Rotator Cuff Tendinopathy or Tear

What is it?

Tendinopathy is essentially inflammation and bruising in a tendon; the same way you get inflammation or bruising when you stub a toe or cut your finger. Inflammation is part of the healing process of the body and is an extremely important part of recovery from physical activity. Although, when a Rotator Cuff Tendon (or any tendon for that matter) is put under consistent high load, this inflammatory process can become repetitive and result in consistent achy Shoulder pain. This happens because the inflammation in the tendon is not recovering properly between each load session. If left untreated this can result in long term change to the state of the tendon and the strength of the Rotator Cuff muscles.

Tendinopathy very rarely happens in isolation, but generally has an underlying reason for a spike in load. This could be something as simple as a recent increase in training or something a little harder to see, such as changes in the way the shoulder is moving under load. This could be putting greater than normal load on one specific tendon in the shoulder.

How do I Identify it?

Rotator Cuff Tendinopathy typically presents with consistent build up of niggly shoulder pain. This can build up over the course of anywhere between one week to a few months depending on the severity of the inflammation. They tend to be more painful in the morning when first waking or when warming up for exercise but start to feel better when the shoulder is warm and the body is ready to go. Despite feeling good while you exercise the pain tends to come back and be quite sore once the body has cooled down and inflammation has had time to set it. 

What can you do?

The process for settling sore tendons is quite simple and is very effective, however it does take a bit of time for the inflammation to completely settle. 

Step 1: Relative rest – Relative is the important word here. IF you rest completely from exercise the pain will settle only to come back when you return to exercise again. It is important to REDUCE your exercise level to a point that is pain free and comfortable during and after the exercise but NOT STOP completely. For example, in climbing this might mean reducing your climbing level from v.4-5 to v.2-3.

Step 2: Load and Unload – Plan your week to have load days and rest days. Always follow a load day with a rest day. 

Step 3: Specific tendon Loading – Tendons love static load to help stimulate healing, without overloading and increasing the inflammation. My favourite two exercises to help stimulate the tendon are:

  1. Static 45 second External Rotation Holds – 3 x 45 second holds at 40% exertion or a slight awareness of discomfort. A little discomfort is wanted with this exercise but it’s very important the pain leaves after completing the exercise or doesn’t increase after repeating the exercise.
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2. Eccentric external rotation – 3 x 10 Repetitions. Use your other hand to bring the band to full external rotation position then slowly resisting the band bring the hand back to neutral

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3. Spikey ball the culprit – When the tendon is irritated the muscle connecting to that tendon tends to tighten up and perpetuate the problem. Releasing the muscle with a spikey ball is not particularly fun but it’s very effective and reduces pain allowing the tendon to rest properly on those rest days.

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Big No No: The most important things to avoid when you think you might have Tendinopathy?

  1. She’ll be right mate: Pushing through or ignoring pain is probably the worst thing you can do for irritated tendons. The problem tends to only get worse if left or ignored as the inflammation just continues to develop. Over time this can cause significant changes to the tendon, which may make it more susceptible to pain or irritation further down the track. 
  2. Cortisone Injections: There has been a vast amount of research done into the validity or Cortisone Injections to treat/reduce shoulder pain in the presence of Tendinopathy. It can be very effective at reducing the pain in the short term, however the research suggests it is more like a bandaid than an actual solution. Cortisone has been found to have long term ill effects on tendon health, as well as only having short term relief from pain. People who opted to not have Cortisone, but to undergo a period of exercise rehabilitation and physiotherapy, tended to have much better long term pain outcomes than groups with either no treatment or Cortisone Injections. Essentially, leave the cortisone in the syringe and go to work actually fixing the reason for the pain in the first place. 

Quick Tips:  

  1.  Control the Load
  2. Specific Tendon Exercises
  3. Don’t Soldier On

Final Thoughts – When treating the shoulder or managing any type of shoulder pain it is important to take into account any other factors that could be affecting the movement or load on the shoulder. Because the shoulder is such a mobile joint, very rarely do things happen in isolation and I would always recommend looking at shoulder position, upper back posture and shoulder strength in conjunction with the tips in this article to ensure the best results for your shoulder.

We hope you found this helpful! If you have any other questions please don’t hesitate to Contact Us.

The Climbit Physio Team

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