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Brian Schiff’s Blog

Injury Prevention, Sports Rehab & Performance Training Expert

Tag: rotator cuff pain

There are several things that contribute to shoulder impingement and rotator cuff pain.  Perhaps one of the biggest issues that impacts overhead athletes, Crossfit enthusiasts and the avid weight lifter is limited shoulder mobility.  Poor flexibility in the pecs, lats, posterior shoulder as well as limited thoracic spine extension and rotation all contribute to suboptimal movement.

Poor mobility can place the scapula in biomechanically flawed positions, increase glenohumeral internal rotation and restrict shoulder movement at end range creating compensatory movement and pain.  The video below is a snippet from my upcoming webinar on rotator cuff dysfunction and nonoperative treatment.

This webinar will be great for strength coaches, exercise enthusiasts, Crossfit athletes/coaches, athletic trainers and physical therapists. If you want to attend the webinar or catch the on-demand version, simply visit www.alliedhealthed.com.  In addition, you may find my DVD on rotator cuff training very helpful in overcoming shoulder pain and staying pain free in the gym.

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Click here to see a brief video overview of the DVD or visit my site at www.BrianSchiff.com for more info.  Use the code Holiday15 at checkout from today until December 25 to save $10 off the retail price.

Have a great Thanksgiving and enjoy your time with family and friends!

So, I treat a number of fitness enthusiasts in the clinic and many include Crossfit clients.  Recently, I evaluated a 38 y/o male on 2/16/12 with a 3 month history of right shoulder pain.  He performs Crossfit workouts 6 days per week.  His initial intake revealed:

  • Constant shoulder pain that worsens with overhead movements
  • Pain with bar hangs, overhead squats and wide grip snatches
  • Unable to do kipping (only doing strict form pull-ups)
  • Pain if laying on his right side at night
  • No c/o neck pain, referred pain or numbness/tingling

Notice the shoulder position during the kipping pull-up and overhead squat below.  This is a position of heightened risk for the shoulder.

His exam revealed the following:

  • Normal range of motion
  • Strength within normal limits except for supraspinatus and external rotation graded 3+/5 with pain
  • Positive impingement signs
  • Negative shrug sign
  • Negative Speed’s and O’Brien’s test
  • Tender along distal supraspinatus tendon

Based on the clinical exam, it was apparent he had rotator cuff inflammation and perhaps even a tear.  Keep in mind he had not seen a physician yet.  I began treatment focused on scapular stabilization and rotator cuff strengthening as well as pec and posterior capsule stretching to address the impingement.  Ultrasound and cryotherapy were used initially to reduce pain and inflammation.

One month following the eval

By 3/14/12, his pain was resolved with daily activity and he had returned to snatches and push-press exercises without pain. He still could not do overhead squats with the Olympic bar pain free, but he could with a pvc pipe.  Strength was now 4/5 for supraspinatus and 4+/5 for external rotation.  All impingement tests were now negative as were Speed’s and O’Brien’s testing.


Continue reading…

I have been rehabbing rotator cuff injuries for the better part of 13 plus years now.  I also have the privilege of teaching fitness boot camps, educating other fitness pros on training/rehab and training athletes.  One of the most common issues I encounter in my work is rotator cuff pathology (tendinitis, tears, etc.).

I have sold well over 10,000 copies of my Ultimate Rotator Cuff Training Guide (e-book and print versions) since its release in 2004.  While most of the training methodology is still sound today, I wanted to add some new content and tweak a few progressions.  Like anything, with time you gain more experience and wisdom.

In addition, many people were asking me for the DVD version to better understand how to perform the exercises.  So at last, I have released the DVD version.  Some of the new additions include:

  • Soft tissue mobility exercises
  • Self assessment screening tools
  • Integrating a towel roll with rotation exercises

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In addition to the DVD itself, you get a companion CD-ROM with my Self Stretching Guide, personal interview on rotator cuff injuries, my 60 minute rotator cuff explained power point and audio seminar, the entire updated rotator cuff e-book, and 5 second video clips of each the particular exercises in the rehab plan.

I am selling this product for $49.95, but until next Wednesday (June 16) you can get it for only $29.95.

Click here to see a sample clip from the DVD

If you decide to grab a  copy, simply use the code BFITCUFF (all caps) at checkout and be sure to hit apply to get credit for the coupon.  You can order at www.brianschiff.com.

This DVD is ideal for people with acute or chronic nagging shoulder pain related to bursitis, scapular imbalances, rotator cuff tendinitis and rotator cuff tears.  As always, I offer a 60 day money back guarantee on all my products.  If you have any questions, simply post them on the blog.

Here’s to happier and healthier shoulders!

If you have ever experienced shoulder pain (whether sudden or chronic) you have probably heard people or docs throw out the terms tendinitis, bursitis, or partial and full thickness tears.  In this post, I will attempt to summarize these and delineate as best I can between the symptoms you may experience.

Bursitis - inflammation of the subdeltoid bursa (fluid filled sac) beneath the deltoid.  Bursae are in place to cushion the soft tissue and prevent rubbing or friction.  They lie between tendon and bone or between the tendon and skin.  In the shoulder, signs of bursitis include:

  • Pain and tenderness along the upper arm with radiating pain down the to the elbow in many cases
  • Pain lying on the affected shoulder (esp. at night)
  • Pain with repetitive motion (especially overhead and behind the back)
  • Warmth and swelling along the middle deltoid

Tendinitis - the tendon itself becomes inflamed and swollen (usually the supraspinatus) and may become trapped or start rubbing beneath the acromion (top of the shoulder blade) and then becomes an impingement problem (known as impingement syndrome).  Pain may also be felt along the biceps tendon as it may undergo undue stress and strain in relation to a cuff issue.  It is also important to note that bursistis often accompanies tendinitis.  Typical symptoms include:

  • Point tenderness at or near the top of the shoulder or over the biceps tendon as it meets the shoulder
  • Pain and joint soreness along the front of the shoulder
  • Pain that worsens with elevating the arm above 90 degrees or moving it away from or behind the body
  • Pain with lying on the affected shoulder
  • Pain tucking in your shirt, fastening a bra or styling your hair

Tear - defined by a disruption in the quality or integrity of the muscle and or tendon.  Tears are typically quantified by the location (articular or bursal side) size (in centimeters) and degree (partial or full thickness).  Not all tears are created equal - that is a fact.

I have seen small tears (less than 1-2 cm) create equisite pain and dysfunction, while large tears (greater than 3 cm) may produce less pain and limitations in daily activities for folks.  Hallmark symptoms of a tear include:

  • Pain at night that interrupts sleep
  • Persistent dull ache or even throbbing pain that is not affected by rest or positional changes
  • Significant weakness or even muscle atrophy (look at the shoulder blade from behind or int he mirror)
  • Loss of elevation and arm rotation overhead and behind the back
  • A positive shrug sign (see below as excessive upper trap work that compensates to elevate the arm in light of a torn rotator cuff muscle)

Positive Shrug Sign

Positive Shrug Sign

Some research suggests up to 90% of tears will worsen over time.  Tears do not spontaneously heal.  With that said, many respond well to conservative rehab with an emphasis on restoration of motion, appropriate strengthening and avoidance of abusive activity.

The prescription for healing bursitis and tendinitis is much the same.  However, catching the “itis” early on and using ice, rest and anti-inflammatory medication as prescribed can often cure it in weeks and prevent further damage.  Pain shouldreally guide all activity and exercise progression.  The other forgotten friend is ice - whether acute or chronic I advise daily icing for pain relief.

Want more answers to rotator cuff issues?  Visit my site at www.rotatorcufftraining.com.