or lift your arm above your head.
What happens to my shoulder in rotator cuff tendinopathy?
Rotator cuff tendinopathy develops as a result of an overload to the rotator cuff muscle and tendon group. Essentially, the muscles lack the capacity and fitness to perform the tasks required of them.
This condition can occur as a result of a one-off incident, such as from a moving lots of heavy furniture or a day of intense gardening. However, rotator cuff tendinopathy more commonly develops gradually over a period of several weeks, with no acute or traumatic incident.
What are the symptoms of rotator cuff tendinopathy?
People who have developed rotator cuff tendinopathy report having pain around the shoulder joint (front or back) and down the upper arm. The pain is often a dull aching sensation at rest, and will become sharp during certain movements involving the shoulder joint, such as carrying a heavy bag, hanging up the washing, pulling on a heavy door, or putting a jumper on/off.
In the milder forms of tendinopathy, patients will be able to tolerate most of their daily routine, but will experience pain during more demanding activities, such as swimming, throwing, and loaded shoulder work at the gym (push-ups, pull-ups, bench press, overhead press).
Patients may also find it painful to lift their arm above their head or to sleep on their affected side, and will occasionally wake up in the middle of the night after rolling onto their painful shoulder.
How do I treat my shoulder pain?
There have been numerous studies published so far that have found exercise and education to be the best form of treatment for rotator cuff tendinopathy.
The essential step in the recovery of this condition is to strengthen the muscles of the rotator cuff, to allow them to develop the strength and fitness they need to support the arm and perform functional tasks.
We know that all tendons hate change, so if you have a largely sedentary lifestyle, or havent been to the gym in 12 months, then returning to the gym and lifting 20kgs is likely to be too much change for the tendon and cause injury. Likewise doing some DIY such as painting the inside of your house, or even just a room might be way too much, particularly if you don’t do it regularly.
Therefore the first step in managing this condition is to understand which movements or activities are good for your shoulder, and which ones may be too aggravating in the short-term.
The key is to reduce the load on your shoulder initially, and slowly build up its capacity so it can tolerate everything you need it to do.
- Strengthening your shoulder
Tendons love being exercised in a slow and progressed manner. Start with low weight, and slowly build. Think about building up the weight over 12 or even 16 weeks, not 2 to 3 weeks. Strengthening a sore tendon may require pushing through a little bit of discomfort initially, just be cautious not to push too hard.
Start off with simple pushing/pulling movements, keeping your arm by your side to start with. Then slowly progress to movements with your arm higher up, to allow you to achieve pain-free movement and regain strength above your head.
- Supporting strategies
Treatment including manual therapy and massage will reduce pain and enable your shoulder muscles to function more efficiently, which allows you to progress your strengthening exercises and slowly get back to using your shoulder in day-to-day life. Other strategies such as using a heat pack and supporting the arm at night will also help to promote and support this strengthening phase.
- Trust the process
Symptoms will start to improve within a few weeks for most people, however the recent research recommends a 12-week period of strengthening in order to resolve a rotator cuff tendon problem. The most important thing you can do is to be patient and stay motivated! Our bodies are able to change and adapt dramatically, but we need to stay consistent, put in the work, and trust the process.
Shoulder pain can become a very restrictive and disabling condition, and is often one that doesn’t go away on its own. If you have been struggling with shoulder pain and not found much relief, find a great physiotherapist who can work with you to guide your path to recovery.
If you’re suffering with a painful shoulder you can book an appointment to see one of our Physiotherapists at Pathways Physiotherapy for a full assessment.