Shoulder Pain and the Rotator Cuff

By: Dr. Rick Weinstein MD

As we get older (more mature), it is very common to develop shoulder pain. Pain may be due to specific trauma, such as lifting weights or directly hitting the shoulder, but it is much more common to develop pain without a specific injury. The most common reason for shoulder pain in adults older than 30 is due to impingement. The acromion bone, which sits on top of the shoulder, can irritate the bursa and then rub against the rotator cuff, causing impingement syndrome. This causes the development of rotator cuff tendinitis or bursitis which causes pain, typically when reaching the arm overhead. If the bursitis and tendonitis persists, this may lead to a tear of the rotator cuff.

The rotator cuff consists of 4 muscles that allow us to rotate our shoulder. The most commonly torn and injured part of the rotator cuff is the supraspinatus tendon, which sits on top of the other tendons. The problem with a tear of the rotator cuff is that if there is a complete tear it will never heal. My goal as a sports medicine orthopedist is to correct the problem in the shoulder before my patients require any surgery. Almost all patients can get back to normal activities with appropriate physical therapy and avoidance of aggravating activities.

How do we prevent shoulder problems to begin with? Typically, when we work out, we stress the large muscles around the shoulder and neglect the smaller muscles. Well-defined deltoid and pecs look great, but they are only part of the shoulder that needs to be strengthened. Simple rotation exercises with the elbow at the side are extremely important to preventing rotator cuff injuries. This should be done with very light weight initially. With any shoulder workouts with weights or machines, it is best to keep the hands in front of the head and not behind the head. Shoulder presses and latissimus pulldowns should be done in front rather than behind the head.

If you develop shoulder pain or weakness of the shoulder, do not neglect this. If it persists for more than a few days, see a sports medicine specialist. It is better to identify if there is a tear or just tendonitis early on so as to prevent needing surgery. Don’t work through pain because you may be causing significant damage. It is always better to prevent an injury rather than have to fix it!

Rest to See Better Results

It is common knowledge that exercise and physical activity are beneficial to your health. But how much is too much? Many people don’t take any days off from exercising, and therefore they don’t allow any time for recovery. Too much exercise can be just as dangerous as not exercising at all!!! It is important to remember that exercise can prevent injuries, but it can also cause them! Rest and recovery is an essential part of any exercise program. In order to train more effectively, you need a recovery plan. This will have a significant impact on your fitness gains and sports performance.

During a workout, muscle fibers are damaged. When resistance is placed on a muscle through running, weight training, etc, the muscle develops tiny microscopic tears, which activate muscle building. The tears cause the formation of new muscle protein strands which increase the strength and size of the muscle. Additionally, the tears start the process of healing by creating new cells to heal the damaged tissue and relieve any soreness. This alters the homeostasis in the body, which creates stress. The greater the tear in the muscle, the more likely it is to have muscle soreness and an altered homeostatic state.
After exercise, recovery is essential to muscle and tissue repair and strength building. Muscles are repaired and rebuilt only during the recovery period. Without proper recovery, especially after a workout that is too strenuous or prolonged, the body stays in the altered homeostatic state for longer than it should, which may lead to injuries. A muscle needs anywhere from 24 to 48 hours to repair and rebuild, and working it again too soon leads to tissue breakdown instead of building.

Recovery should take place both during and after workouts. It is important to rest between weight sets or cardiovascular intervals as well as between workouts in the same week. For weight training programs, never work the same muscles groups two days in a row. Rest helps replenish your energy stores, which get depleted during workouts. People often don’t find the time to rest and relax, but it is one of the easiest things to do to promote recovery and repair. One easy way to recover faster is to design a smart workout routine in the first place. You will limit your progress and undermine your recovery with excessive exercise, heavy training at every session or a lack of rest days.

Stretching is another way to aid the recovery process. It prevents the muscles from becoming knotted and helps improve flexibility. Additionally, it is important to remain hydrated to aid in muscle recovery and to keep heart rate and blood pressure stable. Water supports every metabolic function in your body and must replaced when lost through sweat. A lot of fluid can be lost during strenuous workouts and it needs to be replaced both during and after exercise. Endurance athletes who sweat for hours and lose large amounts of water especially need to replace their fluids for optimal performance and recovery.

Sleep is also extremely important. It is imperative to get between 7-9 hours of sleep to ensure hormones and chemicals like growth hormone and cortisol are produced and in balance. GH is largely responsible for tissue growth and repair. Sleep also enhances protein synthesis, boosts immune function, and helps relax the nervous system. Optimal sleep is essential for anyone who exercises regularly.

The most important thing you can do to improve fitness, prevent injury and speed up recovery is to listen to your body. If you feel tired or sore, take a break or rest. Your body will tell you what it needs if you pay attention to it, rather than ignore the warning signs. The best way to ensure you are training and resting optimally is to consult with a personal trainer to design an effective exercise program and help prevent you from overtraining.