Recovering from an Injured Rotator Cuff
Rotator cuff injuries are a very common, often extremely unpleasant, debilitating sports and weight lifting related problem that can be caused by a number of factors. The rotator cuff is actually made up of 4 muscles and their associated tendons and the purpose of the ‘cuff’ is to allow for both a range of motion around the shoulder bone and the stability of the shoulder making it a very complex and crucially important set of muscles for a lot of physical activity.
Types of Rotator Cuff Injuries
Strain is really an encompassing term that’s used to describe varying degrees of injury to muscles and tendons. Very mild strain is what you experience after an intensive weights workout where you have micro-tears in the muscles and slight stretching. When those tears and stretching increase beyond our usual workout limit then an injury has occurred. When the muscles and tendons that make up the rotator cuff become strained and tear then we have a rotator cuff tear/strain.
A mild strain is one of the more common forms of rotator cuff injury, the least serious and the quickest to heal with just a few weeks rest.
Tendonitis is something I’m sure many of us are familiar with as it’s a common form of tendon injury in a variety of areas other than the rotator cuff. When the tendons of the rotator cuff become inflamed then this is tendonitis of the rotator cuff.
Tendonitis can vary from mild to quite serious depending on the circumstances surrounding the injury. It can take anything from 3 weeks to 6 months to heal fully depending on the severity.
Bursitis, like tendonitis is an inflammation of a soft tissue area. Specifically it’s where what’s called a bursa becomes inflamed. That’s a slippery area on the bone where a tendon passes over it to allow the tendon to glide over the bone easily. When this becomes inflamed it creates a lot of pain and friction under movement.
- Impingement Syndrome
The tendons pass through narrow spaces in our shoulder called the subacromial space. When that part of the tendon becomes inflamed it closes up that space, or “impinges” it and this causes pain and loss of strength.
- Partial Tears & Full Tears
As mentioned above when discussing strains we talked about how tears fall under the category of strains and can refer to tears of the tendon and/or muscle.
Listed below are some of the common causes for shoulder related injury but as our shoulders are such a complex mechanism that’s used for so many tasks there are many more causes of injury than what’s listed here.
- Heavy lifting in certain positions
We can go many years without noticing any problems but we could have been slowly degrading our rotator cuff over time with certain lifting techniques. See below for a section about which lifts to avoid.
- Physical trauma due to excessive force like falling.
- Repetitive motions. Specifically repetitive overhead motions.
- Reduced blood flow to the tendon from a variety of factors.
- Age. Our tendons become more fragile as we get older.
There are a large variety of symptoms that can indicate one of the rotator cuff injuries above. You should always seek to get a proper diagnosis from a qualified physician and not rely on a self-diagnosis, but the following is a list of typical symptoms associated with rotator cuff injuries.
- A constant and recurring pain in the shoulders. Especially when engaging in overhead activities.
- Discomfort when trying to sleep on the affected side.
- Muscle weakness. Particularly when lifting overhead.
- Limited motion.
- Clicking, cracking, grating or generally unusual sounds when the rotating the arm.
- A dull pain when at rest.
Fortunately even though there are a variety of different shoulder injuries that come under the heading of ‘rotator cuff injuries’ they all share very similar treatment options. The first approach for treatment should always be non-surgical. In most cases with the widely accepted non-surgical treatment options you will achieve decreased pain and symptoms from within the first two weeks and a complete recovery within four to twelve weeks.
For immediate relief it’s best to apply ice to the affected area for 15 to 20 minutes, remembering to place something between the ice and the skin such as a paper towel or a thin cloth. Pain free movement is encouraged to promote healing and prevent the area from becoming stiff. Rest is unfortunately going to have to be the primary method of healing which means you’ll have to take time away from your usual activities at the gym until the affected area is completely healed.
If you’re in a lot of pain and have particularly bad inflammation beyond the swelling reduction capabilities of ice then you can apply topical pain medications such as creams and patches or your physician might prescribe you nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce the swelling and associated pain from the swelling. You may also receive a corticosteroid injection in the most severe of cases.
Once the initial swelling and pain is under control you can look towards therapeutic massage treatment, which is an excellent option for accelerated healing but can be a costly option with treatments ranging from $50 to $150 and ideally two to three treatments a week up to 12 weeks total treatment time required. Most health insurance providers won’t cover the cost of therapeutic massage unfortunately.
Once you’re passed the worst stages of the injury you can start strengthening and stretching the rotator cuff to further increase healing and recovery. The following exercises below can be done using an elastic band or very light weights. It’s crucial that you rebuild the strength and flexibility in your rotator cuff prior to resuming your main weight lifting and sporting activities or you could cause another injury.
While leaning over and with bent hips, using a hard surface for support. Make easy movements in all directions with your arm. A very light weight can be used here and you should maintain the movement for 1 to 2 minutes.
With clasped hands, hold a cane or some sort of stick. Keep your knees bent and stretch your arms over your head. Repeat this 10 times.
While flat on your stomach on the edge of a chair or some other surface let your arm hang straight down. Bend your elbow while lifting your hand towards your armpit, squeezing the shoulder blade as you do it. A light weight may be used here. Perform 2 to 3 sets of 10 reps.
Prone Horizontal Abduction
Get in the same position as with the prone rowing except this time raise your arm straight out to the side so it becomes parallel to the ground and perpendicular to yourself. Your palm should face the floor at the top of the movement. Perform 2 to 3 sets of 10 reps.
Side Lying External Rotation
Lie on the opposite side of the affected shoulder and place a rolled up towel underneath your armpit. While keeping your elbow at your side, lift your forearm away from your abs. Let your hand down slowly while returning to the initial position. You can use a light weight here and should perform 2-3 sets of 10 reps.
Posterior Capsule Stretch
Grasp the elbow of the arm with the affected shoulder. Gently pull it across the chest so you stretch the back of the shoulder. Make sure to keep your shoulder depressed so you avoid pinching the front of the shoulder. Hold this for 10 to 30 seconds and repeat the exercise 3 times.
Remember you shouldn’t feel any significant pain while doing these exercises. If you feel a lot of discomfort then it may be too soon for you to begin with the exercises. Continue to rest and engage in basic pain free movement to keep the rotator cuff from stiffening up and seek advice from your medical practitioner about when you can safely start to perform the strengthening and stretching exercises above.
Exercises to Avoid when back at the Gym
Weight lifting in general when done properly is extremely effective at preventing a rotator cuff injury7. There’s a few movements that can make you more prone to injury and it’s advisable to avoid those if you want to maximize your chances of staying injury free.
- Pec Flies
Pec flies put a lot of strain on your rotator cuffs, particularly at the lower end of the movement. I advise to completely avoid doing these if you’ve had a rotator cuff injury and even if you haven’t it’s still advisable to avoid them. A lot of weight lifters swear by them and will insist that they work the inner chest, but there’s no scientific evidence that backs this up. Bench pressing will give you more than enough of a workout for your chest. Also be aware that pec flies on the machines are actually worse than with free weights due to the fact that your elbow points down instead of out when using the machine so it’s safest to leave the machine well alone.
- Behind the Neck Pulldowns
Pulldowns behind the neck put your shoulders in an unnatural position and causes unnecessary strain. It’s recommended that you pull down to the top of the chest instead. I also personally don’t do wide grip lat pulldowns as when I go heavy I get a rotator cuff related strain on my right arm. While I didn’t find any studies backing this up I’ve found that using a narrower grip and in particular a reverse grip I can go very heavy on the pulldown without any pain on my right shoulder. I did find a study that found that the lats are engaged to the same extent whether or not the palms are facing forward or reversed10. It also found that the ratio between lat usage and bicep usage is higher with the wide grip than it is for the close grip. In other words we use our lats more with the wide grip. What it didn’t prove is the widespread belief that a wide grip works your “outer lats”. So you’ll still be able to build big lats with a close grip.
- Out of Control Bench Pressing
Fast, bouncing movements with a weight that’s too heavy can put a strain on your rotator cuff at the lower end of the movement. If you’ve had a rotator cuff injury then be aware of that and make sure your bench pressing is slow and controlled.
- Lateral Raises
This movement can cause strain in susceptible individuals. For most people lateral raises are ok providing we don’t go too heavy and twist the pinkie up towards the ceiling when the arms are at shoulder height but if you’ve had a rotator cuff injury then you should either completely avoid lateral raises or stick with a nice light weight. A tip to help reduce strain is to turn the thumbs up 45 degrees when the arms are at shoulder height. The lateral deltoids(side shoulders) respond best to low weight, high rep movements anyway so this shouldn’t be too much of a hindrance at the gym.
Remember that it can take years for your shoulders to slowly degrade so even if you are currently doing some of these exercises above and haven’t had any problems thus far it does not mean you are immune. You could simply be biding your time before injury.
The main thing to remember when recovering from injury is to always take it easy and don’t push yourself too hard. Pain free movement and stretching are the key things to remember in the recovery phase and if in doubt about anything always seek advice from a qualified medical practitioner.
- UCLA Orthopedic Surgery (n.d.). Shoulder Rotator Cuff Tear. Retrieved December 10, 2011 from http://ortho.ucla.edu/body.cfm?id=161
- American Academy of Orthopedic Surgeons (n.d.). Rotator Cuff Tears: Surgical Treatment Options. Retrieved Dec 10, 2011 from http://orthoinfo.aaos.org/topic.cfm?topic=A00406
- Schuldt, Jill (2009, March 16) Conservative Treatment of Rotator Cuff Injuries to Avoid Surgical Repair Retrieved Dec 10, 2011 from http://www.pcc.edu/library/news/prize/conservative_treatment.pdf
- Marx, Robert, Koulouvaris, Panagiotis, Chu, Samuel, and Bruce, Levy, (2009, February 4). “Indications for Surgery in Clinical Outcome Studies of Rotator Cuff Repair.” Clinical Orthopedics & Related Research 467 Issue 2: 450-456.
- Cedars Sinai (n.d.). Rotator Cuff Tears. Retrieved Dec 10, 2011 from http://www.cedars-sinai.edu/Patients/Health-Conditions/Rotator-Cuff-Tears.aspx
- Tang Center at UC Berkely, University Health Services. (n.d.). Rotator Cuff Sprain and Strains. Retrieved Dec 10, 2011 from http://uhs.berkeley.edu/home/healthtopics/PDF%20Handouts/Rotator%20Cuff%20Sprain%20and%20Strains.pdf
- Goodwin, Sarah (n.d.). Free Weight Training Gets Workers With Rotator Cuff Injuries Back On The Job, Happy, After Surgery, Traditional Rehab Fails. The American Physiological Society. Retrieved Dec 10, 2011 from http://www.the-aps.org/press/journal/07/21.htm
- Mulrooney, Marie (2010, November 3). Bad Exercises for the Rotator Cuff. Livestrong. Retrieved Dec 10, 2011 from http://www.the-aps.org/press/journal/07/21.htm
- Beggs, Luke Allen (2011). Comparison of Muscle Activation and Kinematics During the Deadlift using a Double-Pronated and Overhand/Underhand Grip. Masters Theses. Paper 87. Retrieved Dec 10, 2011 from http://uknowledge.uky.edu/gradschool_theses/87/
- Lehman, GJ, Buchan, DD, Lundy, A, Myers, N, and Nalborczyk, A. (2004) Variations in muscle activation levels during traditional latissimus dorsi weight training exercises: An experimental study. Dynamic Medicine 3(4).