Shoulder Anatomy

TRAINING WITH SHOULDER PAIN PART 1:

ROTATOR CUFF INJURY

Shoulder Pain from Rotator Cuff Tendinopathy

Recently, we began working with a synchronized swimmer who had developed shoulder pain.  The doctor diagnosed her with rotator cuff tendinopathy.  This is a brief discussion of what was possibly causing this particular case of rotator cuff injury.

In part two, I'll share with you what exercises were used to rehabilitate this shoulder injury in order to get this athlete back into training without pain or restriction.  ​

Please note, that if you are dealing with shoulder pain we recommend you seek medical assistance.  This example applies to a unique case study where a medical practitioner has given clearance to continue training after examining the injury.

The Rotator Cuff

The rotator cuff consists of four muscles:​

  • supraspinatus
  • infraspinatus
  • teres minor
  • subscapularis

Each of these muscles originate at different aspects of the shoulder blade and attach onto the humerus, the bone in your upper arm. The rotator cuff is important in executing a few shoulder movements and stabilizing the shoulder joint.  Primarily the rotator cuff is known for lifting the arm up.  This is an oversimplified description, but you get the idea.

What is Tendinopathy?

Tendinopathy is a term given to describe chronic tendon injury where the mechanism of injury is not clearly understood. There is a long list of mechanisms that can predispose you to irritation in the rotator cuff.  But even if genetics left you with less than perfect shoulders, there is a great deal you can do to keep them healthy, strong and pain free.

Synchronized Swimming and the Shoulder

Back to our swimmer. If you know anything about synchronized swimming, they spend a lot of time in an upside down position. 

The support scull, as it's known, is used for just about everything in synchro. Can you see how important the rotator cuff is in stabilizing the shoulder and to performing well in this sport?

This athlete has to spend countless hours with her arms in an overhead position. When the arm is elevated above shoulder height, the subacromial space becomes even smaller and again the enclosed tissues are at risk of impingement.

Support Scull Image
Shoulder Anatomy

Risk of Overuse Injury

With the best of intentions our synchronized swimmer was strength training by mimicking this movement while pulling on a band (standing upright, of course). A drill known as Banded Shoulder External Rotations. Seems like a good idea, right? Not quite.

Let’s take a closer look at the shoulder.   The space between the end of the collar bone and ball of the shoulder joint, is a 9-10mm gap, called the subacromial space.  It houses a number of important structures including the infraspinatus muscle and tendon. By continually exposing the muscle to that particular drill, it was at risk of overuse. It also may have begun to increase in size and take up more space than necessary. Even low level stimulus like pulling on a band can lead to muscle growth, if enough volume is used.

In this particular case of rotator cuff tendinopathy, working the shoulder through loaded external rotation we felt was not the best way for her to train.

In part 2,  we will go over how we changed the swimmer’s training to maintain strength and function and avoid irritating her condition.

mike.panarella