rotator cuff tendinopathy

Shoulder injuries are very common among rock climbers. This is understandable, considering that rock climbers often hang for extended periods, placing a significant amount of weight and tension on their shoulders in various positions.

Rotator cuff tendinopathy is a very common shoulder injury and is the main focus of this article. Tendinopathy refers to a problem with a tendon, covering a range of tendon issues, including tendinosis, tendinitis, and more. Although this injury is not considered career-ending, it can still take you out of commission for a few weeks or even months. Physiotherapy can help!

Anatomy/etiology

To better understand what a rotator cuff tendinopathy means. We need to understand the anatomy of the rotator cuff.

We have 4 rotator cuff muscles.

MuscleAttachment on scapulaAttachment on humerusAction
SupraspinatusSupraspinous  fossaGreater tuberosity (superior)Abduction
InfraspinatusInfraspinous fossaGreater tuberosity (middle)External rotation
Teres MinorLateral boarder of scapulaGreater tuberosity (inferior)External rotation
SubscapularisSubscapular fossaIntertubercular grooveInternal rotation

Their main goal is providing shoulder stability by making sure that the head of the humerus will stay in place. As you can see in the picture, most of the rotator cuff tendons are found in the sub-acromial space. If for whatever reason, that space is reduced, it could compress and friction the rotator cuff tendons leading to tendinopathies. That space could be reduced for many reasons including poor scapula (shoulder blade) control, poor posture, upper back stiffness, poor trapezius strength, poor dynamic control… Your physio will try to find out the cause of the compression and will show you how to fix it. 

Sign and symptoms

Shoulder pain usually in the deltoid area.

  • Pain on palpation
  • Painful arc: pain only during a specific range of angle when lifting arm up.
  • Pain with body weigh ton arm or when hanging and climbing.
  • Pain at night

Diagnosis:

To diagnose a rotator cuff tendinopathy, your physio will ask you questions to find out if your history match with that condition. Your therapist might ask question about your rock-climbing training habit to detect any potential overuse. Questions about your pain (location, intensity, aggravator and easier) will also be asked. 

A few clinical tests could be performed:

  • Painful arm test
  • Infraspinatus test
  • Hawkins Kennedy test

But that cluster of tests is not the greatest at diagnosis this condition and a combination between a strong history and clinical test will be required.

Your physio will also assess your overall shoulder, scapula, neck and upper back range of motion and strength as all this joints as to be in optimal shape for your shoulder to be able to perform well when rock-climbing.

Psychological factors will also be assessed as it your mental health could highly be related with shoulder pain.

Medical imagery could also be used but is usually not required by the physiotherapist. Even when a muscle tear is considered, imagery results might not change the clinical plan as surgery is very rarely recommended for rotator cuff tear. But an MRI could be use to detect any damaged.

Treatment

Following a rotator cuff tendinopathy, you will have to follow 5 steps of recovery and return to sports.

Protect

First you will have to protect the injury. I am not talking about complete rest here, as it would be counterproductive. You physio and yourself will have to follow the tendon recovery loading principal in order to insure proper adaptation to your tendons. You might have to slow down and the rock-climbing activities, but only temporary.

In term of pain control, ice can be used on the pain full area. Acupuncture could also be used to decrease pain temporarily

Taping

Mobility. 

You will then wok on mobility for every joint involved in shoulder movement which are:

Your physio will prescribe you with mobility exercises in order for you to improve

Strength

Strengthening exercises will be prescribed to improve muscle strength and control

These exercises will be very specific to your weakness and your physio will insure to prescribe you the right exercises and to progress them accordingly.

Scapular muscles are often weak. So strengthening the upper fiber of the trapezius might be important, especially as a rock-climber.

Rotator cuff strengthening will also be important in order to get the tendons stronger.  Your physio will prescribe different exercises depending on the level of tendinopathy. 

Functional dry needling (FDN):

FDN is a technic where we use needle to stimulate muscle. It can be use in addition to exercises to insure proper muscle activation during the exercise. 

Proprioception

At this stage, you will have most of your mobility and strength

Proprioception is the ability of your body to know where you are in pace. 

Shoulders are very mobile, but not very stable. People often mistake the shoulder joint by being a ball in socket joint. It’s not completely false, but I would describe that joint more by being a golf ball on a golf tie. 

Not supper stable at all

Therefore, as a rock climber, you will work a lot on shoulder stability. You will have to control your scapula, in both open and close chain situation, in order to prevent injury

Example of shoulder stability exercises.

Return to sports:

The last stage is there for you to make sure you work on specific skills related to rock-climbing you will restart training, but your risk will be slightly elevated compared to a non-injured athlete.

You will work on more complexes exercise involving the whole body. You should have full mobility, full strength, and great proprioception at this stage.

Sport specific exercises for rock climbers

Prognostic:

Most people will fully recover from rotator cuff tendinopathy. Pain can last quite a few weeks. Rehabilitation can be quiet long (up to a year). On average, rock climber will be back 100% somewhere between 8 to 12 weeks assuming they are getting treated

What to do next:

If you suspect you have a rotator cuff injury, the next step is to seek help from a physiotherapist. A trained professional can assess your condition, identify underlying causes, and create a personalized treatment plan to help you recover. Physiotherapy is key to managing pain, restoring function, and preventing future injuries. If you’re in luck and live in Kanata, Ontario, you can visit us at Kinoveo Physiotherapy Clinic, where our experienced team is ready to help you get back to your activities pain-free.

Disclaimer

The health and medical information on this site is designed for educational purposes only. You should not rely on this information as a substitute for, nor does it replace, professional medical advice, diagnosis, or treatments. Consult your health care professional before making any decisions to your health. Call 911 in case of a medical emergency. If you have any concerns or questions about your health, you should always consult with a physician or another health-care professional. 

The research

Arias-Buría, J. L., Fernández-de-las-Peñas, C., Palacios-Ceña, M., Koppenhaver, S. L., & Salom-Moreno, J. (2017). Exercises and Dry Needling for Subacromial Pain Syndrome: A Randomized Parallel-Group Trial. Journal of Pain, 18(1), 11–18. https://doi.org/10.1016/j.jpain.2016.08.013

Chester, R., Jerosch-Herold, C., Lewis, J., & Shepstone, L. (2018). Psychological factors are associated with the outcome of physiotherapy for people with shoulder pain: A multicentre longitudinal cohort study. British Journal of Sports Medicine, 52(4), 269–275. https://doi.org/10.1136/bjsports-2016-096084

Hegedus, E. J., Cook, C., Lewis, J., Wright, A., & Park, J. Y. (2015). Combining orthopedic special tests to improve diagnosis of shoulder pathology. Physical Therapy in Sport, 16(2), 87–92. https://doi.org/10.1016/j.ptsp.2014.08.001

Lewis, J., Mccreesh, K., Roy, J. S., & Ginn, K. (2015). Rotator cuff tendinopathy: Navigating the diagnosis-management conundrum. Journal of Orthopaedic and Sports Physical Therapy, 45(11), 923–937. https://doi.org/10.2519/jospt.2015.5941

By Anurag Rathod

Anurag Rathod is an Editor of Appclonescript.com, who is passionate for app-based startup solutions and on-demand business ideas. He believes in spreading tech trends. He is an avid reader and loves thinking out of the box to promote new technologies.