At one time or another, most athletes have dealt with nagging shoulder pain, especially in sports with overhead throwing motions. Such pain can be a sign of shoulder tendinitis, which if not addressed, can greatly decrease athletic performance. Shoulder tendinitis can be an issue, but there are ways to cope with it, as well as to prevent, treat and strengthen the injured area.
Shoulder tendinitis is an inflammation of the rotator cuff and/or biceps tendon. It usually results from the pinching of a tendon by surrounding structures. The injury may vary from mild inflammation to severe involvement of most of the rotatory cuff. When the rotator cuff tendon becomes inflamed and thickened (a.k.a. rotator cuff tendinitis), it may get trapped under the acromion, the highest point of the shoulder, which is formed by a part of the scapula (shoulder blade). Shoulder tendinitis is characterized by the following:
Shoulder clicking and/or an arc of shoulder pain when your arm is at shoulder height
Pain when you lie on a sore shoulder or when you lift with a straight arm
Shoulder pain or clicking when you move your hand behind your back or head
Shoulder and upper-arm pain (potentially as far as your elbow)
What Causes Shoulder Tendinitis?
Shoulder tendinitis often occurs in athletes who play sports that require their arms to move over their heads repeatedly, such as baseball players, weightlifters, people who play racket sports, and certain swimmers. The most common cause is repeated micro trauma to the rotator cuff tendon rather than a specific acute trauma, such as being hit by a baseball or falling on your shoulder. Another cause can be repeated shoulder impingement, which causes the rotator cuff tendon to become inflamed and swollen.
There are essentially seven stages an athlete needs to progress through to effectively rehabilitate and prevent a recurrence of shoulder tendonitis:
1. Pain Relief and Anti-inflammatory
As with most soft tissue injuries, the initial treatment is R.I.C.E (rest, ice, compression and elevation.) In the early phase, you’ll most likely be unable to fully lift your arm or sleep comfortably. You should stop doing the movement or activity that provoked the shoulder pain in the first place and avoid doing anything that causes pain in your shoulder.
Ice is a simple and effective tool to reduce pain and swelling. Apply ice for 20-30 minutes every 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot.
Anti-inflammatory medication may reduce pain and swelling. However, it’s best to avoid them during the first 48 to 72 hours, when they may encourage additional bleeding.
To support and protect your tendon injury, you may need to wear a sling or have your shoulder taped to provide pain relief. In some cases, it may mean you need to sleep relatively upright or with pillow support to elevate your arm.
Shoulder tendinitis may take several weeks to heal. During this time, you should aim to optimally remodel your scar tissue to prevent a poorly formed scar that may become lumpy or potentially re-tear in the future.
It is important to lengthen and stretch your healing scar tissue through joint mobilizations, massage, muscle stretches, and light active assisted and active exercises. Researchers have concluded that athletic trainer-assisted joint mobilizations improves range of motion quicker and, in the long term, improves functional outcome.
In most cases, you will also develop short- or long-term protective tightness of your joint capsule (usually posterior) and some compensatory muscles. These structures need to be stretched to allow normal movement.
Signs that you have full soft tissue extensibility include the ability to move your shoulder through a full range of motion. In the early stage, this may need to be done passively with the assistance of an athletic trainer. Some sample stretches you can perform on your include the following:
Warm up your muscles by standing in an open doorway and spreading your arms out to the side.
Grip the sides of the doorway with each hand at or below shoulder height.
Lean forward through the doorway until you feel a light stretch.
Keep a straight back as you lean and shift your weight onto your toes. You should feel a stretch in the front of your shoulder. Do not overstretch.
Stand next to a table and bend forward at the hips.
Place your good hand on the table and allow your injured arm to hang down.
Gently move your arm in small circles.
Do this for a few minutes every day as a warm-up for your other exercises.
Supine Shoulder Flexion Stretch
Lie down on your back.
Hold a cane or stick with your hands about shoulder-width apart.
Starting from waist level, slowly raise the cane over your head as far as you can go and hold the stretch.
Use your good arm to assist the injured arm as you lift. Slowly return back to the starting position.
Cross Chest Stretch
Bring your injured arm across your body.
Place your other hand on your elbow and hold the stretch for at least 30 seconds.
3. Restore Scapular Control
Your shoulder blade, or scapula, is the base of your shoulder and arm movements. It has a vital role as the main dynamically stable base plate that attaches your arm to your chest wall.
Normal shoulder blade movement is required for a pain-free and powerful shoulder function. Your athletic trainer will assess you, help you regain normal shoulder motion and provide you with scapular stabilization exercises if necessary.
Neck or spine dysfunction can not only refer pain directly to your shoulder, it can affect a nerve’s electrical energy supplying your muscles and cause weakness. Painful spinal structures from poor posture or injury don’t provide your shoulder or scapular muscles with a solid pain-free base.
In most cases, especially with chronic shoulders, some treatment directed at your neck or upper back will be required to ease your pain, improve your shoulder movement and stop pain or injury from returning.
5. Restore Rotatory Cuff Strength and Function
Your rotator cuff is the most critical group of shoulder control and stability muscles. It keeps the shoulder ball centered over the small glenoid socket. This prevents impingement and dislocation injuries. The rotatory cuff also allows the subtle glides and slides of your shoulder ball joint on the glenoid socket to allow full shoulder movement.
Rotator cuff exercises need to be progressed in both load and position to accommodate your injured rotator cuff tendons and whether you have a secondary condition such as bursitis.
6. Restore High Speed, Power, Proprioception, and Agility
If your shoulder tendinitis has been caused by sport, it is usually during high-speed activities, which place enormous forces on your body.
To prevent a recurrence, your athletic trainer will guide you with exercises to address these important components of rehabilitation.
7. Return to Full Sport Activities
Depending on the demands of your sport, you will require sport-specific exercises and a progressed training regimen. The perfect outcome will have you performing at full speed, power, agility and function with the added knowledge that the rehabilitation program has minimized your chance of future injury. Some sample exercises to progress you through your rehabilitation include the following:
Resistance Band External/Internal Rotations
Attach a resistance band to a door handle or wall.
For external rotations, stand facing forward with the wall to your right.
Grasp the handle with your left arm bent at 90 degrees and your elbow tight to your side with a rolled up towel between your elbow and side.
Retract your shoulder blades and rotate your shoulder away from the wall in a slow and controlled manner.
For internal rotations, perform the same movement but grasp the handle with your right hand.
Hold a pair of light dumbbells to your sides in a neutral grip.
Keeping your arms straight, retract your shoulders and raise your arms out in front of you, making a”Y” until they are at chest level.
Slowly lower them back to the starting point.
Start with your blade by your side with a single hand grip.
Raise the Bodyblade in front of you at 90 degrees.
Slowly move it out to the side at 90 degrees.
Rotate your arm so your thumb is facing forward instead of up, and return back to your side.
Repeat several times or watch the clock for 60 seconds.