Most shoulder pain is a result of too much, too soon, too often.
Become Pain Free with our 3-Step Rehab Solution.
The Mighty Shoulder
Your body is amazingly robust and adaptable, when you give it the right stimulus over a period of time, it progressively acquires more Movement Capacity.
Your shoulder is no exception, given the right training and an appropriate schedule, it continues to adapt giving you more and more capacity for more complex and demanding movement.
The shoulder joint is uniquely incredible. It is the most mobile joint in the body yet it can also support an immense load, such as your entire body weight in a handstand. When you’re doing a handspring on a spinning dance pole, it actually takes more than your body weight due to centrifugal force!
As awesome as your shoulder is, it can still succumb to pain and injuries.
Tendinopathy is the most common shoulder complaint and it often seems to have a “mysterious” origin – You’re happily enjoying your (often new) favourite movement activity and one day, out of nowhere, you start to feel some stiffness and/or a little niggle in your shoulder. You think it’s nothing and that it will go away, a few weeks later, it not only hasn’t gone away, but is now starting to interfere with you doing handstand, pole dancing, Yoga…. etc. You ask yourself “What have I done? I don’t recall any incident that could explain my shoulder pain at all?”
The physiological processes that “make you more awesome” takes time to happen, take collagen synthesis for example, the cellular processes continue “under the hood” for up to 48 hours after your activity!
This means there is a lag from activity to outcome, and this goes for both positive and negative outcomes :
- It takes time to get stronger.
- It takes time for a Capacity Deficit to show up.
Which means there is indeed a perfectly good explanation for your shoulder pain, only the reason is “invisible” and flies under the radar for weeks before it is detected. This is an exceedingly common presentation for shoulder tendinopathy – you do too much too soon, your body isn’t ready for all the fun and grumbles at you with stiffness and niggles.
In other words, stiffness and niggles are often the first signs of a Capacity Deficit.
3 Steps to Pain-Free Shoulders
With this valuable information in mind, overcoming shoulder tendinopathy becomes a matter of eliminating your Capacity Deficit and improving your Movement Capacity.
Here’s our 3-step approach:
- Stop Getting Worse
- Bridge The Gap
- Build A Buffer
1. Stop Getting Worst
Contrary to common belief, this DOES NOT generally require you to stop doing what you love completely! This is because stopping does nothing to improve the capacity of your tendon, rather, it is more likely you’d lose capacity further! This is why tendon pain often returns, or worsens, on resumption of activity after a period of rest.
The key in this phase is to find the sweet spot between not getting worse and not losing capacity. You do this by modifying your activity to find just the right amount to maintain capacity without aggravation. This means you actually need to keep moving!
2. Bridge The Gap
Once you’ve found your sweet spot, you then begin bridging the gap to eliminate your Capacity Deficit.
What you need to close your gap is unique to you and depends on your current capacity, the demands of your activity, and what specifically is lacking, i.e. you need to find your missing pieces.
What is lacking could be any number of elements in your Movement Capacity. The key to successfully closing your gap is in tailoring your programme to your individual needs.
3. Build A Buffer
As you begin to close your gap and your symptoms improve, it is important that you continually evaluate and progress how much you do as guided by your symptoms.
The reason you want to build a buffer is because it is not a good idea to work at 100% capacity all the time without any margins for error. You want to always have more juice in your tanks to handle whatever you throw at yourself plus room for anything unexpected.
Building a buffer typically involves ongoing strength building and is best done separate to your movement activity. E.g. 2 movement classes + 1 dedicated buffer building session per week.
As you can see, overcoming shoulder tendinopathy is a straightforward process though it doesn’t mean it is easy. The good news is you don’t have to do it alone!
Your physiotherapist can help you determine your sweet spot of activity, your missing pieces, and help you build a generous buffer so you can enjoy doing what you love for as long as you want.
The 5 no-no’s For Tendon Pain
Here’re a list of what NOT to do if you have tendon pain.
Do Not Ignore Stiffness
Next-day stiffness is tendon talk for “I’m not coping with what you did to me”. This is often the earliest sign of a Capacity Deficit. The onset of stiffness is the best time to sort it out and turn things around.
Do Not Completely Rest A Painful Tendon
Resting does nothing to improve the capacity of your tendon; pain often returns when you resume movement. The key is to find the right amount to maintain your capacity without aggravation.
Do Not Dig At A Painful Tendon
Whilst it can feel nice and productive to massage a sore tendon, it also tends to irritate it. It’s just like when you have itchy eyes and you rub them with gusto then shortly after they feel like they’re on fire and you kick yourself for doing it.
Do Not Sweat Your Scan Result
Degeneration and tears are seen in the scans of people with pain-free shoulders too; they do not correlate with symptoms nor reflect the tendon’s capacity. In fact, the look of your tendon doesn’t actually change even when pain and capacity improve!
Scans are great for excluding serious issues, other than that, they give people too many normal things to worry about.
Do Not Follow Recipe Programmes
Whilst there’re evidence-based guidelines for tendon rehab, there is no one-size-fits-all solution, not to mention exercise prescription differs depending on what type of tendinopathy you have! The key is to address YOUR specific deficit to give YOU the capacity to do what YOU want.
This is by no means an exhaustive list, rather, it highlights the latest research findings on tendon rehab. We have come a long way from the old ways of treating tendinopathy, gone are the days of routine rest and anti-inflammatory for “tendonitis”. Did you know there is actually very little to no inflammation present in tendinopathies at all?
The field of tendon research is vibrant and ever-evolving, which means we are getting better and better at treating and preventing tendon issues, and being able to apply the most cutting-edge in science and medical research to get results more effectively is most exciting indeed!
Contemplating Shoulder Surgery?
3 Tips for Shoulder Pain