Shoulder pain when lifting can lead to a number of different conclusions about potential rotator cuff injuries. There is, however, a difference between pain and an injury. Lifting as a stand-alone activity may cause pain and discomfort from simple stress on tendons and joints. Muscle fatigue may also lead to temporary bouts of pain. Before you decide to fight through the pain, find out whether you're actually injured so you can take precautions to ensure you heal properly.
Preventing Rotator Cuff Injuries
Because treatment for rotator cuff injury can be a lengthy process, prevention through daily basic stretches and exercises is key, especially for athletes, bodybuilders and weightlifters who place pressure on the rotator cuff every day. Awareness of shoulder strain and motions that are causing damage can also help by signaling need for rest and recovery. If you feel pain when lifting, rest your shoulders for several days. If the pain subsides, try lifting again. If it doesn't, see your doctor before it becomes serious.
Simply acknowledging the issue and following up with rest can prevent an injury from developing in the long run. You can also decrease the intensity and slowly build back to higher weights and repetitions while closely monitoring for a return of the pain and mobility loss indicative of rotator cuff injury.
In addition to acknowledging pain and taking action, a daily stretching routine helps to prevent injuries. Stretch the shoulders and rotator cuff specifically before lifting. Warm up the supporting muscles and joints and gradually increase activity before tackling heavy weights. Focus on maintaining flexibility and range of motion to really protect the rotator cuffs while lifting weights.
Read more: How to Stretch a Rotator Cuff
Diagnosing Shoulder Pain When Lifting
A couple of pain-specific symptoms while lifting can signal the need for a visit with your doctor, who must give an actual diagnosis:
Lack of mobility. Hold your elbow down against your ribs and rotate your forearm away from the body to check for acute shoulder pain and limited mobility. The Cleveland Clinic relates the pain to a toothache because it affects a specific point focused over the tear or damaged area.
Limited range of motion. Slowly raise your arm and wind back to throw like a baseball player. If range of motion is more limited than normal and there's acute pain in the shoulder, see an orthopedic specialist.
People who weight train daily or weekly are usually more in tune with these issues than newcomers or folks returning to the gym after a hiatus. Noticing a new pain is much easier when lifting consistently. Returning to the gym and engaging in intensive lifting can quickly lead to a strain or even a tear.
When consistent pain and lack of mobility are apparent, stop lifting with your arms and see your doctor, who may order an MRI. A full tear is a surgical candidate, but partial tears and strains are often remedied without surgery, which can involve beginning a rehab program to properly engage the rotator cuff while rebuilding to a normal state.
Specific Types of Injuries
Not all rotator cuff injuries are the same. The types of injuries are defined by how the tear is formed and is often also defined by how the injury happened. Some injuries develop over time while others are traumatic and almost instant.
A partial-thickness tear is commonly just referred to as a partial tear according to the American Physical Therapy Association. It means the tear is only partially through the muscle and tendon but has not completely penetrated the entire rotator cuff. The partial tear is repaired through surgery or rehabilitation. Choosing rehab is common to avoid surgery, but it still requires a significant amount of time to heal and rebuild the rotator cuff.
The full-thickness tear means the tear has penetrated the entire muscle. The complete tear really restricts function and is a prime candidate for surgery. After surgery, several months of rehabilitation are still required to rebuild before resuming a normal lifting routine.
Identifying the Cause
The second level of identification is the way in which the rotator cuff was injured. A sudden, traumatic tear occurs from a hard impact. These are often seen by athletes and weightlifters. The traumatic injury is instant immediately followed by the symptoms of a tear. Medical professionals refer to this as an acute tear.
The other type of tear is identified as chronic. This happens over time through repetitive motion. Chronic injuries are common in the workplace but also can happen to weightlifters and bodybuilders who are engaged in daily lifting routines that place pressure on the rotator cuff specifically.
Rotator cuff injuries by bodybuilding are likely different from those occurring among construction workers. A bodybuilder is more likely to have a sudden and traumatic tear that requires a longer rest period, while a construction worker is likely to incur a chronic injury that requires more aggressive rehab and less rest.
Rehab Is Critical
Rehab uses safe exercises with a rotator cuff injury to increase range of motion while slowly increasing strength in the muscles surrounding the rotator cuff.
Rehabbing a clean, sudden tear that is surgically treated is different from a long-term chronic injury. The clean tear is repaired before scar tissue fills the muscle. A chronic tear has scar tissue that is pervasive and difficult to remove surgically. Rehab is more intensive to loosen the tissue and help extend the range of motion in this situation.
During the rehab process, lifting weights on your own is not advised. The rehab itself often involves weightlifting and the process is not always easy. The weights are not heavy and are not intended to build a full spectrum of muscles. The exercises are very focused and designed to increase range of motion by pushing the limits of the muscle through stretching, riding an arm bike and doing resistance exercises. A resistance band is a staple in the rehabilitation training process.
Rest Requirements Before Rehab
Before the resistance bands and weights are incorporated into the rehab, however, a phase of rest and protective measures is necessary. The arm is often placed in a sling to rest, and the rehab movements are typically performed by a therapist. The therapists are essentially testing the range of motion and allowing recovery after surgery or after an injury. They use alternating cold and heat packs and electrical stimulation treatment to help with the healing process.
After a few weeks of rest, massage and healing, the intensity will slowly escalate. This is where the resistance bands and arm bike are incorporated into exercises. Eventually, weights are added and range of motion is pushed as the muscle grows and begins to resume normal movements.
The last phase of rehab is returning to the normal activities in life without yet returning to full lifting. This acts as a test environment to gauge pain and the progress of rehab. If the shoulder is still not back to normal, a return to rehab is required. If the shoulder is feeling stronger and working properly, a return to lifting is possible.
Resuming Full Weight Training
Don't lift weights with a torn or injured rotator cuff. Wait until you've completed rehab and are released by the doctor to resume activity. One major mistake made by many athletes and weightlifters involves returning to full speed immediately. The risk of a repeat injury is greater in the early stages of the return.
A repeat injury means you'll return to the doctor and be forced to repeat the entire rehab process. Avoid this by approaching the weight room passively and slowly rebuilding strength. Don't start at your old weights and reps. Start off on a much lower weight level and spend a few weeks or even months getting back to your former strength.
Additionally, protect the rotator cuff by incorporating daily stretches and stay in tune with any new pain developments. Listen to your body and stop lifting if the old pain recurs.
Changing Your Weight Routine
Chronic shoulder and rotator-specific injuries call for a change in your routine. Pressing through the injuries can ultimately lead to a career-ending injury or a succession of surgeries and more time spent in rehab than the gym.
Many rotator cuff injuries in the weightlifting community occur when lifting above your head. Clean and jerk and overhead presses with dumbbells or a barbell are common culprits. Even the bench press places a high stress load on your shoulders. Doing these lifts with exceptionally heavy weights places more pressure on the rotator cuff.
Read more: Shoulder Pain from Pullups
Move away from these high-stress lifts and focus on lifts that have a lower impact on the shoulders. Some common movements like a front dumbbell raise that stops at shoulder height can help strengthen the rotator cuffs. Keep your lifts focused on movements that take place below shoulder height to avoid injuries. Dead lifts, curls, tricep presses and a number of low-impact lifts can still strengthen and challenge your upper body without hurting your rotator cuff.
Focus on Form
Finally, focus on your form to prevent a range of injuries and improper muscle development. Lifting form is absolutely critical across the board. Overextending on a lift and repeatedly using bad form significantly increases the chances of an injury in general.
Lifting with a partner who can spot and advise you on form while lifting is a great way to ensure you're making the proper movements. Another option for solo weightlifters with shoulder issues is to work out in front of a mirror. Consider videotaping your training sessions. Study the recorded video to locate bad form and potential issues that may lead to a rotator cuff injury.
If you're still struggling with bad form and injuries, see a professional trainer to seek corrective measures. A professional can force your form back into shape. Doing this with repetitions ultimately creates positive habits that increase your performance and abilities as a weightlifter and athlete.
Is This an Emergency?
- American Physical Therapy Association: Physical Therapists Guide to Rotator Cuff Tear
- Men's Health: Here's Why Your Shoulder Hurts So Damn Bad When You Lift
- Mike Reinold: The 5 Biggest Mistakes People Make Returning to Training After a Shoulder Injury
- Duke Health: Preventing Rotator Cuff Injuries
- Cleveland Clinic: Rotator Cuff Injury and Tendonitis