Shoulder Tendinitis...My Ongoing Saga Continues
Imagine an injury that never heals. An injury that progressively gets worst no matter how much rest you get. An injury that puts a halt to all fitness and exercises efforts and makes even walking a painful and awkward task. That, my friends, is the nature of shoulder tendinitis and something I wouldn’t wish on my worst enemy.
I’ve been battling shoulder tendinitis for about 4 years now, and until recently, I thought I’d never be able to overcome this debilitating injury. You can read about my past experience with shoulder tendinitis in the following locations:
Shoulder tendinitis, if left untreated can lead to a variety of progressively worse conditions such as frozen shoulder or calcified tendinitis. Frozen shoulder is just that, a shoulder with very limited mobility due to hardening and shrinking of the tendons. Calcified tendinitis is a condition in which the body responds to a tendon injury (over time) by feeding it additional nutrients, such as calcium. This response is to help strengthen the tendon from further injury but it shrinks, hardens, and reduces a persons range of motion.
The absolute worse thing about tendinitis (besides the ongoing pain) is the progressively worse state your injury becomes. With a lot of injuries (Non life threatening), you can ice the injured body part, give it some rest and over time, it eventually heals. This healing process allows a person to eventually resume physical activities such as weight training or other favoured pass times. Not so with tendinitis.
After awhile it seems like the pain becomes a way of life and you just have to live with it. Well, if you’re suffering from this injury or know someone who is, there is hope and a way to get rid of the pain and get on with living a normal life. I will get into this in more detail shortly.
Tendinitis is a condition that results from wear and tear (injury), irritation / inflammation and the bodies response to help heal the injury. The injury is the main culprit but the pain associated with tendinitis isn’t the actual injury but rather the bodies signalling response to send in fluids and chemicals to help heal and protect the injury.
Let’s take my shoulder for example. My injury stems from years of heavy shoulder pressing, bench pressing, and incline pressing. 4 years ago, I attempted a heavy incline press and noticed a slight “bump” after completing the last repetition. The last repetition was the “final straw” and pushed my scapula slightly downwards along with all the tendons. Soon after, I moved back to Ontario, Canada and during that move, my condition got worse. My shoulder was in complete agony and no matter how much rest I got, it didn’t get any better. That was 4 years ago and I’m still battling with this condition.
The important thing to remember about tendinitis is that it’s not the actual injury or the inflammation that causes the pain but the bodies actual response to the injury. With tendinitis, the injury can stem from the wear and tear of a tendon or a one time injury such as a fall. The bodies response is to send in a bunch of fluids to the injured site to help start the healing process. These fluids contain chemicals that act as pain signals (hurts to the touch) and it’s these chemicals that are the actual culprit for the pain. It’s the bodies way of telling you not to touch the injury.
Your tendon / s are now injured but tendinitis is sneaky. You can wake up one morning and find that the injury doesn’t hurt anymore. You go about your activities and be fine for weeks, months, or even years and than all of a sudden, the injury rears it’s ugly head and this time, the injury doesn’t go away.
Over time, it gets easier and easier to aggravate the injury and each time you injure yourself, the body sends in fluid and chemicals (the ones that cause pain) to the tendon and surrounding structures. Soon, certain types of movement “injures” the tendon and the bodies response is to send in pain signals - This becomes the “normal” response and you find yourself living in constant pain.
I didn’t know this...
You see, the only relief I’d get from the tightness in my shoulder was to lift my arms over my head and “crack” the tendons. This relief would last about 10 minutes but the tightness would always return and always worse than before. The cracking relieved some of the tension but it eventually returned because my tendons have hardened and the actual muscle size has shrunk. Unbeknownst to me, this actually contributes to the problem and over time, deteriorates the condition of your tendons. It also causes me considerable pain as I mentioned above.
Tendinitis is a nasty cycle that repeats itself over and over until the tendon shrinks to such a point that it either calcifies, freezes up, or tears. Yep, I know, it sucks and if your unlucky enough to sustain such an injury, I certainly feel for you. There is hope and I’ll let you in on some very important information shortly but first, let me explain what the biggest problem with an injury such as tendinitis is. It’s...
My injury stems from my scapula (shoulder blade) but the symptoms show up on the front of my shoulder. The pain is caused by the symptoms (front shoulder) but the real injury is to my teres minor and major attachments located on my scapula. I didn’t know this until recently and I’ll get into that shortly.
I’ve been to two different physiotherapists. The first therapist didn’t do a thing for me except cause me more pain. The treatment plan involved painful, deep tissue massage, stretching and ultra sound therapy on the front of my shoulder in order to alleviate the pain and eliminate scar tissue. Four months of agonizing deep tissue massage (For those of you who have had this massage, you’ll know what I’m talking about!) and I got absolutely zero results. This therapist concentrated all her efforts on the front of my shoulder while ignoring the root cause of the problem. After four months, I decided to try another therapist.
The second therapist actually performed a full diagnosis and came to the root cause of the problem. He pinpointed the problem and identified the correct exercises to do. Essentially, he wanted to strengthen the muscles surrounding the scapula in order to “bring” the shoulder blade back up to it’s normal position. In theory, this would loosen up the tendons and take all the tension off the front of my shoulder. This actually worked and my shoulder felt close to 90% - Pain free!!
However, there was one big problem. At that point, my tendons had all this old, nasty fluid trapped inside which caused them to harden and to become a lot more dense. A healthy tendon is flexible and “squishy”- Kind of like a thick, elastic band. These tendons are nice and shiny. A tendon that has been inflamed and afflicted with tendinitis for any length of time will be hard and inflexible kind of like a piece of bark. These tendons are more milky in colour.
I didn’t know this and in all honesty, I don’t think my therapists did either. In fact, off all the places I’ve checked, including medical sites, not one mentioned this phenomenon. No matter where I checked, all sources spouted the same information. Most sources stated that 1) Tendinitis is an inflammation of the tendons; 2) Use hot and cold treatments to help heal the injury; 3) Rest the injury; 4) Use massage to help get rid of scar tissue formation; And 5) Perform specific exercises and stretches to help strengthen and re-habilitate the injury. Does all this sound familiar?
This is the usual course of treatment for tendinitis and works some of the time but there is one big problem. Once pain has been identified, the body has started it’s own healing process and is now hardening the tendon and protecting it from further damage. If the injury is caught early enough and the main source of the pain is identified, regular treatment can work. However, tendinitis is tricky because you may think you’re treating the source of the pain, but your actually treating the symptoms. You can spend months treating the wrong area and in that time, the injury simply gets worse and starts the painful tendinitis cycle.
A doctor may also prescribe a cortisone shot, steroid shot or other anti inflammation medications. This may help with the pain in the short term but eventually it will return. The fact of the matter is that your body has now turned it’s pain response into a normal thing. Any type of inflammation and the body sends more fluid (And pain signalling chemicals) into the tendon and surrounding areas. This in turn, hardens the tendon and shrinks the associated muscle which causes more tightness. Any type of aggravation such as cracking the tendons or something as simple as working on the computer will send signals to your bodies response system which in turn sends fluids that actually cause the pain.
Over time, the body conditions itself to respond in this fashion. This nasty cycle just repeats itself until the tendon gets harder and more dense which greatly restricts mobility and / or the tendon actually tears.
I have to admit, that I’ve done most of these treatments and it was a big hit and miss. In fact, some of these techniques actually helped to aggravate the injury. I’ve learned to never apply heat to an injured tendon. Most “experts” will say that heat helps stimulate blood flow which helps heal the tendon. Yes, it does but it also invites more fluid (And chemical signalling agents) into the area which you don’t want. Apply ice, and if you can use “ice massage” to help reduce inflammation and help kick out unwanted fluids. The more unwanted fluids you have in your tendons, the more they build up.
When should a person use heat? Heat should be used prior to performing stretching and strengthening exercises. Remember, once these exercises have been completed, it is very important to apply ice treatment.
What about rest? Sure, this may work in the short term but trust me, if you do anything that aggravates the injury, it will return. Rest does nothing to remedy the actual problem, regardless of what most experts will tell you. I’ve tried it and the problem always returned. The trick is to rest and identify the source of the injury. Now, this can be tricky because it can be difficult to locate the source of the problem. I think this is why so many people suffer for such a long time with tendinitis.
What about specific exercises designed to strengthen the tendon and associated muscles? It may help but the problem will always remain. The fact is, you now have a dry, hard tendon that is building up and shrinking the entire muscle structure. What use is it to strengthen a muscle while the tendon is still hard and brittle? You must identify the problem, treat it and soften up all that scar tissue so the tendon starts to “reverse” it’s condition. Yes, you can reverse the symptoms and start living pain free but it’s important to identify the problem, treat it, and start the reversal process.
What about heat or ice treatments? Heat will force more blood and fluid into the injury. The extra blood and fluid can help with the healing process but it can also impede it. Remember, you don’t want all that extra fluid building up around the tendons. This makes them dry and hard. If you use heat, always make sure you follow it up with cold treatments as this will impede the inflammation process and help kick out the extra fluid.
Ice treatments can be a very effective method and one that I recommend. It will help reduce the amount of inflammation and eliminate extra fluid. The one person I talked too who actually knew what he was talking about explained it to me this way. Tendons are similar to sponges. You want to fill these sponges with new blood, oxygen and nutrients and expel the waste products that are stuck in the tendons. To expel the waste, one of the better ways is to massage the effected area. Massage can help the healing by eliminating chemical waste and invite more nutrient rich blood into the affected area.
Massage is a very effective treatment and if done properly can reduce the amount of inflammation and scar tissue associated with tendinitis. Deep massage can help kick start the healing process and eliminate the chemical build up in your tendons. This can lead to successful healing. The biggest problem is finding the main culprit. For example, you may think the problem is in the front of your shoulder but a deeper prognosis may reveals that it is only a symptom. The problem may stem from your shoulder blade (scapula) and it’s pulling the tendons down causing friction at the top of your shoulder.
There are some critical things you have to remember about tendinitis. First, you have to understand the injury and work with someone who has EXTENSIVE experience with this type injury. This goes for doctors, therapists, and other health professionals. You want a qualified experienced health professional to help identify the source of the problem and treat it as opposed to treating the symptoms (IE: cortisone and steroid shots and NSAID’s)
It is critical to use the right information and start addressing the root causes of your injury. It took me 4 years to find a person who actually knew what they were talking about. Quiz your medical or health professional using the quiz listed here. Don’t feel comfortable quizzing your doc? Trust me, it’ll be worth it because it can save you years of unwanted pain. If possible ask for a referral to an experienced therapist who has extensive knowledge with this type of injury and proven track record. Don’t make the mistake I made and assume your therapist knows what they are doing. Do some research and make sure your therapist knows what they are talking about.
Beware of using web sites as your number one information source because a lot of them have it all wrong when it comes to tendinitis. In fact, I purchased an e-book for 40 bucks on how to heal my tendinitis and it did nothing but aggravate my injury. This is the tricky part about tendinitis because everyone has a different opinion. Remember there are no magic potions that will help reverse the process or help heal tendinitis. You have to be diligent about what web sites you visit and what information you want to trust. In my experience, there are more incorrect web sites about tendinitis than there are correct ones. Just beware.
I will give you the name and web site of the guy I was talking to and how he changed the way I looked at tendinitis. His name is Joshua and he has a website called the “tendinitis expert” and he explained the entire injury process to a tee. I paid 50 bucks for a 60 minute phone consultation and it was the best 50 bucks I ever spent. Without meeting me in person, he identified the source of my problems, helped diagnose causes, and identified proven treatment options. All the options are natural and can be performed at home. Best of all, these treatments are dirt cheap and very effective.
You want to use the right information and start “re-programming” your body to heal the actual injury, not treat the symptoms.
1) Rest the injury and find the root cause of the problem. This can be a little tricky and as I mentioned before, tendinitis can be difficult to locate but if you can work with an experienced health professional you should be able to locate the root problem. However, this can take some time and trial and error but over time, you should be able to find the problem. Remember, stop all physical activities during this period because if you keep doing those activities, you’ll only aggravate the injury and you don’t want this. Find the injury, rest it, treat it, heal it, and than resume physical activities. How long does it take to heal? This all depends on the severity of your injury. It can take 2 days, a week, a month, or several months depending on how quickly your find the source of the injury and treat it.
Every 20 minutes, I do a simple stretch for my back muscles and every hour I do a simple massage. Since I can’t physically massage the back of my shoulder and back, I use what is called the “tennis ball massage”. I use a simple tennis ball and place it on the wall using my left arm. I leaned into the tennis ball and gently rock back and forth on the affected tendons. I do this for about 5 minutes and it takes away the pain while at the same time, it helps to reduce scar tissue and promote healing.
I will also make sure I watch my posture at the computer. To do this, I will straighten my back and move my shoulder blades back and puff out my chest. This forces me to always watch my posture at the computer.
I also apply ice to the back of my shoulder twice a day for 15 minutes. I’ve also increased my intake of magnesium as this has been shows to greatly help reduce tendinitis inflammation.
3) Apply strengthening activities to supporting structures.
I will do special rotator cuff strengthening exercises and stretches to help increase mobility. I will do these exercises once per day. The first exercise is a teres minor and major strengthening exercise. I use a 4 foot rubber tube band. Using my left arm, I will keep the one end of the tubing just above my waist. With the right hand, I’ll grip the other end of the tubing (The tubing is behind my lower back) and straighten my arm at a 45 degree angle (shoulder level). Using the teres minor and major muscles, I will “push” forward while keeping my arm perfectly straight. I don’t use my shoulders to push forward but my teres minor and major muscles.
The second exercise is a light dumbbell shrug. Using a 5 pound dumbbell and keeping my arm straight at my side, I will raise the dumbbell slightly to my side (not the front) until the dumbbell is about 6 inches away from my body. I make sure I turn the dumbbell upwards with my thumbs facing towards the ceiling. Keeping my back perfectly straight, I shrug the shoulder and hold for 8 to 10 seconds. I will repeat this for a set of 4. This helps to strengthen the entire shoulder structure.
I will do some basic stretching for the chest/deltoid and to the back of the shoulder. Afterwards, I will do a light ice massage for the front of my shoulder and apply an anti inflammatory such as Voltren.
4) Find those activities that contribute to the problem and avoid or improve on how you perform them. I injured my shoulder from years of heavy pressing. I now stay away from those exercises that aggravate the injury and keep the weight moderate. I can no longer do sets of 6 using super heavy weight. I now do 12 to 15 repetitions using moderate weight and keeping the range of motion restricted. That is, I don’t go all the way down for any type of pressing movement. By going all the way down, I can easily aggravate the injury. I also use more machines because they tend to help stabilize my shoulder structure more so than free weights. I ABSOLUTELY stay away from those exercises that can re-injure my shoulder. These exercises include upright rows, heavy press behind the necks, bench press, jump rope (yes, jump rope aggravates my shoulder injury), and other awkward movements.
Remember this very important piece of advice. Once you start back with weight training, you have to "START OVER". You must not jump back into heavy weights like you did before your injury. You basically have to keep up with your physical therapy and start with those puny 3 to 5 pound dumbbells again. Your repetition range should be around the 15 to 20 mark and nothing stressful. It may take a month, or three months but you will start to feel better. The important thing is to take things slow and stop doing super heavy pressing. Remember, use high repetitions and moderate weight.
I can’t stress the importance of treating the root cause as soon as you can. If you feel you have injured tendons, I strongly suggest you see a qualified, and experienced health professional immediately. By doing so, you can treat the root cause of the injury and prevent further injury. There are times when you may want to “train” through the pain but this ALWAYS makes the injury worse and it will always takes more time to recover. Do not aggravate already injured tendons.
If you know someone who is currently suffering from tendinitis, please send them this page using the button below. Simply click the "tell a friend" button to send them this page immediately. It can be the difference between someone living in constant pain and someone who is able to start living a normal life again.
All the best,
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