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The 3 most common shoulder injuries in the gym

Shoulder pain is one of the main reasons people come into clinic and can be very debilitating and affect your gym workouts. We treat a lot of clients who go to the gym so we have a solid insight into gym injuries. At worse you may have to stop doing weights completely and let the injury rest. Finding out exactly what is wrong with your shoulder is important in understanding how to best treat it. When this is known you can then know exactly what you can do in the gym without aggravating your pain also improving your form.

These are the most common injuries we see in clinic in order of frequency:

1) Shoulder impingement.

A shoulder impingement is a broad term for shoulder pain that gets worse when you raise your arm generally beyond 70 degrees. Most commonly pain can occur through a painful arc of 70-120 degrees where either the supraspinatus tendon (rotator cuff), joint capsule, bursa, ligament or biceps tendon can get pinched under the acromion (side of the shoulder blade). Generally if you are told you have a shoulder impingement it will be the Supraspinatus tendon.

Causes can include repetitive pushing motions like push ups, bench press, over head press, lateral and front raises, dips, lat pull downs and chin-ups. Often the reason these actions cause pain is due to instability in the shoulder girdle, muscle imbalances (tightness in the pectoralis major and minor pulling the scapula forward, weakness in the stabilises and the rhomboids mid trapezius), winging scapula or poor posture.

Having good form, setting the shoulders and making sure the shoulder doesn't come forward when lifting is important as this forward movement of the shoulder means that the humerus comes into a position where the tendon can get pushed up against the acromion of the shoulder.

Poor posture sitting at the desk will also contribute to your shoulder impingement as if your shoulders are forward and rounded it means when you lift your arm above your head your humerus will pinch against the acromion. Try this yourself. Slump your shoulders forward and then try to lift your arm above your head, out to the side or out in front. You should notice that you feel a pinching in the shoulder. This is an example of if your shoulders are forward and you are lifting weights above your head you will be constantly pinching the tendons and other soft tissues against the acromion.

Stretching out the chest, focussing on having the shoulders set (back and down) as well as working on shoulder stability exercises will be your best bet in recovering from shoulder impingement and also preventing yourself from getting there in the first place.

As we age the acromion can become hooked which is like a bone spur that will close down the space in the shoulder joint and put more pressure on the suprapinatus tendon. So over the age of 40 we are much more likely to have a shoulder impingement and need to be more careful with our shoulders, especially lifting over head.

2) Rotator cuff tear

A tear in the rotator cuff tendon can cause pain in the shoulder. Generally this pain can be felt in the side of the shoulder joint. A tear in the rotator cuff muscles can be caused by trauma such as falls onto the outstretched arm or shoulder. Over use or heavy weights with poor form can also cause a tear. Usually you will feel the shoulder “go” when lifting something heavy. Generally this will be felt as a dull ache in the back/side of the shoulder with pain in movements above the head or any rotation of the shoulder. If a shoulder impingement goes untreated then it can lead to a tear in the supraspinatus tendon.

Improvement of posture, form, stability of the shoulder and releasing tension in the soft tissues can help this injury recover.

3) Long head biceps tendonitis

Pain in the front of the shoulder is often coming from the long head tendon of the biceps brachii muscle. The tendon of the biceps muscle runs up into the bicipital groove of the humerus and into the shoulder joint attaching to the labrum. Repetitive flexion of the elbow in actions such as heavy biceps curls can irritate the biceps tendon as well as deep bench press and dips. Any pain in the front of the shoulder should be assessed asap as continual training on an inflamed tendon can lead to more lasting permanent damage.

Avoiding heavy bench press, especially going deep, will be key in not aggravating a biceps tendonitis. Deep bench press will but a lot of stress on the biceps tendon. Again having good shoulder stability and not rounding your shoulders is important in not aggravating the biceps tendon.

Other more chronic shoulder injuries

Subacromial Bursitis

Bursae are fluid filled lubricating sacks that live between tendons and bones to protect the tendon from friction. Overuse can lead the bursa to become inflamed. “itis” means inflammation so Bursitis is inflammation of the bursa. There are multiple bursae in the shoulder such as the subacromial bursa, sub deltoid bursa, subcoracoid bursa and subscapularis bursa.

Pain from bursitis can be felt as a dull ache in the shoulder that won't go away. Pain can be felt with overhead movements of the shoulder or internal/external rotation of the shoulder. If you have had pain in the shoulder for a long period of time then this may be bursitis. The most common bursitis in the shoulder is the subacromial bursitis. This lives between the supraspinatus (rotator cuff) tendon and the acromion. When this bursa is inflamed it can also increase the chances of the supraspinatus tendon becoming more inflamed as it will create less space in the shoulder for the tendon the glide.

Usually a scan on the shoulder will show bursitis. Bursitis is also more common in people over the age of 40.

Labral Tear

The Labrum is a cup of cartilage that sits inside the socket of the shoulder (glenoid fossa). It allows a deeper joint for the ball of the humerus to join. The labrum also provides some cushioning to the joint. If you have a fall on your shoulder or on an outstretched arm then you may damage or tear the labrum. Overuse and particularly overhead weights can also damage the labrum.

A labral tear will be experienced as clicking or catching in the shoulder especially lifting the arm up and rotating it.

Note that there is also a labrum in the hip joint that can also be damaged.

As you can see most of these shoulder injuries can present with the same pain symptoms. Injuries such as shoulder impingement are much easier to treat and have better treatment outcomes than something like a shoulder bursitis. Getting the correct diagnosis and treatment is the most important thing in getting better.

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