Dealing with shoulder pain: Rotator cuff problems and how to manage it by Dr. Will Ko DC, CSCS

As a chiropractor and bodybuilder, I frequently see athletes and weightlifters as patients.  One of the most common areas of discomfort that I see in patients deals with the shoulders.  In many instances, shoulder injuries and pain may arise from the rotator cuff muscles of the shoulder.  In this article, I will discuss how the rotator cuff complex works, how shoulder problems arise, and what can be done to prevent or manage them.

The rotator cuff is made of four muscles.  Three of these muscles (supraspintus, infraspinatus, and teres minor) contribute to external rotation of the shoulder.  The fourth muscle (subscapularis) contributes to internal rotation of the shoulder.  These muscles are often activated in activities such as throwing, rowing, and bench pressing.   But most importantly, these muscles work synergistically to stabilize the shoulder joint during strenuous activity.  Proper strength, endurance, flexibility, and balance of these muscles are crucial to optimal function of the shoulder joint, especially with regards to resistance training and sport.

There are several diagnoses that relate to shoulder pain and the rotator cuff complex.  It is important to know how to diagnose shoulder pain and how they are brought on.

  1. Rotator cuff strain:  Strained muscle or a pulled muscle is a tear of theThere are 3 degrees of a strained muscle:  1st degree: minor tear which may result in pain when using or stretching that particular muscle.  2nd degree:  moderate tear resulting in moderate pain, bruising of the region, as well as mild to moderate weakness of the injured area.  3rd degree: full tear or rupture of the muscle, and the most severe.  One may experience severe pain, bruising, and moderate to severe weakness of the injured region.  From my experience, rotator cuff strain is typically brought on by either overload of the shoulder girdle, and/or by using the shoulder complex with poor mechanics or technique.
  2. Rotator cuff tendinitis: Tendinitis is essentially inflammation of the tendon of theThis injury typically comes about with chronic repetitive stress.  People who suffer from rotator cuff tendinitis may experience an intense dull ache or burning sensation in their shoulder.  Pain is typically brought on when beginning an activity or during an activity.   In many cases, pain may improve as the shoulder muscles get warmed up, but may feel very painful and sore as you cool down.  Often times, people will try to “work through the pain” until the shoulder gets warmed up, but this will typically lead to long term issues with the shoulder, and possible further injury.
  3. Shoulder impingement: Shoulder impingement occurs when there is mechanical stress put on one of the rotator cuff muscles, but only with certainTypically when the shoulder is at rest, the patient is essentially pain free.  But when the arm is raised above shoulder height, brought behind them, or with external rotation of the shoulder, the patient experiences a momentary sharp pain, or a “pinch” within the shoulder.  The culprit of the problem is inflammation of the supraspinatus muscle.   When this muscle gets inflamed, it is vulnerable to “pinching” within the subacromial space of the shoulder, which is a very narrow space within your scapula (shoulder blade).  Inflammation may occur with injury or overuse of the shoulder.  It is also important to note that the supraspinatus muscle is responsible for the first 10-15 degrees of shoulder abduction (lateral raising of the arm), so with weight lifting, it makes this muscle vulnerable to strain and overuse.

As athletes and fitness enthusiasts, we always want to have our bodies perform at optimal levels.  Many of us will work harder and eat better to achieve these goals.  But all too often, many of us lack the maintenance work required to keep our high performance bodies at peak condition, and prevent breakdown.  High performance vehicles, such as Ferrari and Porsche, require regular maintenance work to keep the car running optimally.  These “maintenance” suggestions will help keep our high performance bodies at full GO!

  1. WARM UP! Too often many of us do not warm up prior to ourWarming up helps to improve the blood flow to our muscles, reduce viscosity in our joints, and also helps increase elasticity within our muscles, which may allow increased flexibility when stretching.
  2. Stretch! Following your warm up, gentle stretching is advised once again to improve the elasticity of yourThis may help to prevent muscle strain, as well as improve muscular contraction due to optimal muscle cross fiber sliding.  You should only feel mild tension within the muscle while performing these stretches, and most importantly with NO pain.
  3. Variety in exercise routine.  Many shoulder problems arise from chronic repetitiveFrom my experience, staying on the same exercise regiment for too long can make you more vulnerable to tendinitis or strain.  Making sure that your routine is constantly changing can ensure that different angles and different parts of the shoulder muscles are being hit, and may help to avoid constant pounding on the same area of the shoulder.  For example, try dumbbells instead of barbell, machine instead of free weights, etc.
  4. Balance in shoulder strength.  The shoulder joint has the greatest range of motion in theAt times, there can be an imbalance in strength between the muscles of the shoulder complex.   There are a couple things we can do to improve strength and endurance of the shoulder to promote balance and stability:

Perform internal/external rotation. These can be performed with the arm abducted or with the elbow at your side against your ribs.  You DO NOT want to use heavy resistance with these exercises, as the rotator cuff muscles are not large muscles.  Focus on good tempo and high repetition.  You can perform a slow and controlled motion with a cable, and/or you can perform ballistically with a rubber hose or band.  My recommendation would be working with 3-10 lbs of resistance for 15-25 reps, performing in each direction, about 3 sets each.  These exercises are great to do as a warm up before performing upper body or shoulder intensive exercises.







Train rear deltoids first or early in your shoulderIf people even do rear shoulders in their workout, it is usually a low priority and done last.  A lot of the workouts in our routine activate the anterior shoulder frequently, and our anterior shoulder becomes much stronger than our rears.  This may off set the normal joint centration (centering) of the shoulder, and may push the head of the humerus forward.  All of this can predispose our shoulder to injury.  Try training rear shoulders early and heavy in your shoulder routine at least every other workout.

Now that I have shared with you how to help prevent rotator cuff injuries, there are some things you can do to help manage you shoulder pain:

  1. REST:  Although many of us would never imagine skipping a workout, I believe it is better to back off now and allow the healing process to take place instead of having subpar workouts while inTry avoiding pain provoking exercises and motions to prevent further injury and inflammation.  When you return to training normally, make sure your approach is gradual over the course of several weeks instead of going right back into your normal weights and resistance.
  2. ICE:  Most shoulder pain comes fromIcing is a safe and cost effective way to reduce inflammation and help with pain.  Try icing 20 minutes on, and at least 40 minutes off before your next application.
  3. Seek consult from a health professional:  If your pain is severe, or lasts more than 2 weeks, or if it begins to affect your activities of daily living, then I would advise you to seek the help of a healthI would suggest seeing a chiropractor, physical therapist, or an orthopedic for shoulder problems.  They can help to diagnose and treat your pain and help speed up the healing process so that you can be back in the gym training at 100%!

Supplements that help alleviate joint pain: Fish Oil, Glucosamine, Chondroitin 

About the author

It is a passion of mine to inform and help others achieve and feel their best.  Feel free to send questions my way at the Optimum Nutrition Athlete’s site @, or check out my website at  Train hard and train smart!!!

Dr. Will Ko, DC, CSCS

ON/ABB sponsored athlete

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