If you are an athlete in a throwing sport—most notably, if you’re a baseball pitcher—rotator cuff tendinopathy is an issue that’s probably on your radar. But you should also be aware of this chronic shoulder injury if you’re nearing 40 or beyond.
Rotator cuff tendinopathy affects a large segment of the adult population, with an estimated one in three individuals experiencing chronic shoulder pain at least once in their lives.
What Is Rotator Cuff Tendinopathy?
Rotator cuff tendinopathy is an overuse injury that affects the tendons of the shoulder. Specifically, the collagen in the tendons starts breaking down faster than it can be repaired or replenished by the body.
Shoulder tendinopathy is a chronic tendon disease that can be caused by a number of different factors.
- Some people are simply prone to it, due to biology or anatomy.
- Others develop it as a natural side effect of aging. (As we approach and pass the age of 40, normal wear and tear causes our collagen to degenerate. Aging means the tendons don’t recover from tears and inflammation as quickly or as thoroughly as they used to.)
- However, many if not most people (especially those under 40) develop shoulder tendinopathy due to mechanics and/or repetitive strain. Often this is from athletic endeavors like weightlifting or participating in fast, explosive throwing or overhead hitting activities like baseball pitches, tennis (serves, especially) and volleyball serves and spikes.
Using the rotator cuff while it’s injured gets in the way of the body’s ability to heal itself. The rotator cuff tendons, already damaged and breaking down, sustain more trauma that prevents them from recovering. The pain and other symptoms therefore continue.
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How to Prevent Rotator Cuff Tendinopathy: General Advice
Preventing rotator cuff tendinopathy from happening may not be 100% possible if you have a genetic predisposition to tendon degeneration. Age-related wear and tear in the rotator cuff is also normal and expected, especially if you’re over 40.
However, there are some proactive approaches you can take to reducing your risk. The advice below is helpful for non-athletes and athletes alike.
- Practice Regular Shoulder Conditioning. One of the best steps you can take to protect your shoulders from rotator cuff tendon injuries is to perform strength-training and flexibility exercises (i.e., dynamic and static stretches) on a regular basis. Regularly training and stretching your shoulder and the muscles and tendons surrounding it will help to keep it in optimal shape. (You’ll also keep your shoulder in condition, avoiding “weekend warrior” injuries that happen when you suddenly overtax or overload an under-trained or cold muscle.)
A proper rotator cuff shoulder regimen will strengthen the muscles surrounding and supporting your shoulder, which keeps your mechanics in proper alignment while taking the stress off your tendons.
It’s advisable to work with a doctor or physical therapist to design a shoulder conditioning program that works for you. Usually, such a program will target muscle groups that support the shoulder and its rotation: e.g., the upper back, the chest, the biceps and triceps of the upper arm, the shoulder joint itself, and the front of the shoulder. A similar program is often advised for recovery from rotator cuff injuries and surgery, as well.
- Work the Upper Body Into Your Exercise Routine. Any form of exercise that strengthens and stretches the upper body—particularly the back and chest—will help to stabilize the shoulder and compensate for heavy use. If you’re not already working upper body muscles as part of your exercise routine, consider adding in an activity that does work those muscle groups: for example, rowing, a dance class, yoga, Pilates, or a cardio weights workout video or class at the gym.
- Maintain Good Posture. Many problems in the body can be caused or made worse by improper alignment, be it when you’re standing, moving around, sitting, or sleeping. Deviating from a neutral posture can put too much stress on a given muscle, ligament, or tendon. This stress can lead to injury. For example, slumped shoulders or lifting your arms to type on keyboards that aren’t ergonomically correct can lead to shoulder pain (and neck pain, and arm pain). Sleeping on one shoulder all night long can also be problematic for shoulder joints.
If you find yourself slumping when you sit or stand, try to make small corrections to your posture—chin up, shoulders back, arms relaxed. If you sleep in a way that hurts your shoulder, consider changing sleep position, using a body pillow, or looking at a mattress that better suits you. At work or at home, take frequent breaks from sitting at a computer or resting in a chair. Get up, walk around, and do some gentle arm, shoulder, chest, and neck stretches.
- Stay at a Healthy Weight. Studies show that being overweight or obese is associated with tendon disease and injuries. Lowering your BMI may help to protect you from tendon degeneration. Preventing or treating diabetes can also cut your risk; poor glycemic control can contribute to inflammation, which can weaken tendons.
- Avoid Lifting, Catching Heavy Objects, or Raising Your Arms Repeatedly. Lifting heavy items over your head or catching them can lead to tendon strain and injury. Try to minimize how often you participate in these activities. (Easier said than done for athletes who practice competitive cheer, competitive pair skating, ballet, or circus arts!) If your occupation requires you to reach over your head for sustained periods (for example, if you paint houses or work in construction), take frequent breaks and ice your shoulder if it’s sore.
- Prevent Falls and Collisions. Practice safety measures to prevent falling onto your shoulder or colliding with people or objects that may push your shoulder ball outside its socket. If you play a contact sport like football, hockey, or soccer, be aware that collisions and falls carry the risk of rotator cuff injury, among other shoulder injuries (like dislocations and tears). Likewise for baseball slides. If you’re older, take extra care to avoid slips and falls.
Shoulder Tendinopathy Prevention: for Athletes
The most common recommendation to avoid tendon disease is: don’t overdo it. Avoid overtraining and repetitive strain. For competitive athletes like baseball players, this advice is often difficult to hear and even more difficult to follow. How can you avoid using your rotator cuff during a normal sports season?
For athletes and others who participate in a shoulder-reliant physical activity daily, there’s no way to completely avoid risk. However, you can avoid putting excess force or strain on the rotator cuff by practicing a few basic measures:
- Work out regularly. Don’t become a weekend warrior; they get hurt more often than athletes who regularly work their bodies and keep them in good condition.
- Work out properly. Know your correct form. Use equipment safely and properly, and make sure all your gear is in good shape. Tennis rackets, for example, need to be properly strung to maintain adequate tension. Shoulder pads and other protective gear should be checked to make sure they fit your body and are still in good working condition.
- Train early (and often). Showing up cold on the first day of your sports season is a certain recipe for injury. Get in shape before your season begins—at least three weeks early, though months before is better.
- Warm up, cool down, and stretch. Don’t skip these critical parts of your workout. Warming up gets the blood flowing to your muscles and tendons, making them more supple and resilient. Cooling down and stretching prevents tightness (tight muscles and tendons can be more prone to tearing and rupture). Both activities maintain and improve your range of motion, which is crucial when relying on a rotating joint like the shoulder—especially if you’re involved in a throwing sport.
- See a professional. For elite athletes, working with a physical therapist or orthopedist is also a smart move. A professional can design a preventative care program for you that will help to keep your rotator cuff—and your entire shoulder joint—as healthy as possible throughout your season. He or she may prescribe exercises to correct alignment and mechanical issues that could contribute to stress and injury. They may also suggest taking NSAIDs to combat tendon inflammation.
The bottom line: rotator cuff tendinopathy cannot be totally avoided, but you can mitigate your risk by taking care of yourself.
Call Coastal Orthopedics in Corpus Christi, Texas today at (361) 994-1166 with any questions/concerns about shoulder pain or shoulder issues.
Article written by: Rob Williams, MD