Shoulder pain and the signs of rotator cuff injury

Injury to the rotator cuff is common among all age groups and is characterised by a pain or ache from the top of the shoulder that typically spreads down the middle of the upper arm. Most of the time pain is brought on by trauma or a sudden movement causing a strain and damage to the rotator cuff muscle or tendon. Symptoms can also develop gradually over time through repetitive movements or overuse.

What makes up the rotator cuff?

The rotator cuff is made up of 4 muscles (supraspinatus, infraspinatus, teres minor and subscapularis), starting from the shoulder blade (scapula) and attaching onto the long bone of the arm (humeral head). The shoulder joint has a wide range of movement, which can make it prone to injury in certain positions if excessive force is applied.

What are the symptoms?

Pain is typically intermittent or only present when making certain movements with the arm, though in more severe cases pain can be there most of the time. Reaching out for things at waist to shoulder height tend to produce a sudden catch, particularly with added weight. Carrying bags on the affected side if often uncomfortable too.

What can I do to improve my symptoms?

Non-steroidal anti-inflammatory drugs (NSAIDs) can be useful in the early stages when taken 48 or more after the symptoms started. It is always wise to check with your GP or local pharmacist if you would like advice or guidance on taking a course of NSAIDs. Often within 4-6 weeks symptoms can spontaneously resolve with general activity, but if they persist you should attend a physiotherapy consultation, either through your GP or self referral.

What can physiotherapy do to help?

A Physiotherapy consultation will help to determine an accurate diagnosis and put together an appropriate management plan to improve symptoms. Applying tape and using massage or acupuncture can be used for relieving pain. These can be used along with a graded exercise programme to build strength back into the shoulder. The exercises provided will be tailored to your particular goals, e.g. some may want to get back to high level sport, and for others day to day function.

How long does it take to get better?

For mild cases 4-8 weeks, for moderate strains 8-16 weeks and more severe injury can take six months or more to resolve.

What if my shoulder pain doesn’t improve?

It is important to keep a healthcare professional posted on the progress you make with your symptoms. If you do not make the expected progress it may be appropriate to be referred for a specialist opinion with an Orthopaedic Consultant. A chartered physiotherapist or GP will be able to provide advice on this.

Don’t put up with symptoms – get the injury checked out!

Whatever you do, don’t just sit and rest the injury. Rest on its own is never useful for persistent shoulder pain, and if anything can lead to making symptoms worse as the muscles loose strength and the shoulder gets stiff which makes the road back to health even longer. So don’t delay, book an appointment and get the shoulder checked out.

Specialist MSK Physiotherapist - Anthony Cahill
Physio Three Sixty, Hitchin

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Get fit & stay injury free for your ski trip...

Reduce the risk of injury by doing these exercises

Exercise in the run up to your ski holiday is not only a great way to improve your fitness for the trip but can also help to reduce your risk of injury. Compared to normal levels of activity a week of skiing places significant additional strain on the joints, ligaments and muscles which would normally not be tested, and this can lead to an overload injury or trauma.

In order to minimise the risk of this happening we need to train the body to be able to cope with the physical demands of the sport and to help you get the most out of your holiday by boosting performance.

When planning our exercise programme we need to consider the stress placed on the body and plan an exercise programme to suit. The key components of skiing include muscular strength, muscular endurance and agility. An additional consideration is that the exercises should be specific to the sport.

The American colleague of Sports Medicine (ACSM) provides a useful starting point for planning a programme. Their guidelines they recommend 30 minutes of moderate intensity activity five days a week, or 20 minutes of more vigorous activity three days per week. In addition to this strength training should be performed at least two days per week targeting the major muscle groups (Esco, 2013). By following this framework we can start to build a plan and factor in the key aspects of fitness we need. Below I have outlined six great exercises to work into your regular exercise routine.

Key exercises

1. Muscular strength

Squat with weight Deadlift

These can be performed 8-12 times over three sets, with rest periods of around 2 minutes before starting again. For a more advanced workout perform up to 6 repetitions over 4-5 sets with additional weight.

2. Muscular Endurance

Skater squats

Kettle bell swings

These can be performed in 2-4 sets of 15-25 repetitions, with 30sec-1 minute rest.

3. Agility

BoxJumps

Transverse hops over step

These can be done for 30seconds to 1minute at a time, and repeated 3-4 times in a session. They can be complemented by regular cardiovascular work such as running, swimming, bike or cross trainer for a comprehensive workout. Your body will start to adapt after 2-3 weeks, but for full benefit the exercises should be performed over a period of 8-12 weeks.

Further tips on injury prevention:

There are lots of other ways to minimise risk of injury while away. Safety gear including helmet, crash pads wrist guards (for snowboarders) are a wise investment. Always be aware of those around you and think carefully when venturing off piste and heed local warnings. It’s usually best to go with a local guide and take safety equipment particularly after heavy snowfall including transceivers, air bags and shovels. What may look like perfect power could be covering rocks just a couple of inches below. For more useful information on injury prevention check out the ski injury prevention website below.

Happy Skiing!!

Anthony Cahill
Specialist MSK Physio at Physio Three Sixty, Hitchin

References

American College of Sports Medicine: Resistance Training for Health and Fitness, Michael R. Esco, 2013

Conf Proc IEEE Eng Med Biol Soc. 2011;2011:8187-90. doi: 10.1109/IEMBS.2011.6092019.
Influence of muscular fatigue on skiing performance during parallel turns.
Kiryu T1, Murayama T, Ushiyama Y.

World Neurosurg. 2015 Sep;84(3):805-12. doi: 10.1016/j.wneu.2015.05.016. Epub 2015 May 21.

Cohort Study on the Association Between Helmet Use and Traumatic Brain Injury in Snowboarders From a Swiss Tertiary Trauma Center.
http://www.ncbi.nlm.nih.gov/pubmed/26004699

Inj Prev. 2015 Sep 23. pii: injuryprev-2015-041667. doi: 10.1136/injuryprev-2015-041667. [Epub ahead of print]