"Committed to Educate, Not Just Rehabilitate"

Focus on Sports Medicine

"Shouldering Muscle Pain"

The sport of Track and Field involves many events requiring the use of multiple muscle groups. An athlete who is a sprinter relies on a lot more than just his/her leg muscles. Any shot putter will tell you that there is a lot more involved in his/her event than just lifting a ball and throwing it. Many events require the use of the shoulder/arm in executing the proper technique.

Many injuries in sport occur from a breakdown in the proper technique. This mechanical breakdown in muscle function can lead to serious injury. Injuries to the Rotator Cuff muscle are no different. We always hear of baseball pitchers tearing their Rotator Cuff, but what is it ?

The Rotator Cuff is made up of 4 muscles surrounding the shoulder joint. The shoulder is the most unstable joint in the body, and the Rotator Cuff helps to dynamically keep the shoulder ball in its' socket. Injuries occur at a time when the demand is greater than the supply. If an athlete tries to throw an object a certain distance, and the demand to perform this task is greater than the inherent strength of the musculotendinous unit, than there will be a breakdown of musculotendinous fibres with the subsequent development of a "Tendonitis". The Rotator Cuff is responsible for lifting the arm to the side/in front/behind/ and to rotate it in and out.

One does not have to throw an object to develop a "Rotator Cuff Tendonitis". This injury can occur in runners, as well, and can subsequently affect his/her running style. Typically, a person may have pain on the upper outer aspect of his/her arm. There will be difficulty with lifting his/her arm above shoulder level. There may also be pain with bringing the arm across the body (ie/ like in discus). It is also difficult to lie on the affected side when lying in bed at nighttime.

The steps to follow in recovering from this type of injury are the regular five steps of rehabilitation. The first stage involves just eliminating the pain. The second stage involves improving on flexibility and the overall range of motion. The third stage involves improving the athletes overall strength. The fourth stage involves improving the overall fitness of the athlete. The last stage pertains to working on sport specific strengthening exercises.

The best means of achieving these stages is through the assistance of your sports medicine health care practitioner. Avoiding doing any activities above shoulder level/heavy lifting/or throwing motions. Try not to sleep on the affected side. The next thing is to ice the shoulder for pain relief and an anti-inflammatory effect. Ice for 10-15 minutes at a time 3-4 times/day. The use of an NSAID is also helpful. The therapist that you see will use ultrasound, interferrential current, laser, TENS and other modalities to try and achieve the same result. Once the pain is gone, one can move to the next step. The next couple of stages involve the development of a comprehensive stretching and strengthening program for the Rotator Cuff. These exercises are meant to be done well past the time of one's rehabilitation. The exercises are meant to be done to help maintain the strength as well. One would have to avoid any offending activities during the treatment period to ensure a speedy recovery. This condition usually takes approximately 3-6 weeks to treat. X-Rays are not always necessary, so this is left up to the discretion of the healthcare practitioner.

The greatest cause of Rotator Cuff Tendonitis is doing too much too soon. Your coach is one who should be able to help you in your training schedule. Haste always makes waste. "Shouldering" muscle pain can be quite debilitating, particularly for a throwing athlete. Make sure that you have it looked after quickly, so that you can help avoid it from becoming chronic. Always listen to your body when you start to feel the pain coming on. Remember, "No pain, no gain, is only for the Insane."

Respectfully submitted,


Howard A. Winston
MD, CCFP, FCFP
Dip. Sport Med. (CASM)
Medical Director, The Centre for Health & Sports Medicine

07/2000