Introduction: That Sharp Twinge You Can’t Ignore
That sharp twinge when you reach overhead, the nagging ache at night—if this sounds familiar, you could be dealing with rotator cuff tendinopathy.
Roughly two years ago, I was working on a fellow PT at the end of the workday. He is a large guy and I was mobilizing his lumbar spine when I felt a tear in my right shoulder. He looked at me and I looked at him like, “uh oh!” Ever since, that shoulder gives me occasional trouble, but I am able to manage well with self-treatment.
The tricky thing with the shoulder is that because it’s our most mobile joint in the body, it’s also the most inherently unstable. This makes it vulnerable to several different issues, one of which is rotator cuff tendinopathy.
Shoulder Pain Is Common… But Treatable
Shoulder pain in general is the third most common reason for doctors visits following spine and knee. It’s most commonly caused by impingement between the point of the shoulder (acromion) and humerus and/or rotator cuff issues.
The rotator cuff consists of four muscles which lie upon the scapula: supraspinatus, infraspinatus, teres minor, and subscapularis. The role of the rotator cuff is to hold the ball in the socket (the head of the humerus in the glenoid fossa of the scapula). The tendons of these muscles “cuff” the head of the humerus and run right underneath the acromion.
Because of the narrow space, any disruption in the mechanics of the ball within the socket can irritate those tendons and rotator cuff tendinitis (acute inflammation) ensues. This can occur after a direct blow to the shoulder, falling on an outstretched arm, or from poor body mechanics on the job or in sports.
Over time, repetitive rotator cuff irritation triggers a change in the structural makeup of the tendons, aka rotator cuff tendinopathy. Ultimately, partial and/or full thickness tears of the tendons can occur.
What Causes Rotator Cuff Tendinopathy?
There are two theories surrounding the cause of rotator cuff tendinopathy: extrinsic compression or an intrinsic mechanism.
With extrinsic compression, the undersurface of the acromion contacts the rotator cuff tendons, causing a mechanical impingement. It can occur secondary to a degenerative bursa (the fluid-filled sac between the tendons and acromion), bone spurring of the acromion, or an abnormally shaped acromion (hooked).
An intrinsic mechanism of injury occurs when there is weakness of the rotator cuff muscles for whatever reason. Once this happens, the ball migrates superiorly within the socket and the space under the acromion is narrowed.
Hence, the rotator cuff tendons become susceptible to the extrinsic compressive forces mentioned above. Once this cycle starts, a person will eventually develop symptoms, as inflammation within the joint inhibits the muscles which causes more inflammation, and so on.
Recognizing the Symptoms
Rotator cuff tendinopathy commonly presents as pain and stiffness when the arm is lifted. There may also be pain when the arm is lowered, which can radiate from the front of the shoulder to the side of the arm.
It can be sudden and sharp with lifting, reaching, or throwing. As the problem progresses, the symptoms get worse and often include pain at night and possibly a loss of arm strength and shoulder range of motion. People usually have the most difficulty with reaching overhead or behind the back.
The good news is that rotator cuff tendinopathy responds very well to conservative treatment, especially in the early stages.
Managing Rotator Cuff Tendinopathy
Working to decrease inflammation and strengthen the rotator cuff within a pain free range (below shoulder height) is a great place to start, and approaches such as targeted exercise and yoga for shoulder pain can support this process.
Here’s what helps:
- Lightweight resisted shoulder external and internal rotations with the elbow at the side
- Maintaining good posture: open the chest, extend the upper thoracic spine, and reestablish proper neck alignment
- Restoring full range of motion to improve shoulder mechanics
- Using optimal body mechanics during repetitive work or sports
At LYT Yoga, we stress the importance of keeping the head of the humerus centered within the socket throughout a yoga practice. This is the best way to avoid creating a rotator cuff tendinopathy and also a great way to strengthen the rotator cuff and scapular stabilizers.
And don’t forget, weakness in the core will affect how the ball moves in the socket, so more core will go a long way to prevent future injuries.
A Clear, Practical Guide to the Shoulder Girdle for Movement Professionals
If you’re a movement professional or just want a deeper understanding of shoulder mechanics, check out my new mini-course on breaking down the shoulder girdle complex.
You’ll learn how to identify key structures of the shoulder, screen shoulder mechanics using clear, accessible methods, and how to build targeted exercises based on what you find. Take control of your shoulder health and keep moving with confidence!
