Weakness in your rotator cuff muscles can lead to persistent shoulder pain—prevent it before it sidelines you.
Shoulder impingement is characterized by a pinching sensation, pain in your shoulder and possibly weakness when you lift your arms above your head.
The rotator cuff is a collection of muscles that surround the shoulder joint and help hold the humerus bone of your upper arm in the shoulder socket. Impingement happens when the arm lifts and a bone in the shoulder called the acromion impinges—digs into or pinches—the rotator cuff tendons and/or the subacromial bursa, causing pain.
This can happen for many reasons: bursitis; weakness in the rotator cuff and scapular (shoulder blade) stabilizing muscles; an injury to the tendon attaching the rotator cuff to the humerus, especially when there is tendonitis; poor athletic mechanics; and a shoulder shape that predisposes you to injury. Swimming and weight lifting can both put you at risk.
Also beware of “frozen shoulder,” which can come on spontaneously or after an impingement when the shoulder isn’t being used. The joint tightens, or “freezes,” especially at night. Women tend to be more prone to this. See a doctor because early diagnosis and treatment—usually with a cortisone injection—is key.
See a doctor. The shoulder is a complex and important joint, so see a sports doc at the first sign of shoulder pain.
Take it easy. Lay off the upper-body work (including swimming), and use lower-body workouts to maintain fitness.
Ice it. Ice applied to the shoulder for 15 minutes several times a day can help reduce inflammation.
Try an NSAID. An anti-inflammatory like ibuprofen or naproxen can help with the pain.
Start rehabbing. As the pain improves, do some rotator cuff exercises to help strengthen your shoulder. Here are three.
Shoulder Squeeze #1
Lie facedown on an exercise bench. Hold your arms out to your sides parallel to the floor, bent at 90 degrees with your thumbs pointing toward the ceiling. Now try to raise your elbows toward the ceiling and feel your shoulder blades squeezing together. Hold for a moment and return to the starting position. Do 10 to 20 reps depending on your strength.
Shoulder Squeeze #2
While lying facedown on the bench, hold your arms along your sides with your palms up. Keeping your arms straight, lift your palms toward the ceiling, again feeling your shoulder blades squeeze together. Hold for a moment and return to the starting position. Do 10 to 20 reps.
Seated Dumbbell External Rotation
Grab a dumbbell in your right hand and sit on a bench. Place your right foot on the bench with your knee bent. Bend your right elbow 90 degrees and place the inside portion of it on your right knee. Use your free hand for support. Without changing the bend in your elbow, and while keeping your wrist straight, rotate your upper arm and forearm up and back as far as you can. Pause, then return to the starting position. Perform the prescribed number of repetitions with your right arm, then switch and perform the same number with your left arm.
Having a strong, balanced shoulder resists this type of injury because well-conditioned muscles reduce the load on the rotator cuff. This means that shoulder work must be a staple of your upper-body workouts, and you must work opposing muscle groups to avoid an imbalance (for every pushing exercise like push-ups, do an equal amount of a pulling exercise like rows). The stretches and exercises here can be added to any workout.
Improve your swim mechanics. Learning proper technique straight out of the gate is the best way to start. If you’re already a dedicated water rat, a good swim coach can spot and correct any mechanical flaws you have that could cause injury.
Lie on the floor on your left side with your left upper arm on the floor and your elbow bent 90 degrees. Adjust your torso so that your right shoulder is slightly behind your left, not directly over it. Your fingers on your left hand should point toward the ceiling. Gently push your left hand toward the floor until you feel a comfortable stretch in the back of your left shoulder. Hold for 30 seconds, then roll over and repeat the stretch for your right shoulder. Perform 2 to 3 times a day to improve flexibility, or 3 times a week to maintain flexibility.
Serratus Chair Shurg
Sit upright on a chair or bench and place your hands flat on the sitting surface next to your hips. Completely straighten your arms. Allow your shoulders and back muscles to relax so your torso lowers between your shoulders. Your hips should just be off the edge of the bench. Press your shoulders down as you lift your upper body. Your torso should rise between your shoulders. Pause for 5 seconds, then lower your body back to the starting position.
Grab the pull-up bar with a shoulder-width, overhand grip. Hang at arm’s length. You should return to this position—known as a dead hang—each time you lower your body back down. Cross your ankles behind you. Pull your chest to the bar as you squeeze your shoulder blades together. Once the top of your chest touches the bar, pause, then slowly lower your body back to a dead hang.
New York City sports medicine specialist Jordan D. Metzl, M.D. is a 33-time marathon finisher and 13-time Ironman. His book, The Athlete’s Book of Home Remedies, has more than 1,000 tips to fix all types of injuries and medical conditions.