Ideally, we want weight training to be as pain and hassle-free as possible, yet still effective. It’s not comfortable when you push your muscles hard, but it shouldn’t be frankly painful. No pain, no gain only holds true up to a point – and not to the point that you injure yourself. What if you’re doing an upper body exercise, like overhead press, and you feel a twinge in your shoulder?
First, pain in the shoulder isn’t normal, even if you’re pushing yourself. The worst thing you can do if you feel a shoulder twinge is to ignore it and keep training. One of the biggest concerns with shoulder pain is that it’s a rotator cuff tear, one of the most common causes of shoulder discomfort when you move your shoulder.
What is this joint that makes up your shoulder? Your shoulder is a ball-and-socket joint known as the glenohumeral joint, an unstable joint and one that’s prone to injury. That’s because the socket, the portion of the joint that holds the head of the humerus is small and shallow. The main source of stability comes from the joint capsule and the muscles that make up the rotator cuff. In all, there are four rotator cuff muscles and tendons that help stabilize the shoulder joint when you rotate and raise your arms above your head. Unfortunately, these muscles are easily injured and when they are, the injury can become chronic.
Rotator cuff problems are typically of two types. The tendons that connect the rotator cuff muscles to the bone can become inflamed from overuse, also called rotator cuff tendinitis, or one of the rotator cuff tendons can tear, obviously a more serious form of injury and one with a longer recovery period.
The more serious form of rotator cuff problem, a rotator cuff tear, can happen due to trauma such as a fall or come on suddenly while you’re weight training. For example, you could potentially tear a rotator cuff when you quickly jerk a weight or kettlebell that’s too heavy. Rotator cuff tears due to trauma can be complete or partial. With a complete tear, the tendons become detached from the bone, whereas a partial tear means there is still a connection between bone and tendon.
With a full rotator cuff tear, you typically experience severe pain and arm weakness. Full tears typically require surgery, whereas a partial tear may heal on its own with physical therapy.
Rotator Cuff Tenonitis
Hopefully, you’ll never experience a full rotator cuff tear. Even if you only injure your rotator cuff, the tendons can become painful and inflamed from being overworked or from using incorrect form when you lift weights. Rotator cuff tendonitis becomes more common with age as the tendons lose water and become thinner and stiffer. Doing weight training exercises where you lift your arms overhead, like overhead presses or lateral raises, repeatedly can inflame the tendon, especially if you use sloppy form.
Athletes who play sports that require overhead arm movements are also at higher risk of rotator cuff tendonitis, including volleyball players and pitchers. People with certain occupations, like those who do home remodeling or other jobs that require overhead work are also susceptible to rotator cuff irritation and repeated trauma.
Sometimes what appears to be rotator cuff tendonitis turns out to be a small tear in the tendon that happened gradually over time. It’s important to remember that shoulder pain isn’t normal, and you shouldn’t assume it’s due to overuse. You may actually have a small rotator cuff tear and shouldn’t keep lifting through the pain.
As mentioned, pain when you do certain exercises, particularly overhead presses and lateral raises, are a red flag for rotator cuff problems. If you have a small tear, you might also experience tenderness in the shoulder or back of the arm when you reach your arm behind you or raise it above your head. In addition, your shoulder might make crackling or cracking sounds when you move it certain ways. It’s not uncommon to have discomfort in the affected shoulder at night while you’re sleeping, especially if you’re lying on it.
Sometimes a small rotator cuff tear begins insidiously with mild symptoms, like pain when you do certain weight training exercises, and worsens over time to the point that you have difficulty raising the arm beyond a certain point and experience weakness on the affected side. That’s why it’s so important to take shoulder pain seriously and not train through it.
How do you know if you have a torn rotator cuff? The best way to find out whether you have one is to see your physician and get a full exam. They’ll likely want to do an imaging study. Standard x-rays aren’t very helpful as many rotator cuff tears won’t show up. Better studies are ultrasound or MRI since these tests show the soft tissues in the shoulder, including the tendons.
What If You Have Pain Involving the Rotator Cuff?
Unless you have a full tear, the injury will likely heal with conservative treatment. You’ll have to rest the shoulder and modify your activities so that you don’t place additional stress on it. Physical therapy can be of benefit too, specifically exercises that safely strengthen the injured shoulder and improve flexibility. If the pain is severe, some healthcare practitioners may offer a steroid injection to reduce the pain and inflammation.
Preventing Rotator Cuff Tear Problems
Rotator cuff problems are common and dealing with one is frustrating and painful. Make sure you’re doing what you can do to keep your rotator cuff muscles and tendons healthy. First, always do a warm-up to bring up your body temperature before working muscles, including the muscles in your shoulders. Cold muscles are stiffer and more prone to injury. Never begin with heavy weights. Do a few warm-up sets using lighter weights before picking up heavy dumbbells or barbells.
Also, do exercises specifically designed to strengthen your rotator cuff. Examples are internal and external rotation dumbbell curls and forward raises. Use lighter weights and higher repetitions when working the rotator cuff muscles as the muscles are small. Follow each session with rotator cuff stretches.
The Bottom Line
Hopefully, you’ll never have shoulder pain or a rotator cuff injury, but if you do, you now know why it’s important not to ignore it or train through it. It’s better to be safe than develop a chronic shoulder problem.
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