The 3 Most Common Shoulder Injuries from Working Out

Exercise is an important part of any health routine and has benefits not just physically, but mentally as well. During intense gym workouts, the shoulder is often one of the most common areas of injury. The shoulder joint is a ball-in-socket design, shaped like a golf tee, which gives a large range of motion. The socket is flat on top, making the ball of the upper arm bone moveable, but also which means that it can be easily dislocated.

When gym workouts that include weightlifting are part of your regular routine, improper technique or excessive weight can cause a great deal of wear and tear to the joint, muscles, and tendons of the shoulder. Below, are three of the most common shoulder injuries that happen in the gym.

Rotator Cuff Injury

By far, this is the most common form of injury in the shoulder. The rotator cuff is made up of four muscles that rest along the perimeter of the ball of the shoulder joint and allows the shoulder to move. This injury can happen as a result of repetitive movements like overhead lifting and cause the top of the shoulder blade to pinch at the muscles of the rotator cuff. The repetitive motion can lead to overload on the tendons, eventually developing tendonitis. If this pain is ignored, then it can eventually lead to a tear in the rotator cuff.

Weight Lifter Shoulder

The acromioclavicular (AC) joint is at the topmost part of the shoulder blade and connects to the collarbone. For those who engage in exercises where the elbows are lowered behind the shoulders (benchpress, chest fly, etc), this motion can place additional stress on this joint and bone. Over time, this can cause small tears or fractures. If not given the time to heal properly, this injury can lead to painful inflammation of the joint. This condition is often referred to as “weightlifter shoulder“.

Dislocated Shoulder

A dislocated shoulder is a common occurrence in both gym members and athletes alike. It occurs when the ball at the top of the shoulder slips out of the socket. Once dislocated, the ball can then slip backward, forward or downward. Generally, this occurs after a strong hit to the shoulder in football or hockey; however, it can also happen if you rotate the shoulder too far.

High Mountain Orthopedics specializes in bone, joint and muscle injuries, including shoulder injuries. Dr. William Matarese and Dr. Tony Wanich have over 25 years of combined experienced treating orthopedic and sports injuries. Our practice uses a multi-disciplinary approach that includes physical therapy and activity modification. If surgery is necessary, our team utilizes the latest advancements in Minimally Invasive and Arthroscopic procedures to expedite the healing process. If you are suffering from a bone, joint or muscle injury – contact our offices today!

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If you are feeling pain in your shoulder, it is probably in your best interest not to continue working out and to instead allow the pain to subside before working out again. Shoulder pains occur from a variety of shoulder injuries, some of which are referred to as “repetitive motion injuries” while others are tears or strains of muscles and ligaments in the region. While more serious shoulder injuries require total immobilization, some stretching and low-impact exercises can still be performed while experiencing shoulder pain.

Common Shoulder Injuries

While shoulder pain can stem from a variety of injuries and ailments, some of the most common shoulder injuries include impingement, instability, rotator cuff tears, bursitis and tendinitis. Repetitive strain injuries, such as a rotator cuff strain, or bursitis and tendinitis often result in a dull and inflamed pain. Instability of the shoulder occurs when a shoulder joint is forced out of its normal position, resulting in pain when raising your arms. Impingement is often due to excessive rubbing between your shoulder blade and shoulder muscles. Shoulder instability and impingement are two types of injuries that can be prevented or minimized through basic arm-strengthening exercises such as wall push-ups and shoulder press-ups.

Stretching

If you are suffering from a bursitis or overuse injury that results in a dull pain, stretching can often help reduce tension and improve blood flow to these regions. If the pain has gradually decreased as days go by, it is safe to stretch out your shoulder and arms. Shoulder stretches range from arm extensions to elbow bend stretches. To perform an elbow bend stretch, stand up straight with your arms at your sides and knees slightly bent. From there, lift your injured arm up, bending it at the elbow and placing your hand flat on the back of your neck. Take your other hand and place it on the top of your elbow, pushing down until you feel a stretch. Hold the stretch for 10 seconds before relaxing.

Low-Impact Exercises

If you are rehabilitating from a shoulder injury, you eventually need to integrate low-impact exercises back into your daily routine. While your shoulder may still hurt, performing low-impact exercises that do not increase the pain of your shoulder can help improve range of motion, as well as strengthen the muscles in your arms. Low-impact arm exercises can be performed while swimming or using resistance bands to perform curls or arm extensions. To perform a resistance-band curl, attach the center of a resistance band to a static object, grabbing the ends of the band with both hands. While standing up straight with your knees slightly bent, curl your arms by bending at the elbows. Curl until your hands are at shoulder height before extending back out. Repeat until fatigued.

Caution

While it is possible to exercise with an injured shoulder, always consult with your doctor to make sure working out in your condition won’t result in further damage to your arm. If your shoulder injury is a result of a surgery, you’ll eventually have to work out to restore strength and range of motion to your arm. Despite this, it is important to distinguish between exercising with a stiff and immobile arm and exercising with pain. If you feel severe pain in your shoulder, you should not work out.

The shoulder joint is the most complex joint in the human body. It is tasked with giving you both the mobility to move your arm 360 degrees, as well as the stability that allows all the bones, muscles, tendons, and ligaments that make up the shoulder to work together.

With all of parts that make up the shoulder, it’s common to experience pain or loss of mobility due to injury. If you are experiencing shoulder pain, try these exercises to help relieve your pain. Remember to always see a doctor if you experience shoulder pain that is not relieved by several days of rest, ice, massage, and elevation.

1. Arm-across-Chest Stretch – Hold your right hand out in front of you, keeping it near your waist. Reach your left hand behind your elbow, pulling your right arm to the left and across your chest. If you feel pain in your shoulder, lower your arm until the pain subsides. The goal is to be able to pull your right arm across your chest without feeling any pain. Hold for 30-60 seconds then relax and repeat with your left arm. Repeat 3-5 times.

2. Neck Release – Sit up straight then slowly bring your chin toward your chest until you feel the stretch in the back of your neck. Try leaning your head to the left to stretch your right shoulder or leaning your head to the right to stretch your left shoulder. Hold the stretches up to one minute in each direction, breathing deeply as you concentrate on relaxing. Repeat 3-5 times.

To progress the stretch, elevate your arm as you pull it across your chest until it is the height of your shoulder.

3. Chest Expansion – Put an exercise band, rope, strap, or even a tie behind your back and grasp it with both hands. While holding the strap, draw your shoulder blades toward each other and gently lift your chin toward the ceiling. Breathe deeply for 10 to 15 seconds and release. Repeat 3-5 times.

To progress the stretch, move your hands closer together on the strap.

4. Seated Twist – Sit straight up in a chair with your knees together. Twist your torso to the right, placing your left hand on the outside of your right thigh. Relax your shoulders as you look towards your right, gentling pushing on your right thigh. Breathe deeply for 10 to 15 seconds and release. Repeat with your left side. Repeat both sides 3-5 times.

5. The 90, 90 Shoulder Stretch – Stand in a doorway, holding your arms up so your elbow is at a 90 degree angle and your arm forms a 90 degree angle to your body at the shoulder. Place each hand on one of the sides of the door frame, placing one foot forward as you stand up straight aligning your neck with your spine. Lean forward as you brace yourself against the door frame. Hold the stretch for 20-30 seconds. Repeat 2-3 times.

Shoulder Pain

A common cause of shoulder pain is soreness of the tendon (a cord that attaches a muscle to a bone) of the rotator cuff. This is the part of the shoulder that helps circular motion. Another common cause is soreness of the subacromial bursa (a sac of fluid under the highest part of the shoulder).

You might experience soreness after painting, lifting items, or playing a sport—anything that requires you to lift your arms. Or you may not remember any specific injury, but you still feel pain in your shoulder.

How does the rotator cuff get hurt?

The main joint in the shoulder is formed by the arm bone and the shoulder blade. The joint socket is shallow, allowing a wide range of motion in the arm. The rotator cuff is made up of 4 muscles that surround the arm bone. This cuff keeps the shoulder steady as the arm moves.

The supraspinatus muscle rests on top of the shoulder. Its tendon travels under the bone on the outside of the shoulder (the acromion). This tendon is the one most often injured because of its position between the bones. As the tendon becomes inflamed (sore and swollen), it can become pinched between the 2 bones. The sac of fluid that cushions the tendon can also be damaged.

How do I know the rotator cuff is hurt?

If the rotator cuff is involved, the pain is usually in the front or outside of the shoulder. This pain is usually worse when you raise your arm or lift something above your head. The pain can be bad enough to keep you from doing even the simplest tasks. Pain at night is common, and it may be bad enough to wake you.

Path to improved health

Your doctor can help you with a treatment plan to relieve the pain and help you restore your shoulder to normal function. Pain relief strategies include active rest. During active rest, you can and should move your shoulder. Avoid difficult activities like lifting heavy objects or playing tennis. You may also get relief by applying ice, taking nonsteroidal anti-inflammatory medicine such as ibuprofen (brand names: Advil, Motrin) or naproxen (brand name: Aleve), and, occasionally, an injection of anti-inflammatory steroids. Special exercises may also help.

The first step of rehabilitation therapy is simple range-of-motion exercises. By bending over and moving (rotating) your shoulder in large circles, you will help to avoid the serious complication of rotator cuff injury, called a frozen shoulder. You should follow these range-of-motion exercises with resistance exercises using rubber tubing or light dumbbells. The final step is resistance training with weight machines or free weights.

What exercises should I do?

The following exercises may help you. Ask your doctor if you should do other exercises, too.

Range of motion

Stand up and lean over so you’re facing the floor. Let your sore arm dangle straight down. Draw circles in the air with your sore arm. Start with small circles, and then draw bigger ones. Repeat these exercises 5 to 10 times during the day. If you have pain, stop. You can try again later.

Rotator cuff strengthening

Use a piece of rubber tubing for these exercises. Stand next to a closed door with a doorknob. Loop the tubing around the knob. With your hand that is closest to the door, bend your arm at a 90° angle (at the elbow) and grab the loop of the tubing. Pull the band across your tummy. At first, do 1 set of 10 exercises. Try to increase the number of sets as your shoulder pain lessens. Do these exercises every day.

Upper extremity strengthening

As your pain goes away, try adding a general upper body weight-lifting program using weight machines or free weights. Lie on your right side with your left arm at your side. With a weight in your left hand and your forearm across your tummy, raise your forearm. Keep your elbow near your side.

What else can I do to help this injury heal?

An aerobic exercise program will help improve the blood flow to the tendon or bursa. The blood flow will help reduce soreness. Smokers should quit smoking so more oxygen reaches the injured tendon. This will help the injury heal faster.

Things to consider

It often takes a shoulder a long time to heal. The earlier you address the pain, the better. Depending on your injury, you should be able to make a full recovery. However, many people complain that even with a full recovery, their shoulder is not as strong as before.

When to see a doctor

Sometimes an injury that lasts a long time will cause the tendon to tear. Tell your doctor if your pain goes on in spite of a good treatment program. Or when there is weakness in certain motions of the arm. You may have torn your rotator cuff. This type of injury may need surgery.

Questions for your doctor

  • What is causing my shoulder pain?
  • Could my shoulder pain be caused by my sleep position?
  • Do I need to limit my activities?
  • Why is it taking so long for my shoulder to heal?
  • How can I prevent a repeat of my shoulder pain if I don’t know what caused it?
  • Will my shoulder heal completely?

Resources

National Institutes of Health, MedlinePlus: Shoulder Injuries

National Institutes of Arthritis and Musculoskeletal and Skin Diseases

We ask a lot from our shoulders, including having the strength and flexibility to reach, lift, hold, carry, press and pull. With all this activity, it’s unsurprising that we experience some degree of shoulder discomfort in our life. If shoulder pain is left untreated, however, it can become a chronic problem that can inhibit everyday activities like carrying groceries, getting dressed or combing your hair.

Contrary to what many believe, the shoulder is more than just a single joint. The shoulder is actually comprised of several joints that combine with tendon and muscles to provide the rotation and stability we’re all familiar with. The shoulder complex can involve many other body parts, including the:

  • Neck
  • Ribs
  • Scapula (shoulder blade)
  • Clavicle
  • Thoracic region of the spine
  • Humerus

Causes of Shoulder Pain

Some sources of shoulder pain constitute a medical emergency and require immediate attention followed by professional rehabilitation led by a physical therapist, such as dislocation, separation or fracture.

Some of the common causes of shoulder pain are arthritis, impingement, instability and overuse. Other common causes of shoulder pain may include:

Rotator cuff tendonitis. The rotator cuff is a group of four muscles tasked with supporting and moving the shoulder. The tendons attach to the arm bone in an area underneath the bony prominence of the shoulder blade. Rotator cuff tendonitis can become pinched under this bone, which causes inflammation and soreness.

Biceps tendonitis. The biceps tendon attaches your biceps muscle in the upper arm to the front of the shoulder. This tendon can become pinched due to the bony anatomy of the shoulder blade or by ligaments that attach to the collarbone and shoulder blade.

Bursitis. Shoulder bursitis occurs when the bursa, a fluid-filled sac that enables body structures to glide smoothly over one another, becomes pinched. There is a bursa between the humerus bone and the shoulder blade.

Frozen shoulder. Also called adhesive capsulitis, frozen shoulder is condition where the shoulder becomes painful and gradually loses motion due to lack of use, a worsening rheumatic disease, a lack of fluid to help the shoulder move or bands of tissue that grow in the joint and restrict motion.

Exercises and Stretches to Relieve Shoulder Pain

If your shoulder pain is the result of a trauma, or if the pain has persisted beyond two to three weeks, you may want to seek medical attention. Certain causes of shoulder pain, such as rotator cuff injuries and frozen shoulder, get worse over time and may require surgical intervention if more conservative treatments are unsuccessful.

If you don’t feel your pain warrants a visit to the doctor, you should consider enlisting a physical therapist to help. You don’t need a referral to do this. After an initial evaluation and assessment of the pain, your physical therapist may use a goniometer to measure your range of motion and strength while monitoring the quality of the shoulder motion. Your physical therapist will then likely recommend stretches and exercises to help control inflammation and relieve pain.

Some of the most effective exercises and stretches to relieve shoulder pain at home are:

Pendulum. To do the pendulum exercise, start by leaning over and supporting your non-injured arm with a table or chair. Allow the sore arm to dangle straight down and then draw circles in the air. The circles should start out small but gradually grow, and you should also reverse direction periodically. Repeat this exercise 5 to 10 times throughout the day.

Arm across the chest. To do this stretch, hold your right hand out in front of your body, keeping it near the waist. Then reach the left hand behind the elbow while pulling the right arm to the left and across the chest. Lower the arm until the pain lessens. Hold in this position for 30 to 50 seconds and then release. Repeat this stretch 3 to 5 times. Neck release. While sitting up straight, slowly tilt the chin toward the chest until the stretch can be felt in the back of the neck. Then lean your head toward the left to stretch the right shoulder, or conversely lean to the right to stretch the left shoulder. The stretch should be held for a minute on each side. Try breathing deeply to help relax and maximize the stretch. Chest expansion. For this exercise you’ll need an exercise band, rope, strap or a tie. Take one of these items and hold it behind your back while grasping with both hands. Move the shoulder blades toward one another and gently lift your chin toward the ceiling. Hold for 10 to 15 seconds while breathing deeply. Do this 3 to 5 times. If you’re experiencing pain performing any of these exercises, or if your pain levels don’t progressively improve after about 6 weeks, you should consider asking a licensed physical therapist about manual therapy. Manual therapy is a specialized form of therapy in which the physical therapist uses their hands in lieu of equipment to address pain sources.

Soreness and pain from workouts can happen to the best of us. Maybe the issues started after you missed a few upper body workouts in a row and you’re feeling a little soft—so when you finally get back into the swing of things and hit the gym, you hit it hard. Maybe too hard. The next day, you wake up with sore shoulders.

The good news? As long as the feeling of soreness goes away within 24 to 72 hours, it can be a sign that you did some real work. You loaded your body just enough to cause “microtrauma” to the tissue (sounds worse than it is) and that feeling can actually indicate you made some changes. The bad news? You’re feeling all that work, and it doesn’t feel great.

Delayed onset muscle soreness, or DOMS, can contribute to a feeling of fatigue, soreness, weakness, stiffness and even pain. It usually occurs after a bout of high intensity training during which the muscles are eccentrically loaded to a degree that causes small tears in the muscle fibers. While not completely understood, these microtears in turn may lead to increased protein synthesis and the body adapting to the new stress put upon it. Eccentric loading of the muscles is an important way of building strength.

But there is a fine line between loading the muscles and overloading the muscles, so DOMS can also function as a signal that you’re doing too much.

If you are experiencing sore shoulders, there are a few things you can do to ease the pain and discomfort and accelerate the recovery process. Stretching, unfortunately, is not one of them.

Your Move: The evidence on how to treat DOMS is mixed, but there are a few methods you can try. To reduce inflammation and improve mobility for those sore shoulders, you’ll want to increase blood flow to the area.

This can be done a few ways: Try applying moist heat for 10 to 15 minutes 2 to 3 times a day, gentle massage, or low intensity activities that use and move the affected muscles without straining them. A sauna session and a hot bath or shower may also help.

If you’re experiencing pain, consider anti-inflammatories, but don’t use ice—research indicates ice may work against you in this case. Make sure you’re consuming a good amount of water and protein.

Most importantly? Be patient. Symptoms should reduce within 1 to 3 days. If your issues persist or intensify, consider seeing an MD or Physical Therapist to rule out injury.

Dr. Rachel Tavel, PT, DPT, CSCS Dr Rachel Tavel, PT, DPT, CSCS is a Doctor of Physical Therapy, Certified Strength & Conditioning Specialist, health and fitness writer, and runner who works as a PT at Shift Wellness in New York City.

‘Good Pain’ Versus ‘Bad Pain’ for Athletes

By: Edward G. McFarland, M.D. and Andrew Cosgarea, M.D.

What is the difference between good pain and bad pain?

It is well known among athletes that some discomfort is part of athletic activities and is often part of a successful training program. For muscle strength to increase, the muscle must see some increase in stress over what it is used to experiencing, and this stress is usually perceived as the “burn” in muscle during activity. This mild burn is what we call good pain and is the basis of the popular phrase, “No pain, no gain.” This pain should be short-lived and resolve soon after the activity ends.

Fatigue after a good, strenuous workout is also a sign that the exercise is pushing the limits of the athlete’s physiology, but it too should not be excessive. This fatigue should leave the individual somewhat exhilarated but not overly exhausted. Fatigue that lasts days means the individual’s physiology has been excessively challenged, and this means that the muscles and the energy stores are not being effectively replenished. Chronic fatigue after excessive exercise suggests that the individual may be overtraining. If after appropriate rest the fatigue continues, it may be a sign of other medical problems and you should consult a doctor.

What are the signs of bad pain?

The muscles, tendons, ligaments, cartilage and bones of the body are living structures that react to the stress of exercise only gradually. If they see stress too fast, they cannot respond effectively and may begin to fail. The causes of the failure can be too much stress too fast, or it can be the accumulation of excessive stress over time. When this occurs, each one of these tissues responds a little differently. This can result in bad pain.

For example, when muscles that have not been exercised for long periods of time see a lot of stress, they respond by getting sore. Muscle soreness typically occurs if you do a new exercise to which you are not accustomed or if you do a familiar exercise too hard. This soreness typically begins within a few hours but peaks one to two days after exercise. This soreness is called delayed onset muscle soreness and may represent actual muscle damage. A little soreness or discomfort means that the muscle has been stressed, but if the muscle is exercised too much, the muscle can become very sore to move and touch and may even swell. In severe cases, the muscle may be damaged to the point that the muscle starts to develop permanent damage. In extreme cases, individuals who are not adequately conditioned who exercise excessively can develop a condition where the muscle is permanently damaged and proteins are released into the blood stream, which can shut down the kidneys. While it is rare, there have been cases of death due to this extreme overexercising of the muscles, so it is generally recommended that if you start an exercise program, you begin very slowly and build up gradually. To prevent this problem with your muscles, we usually recommend the following rule: Take the amount of exercise you think you can do and cut it by one third the first few times you do it.

In a similar fashion, the tendons that connect muscle to bones may get irritated if they see too much stress too rapidly. They respond by getting inflamed, which is characterized by pain and sometimes swelling. Tendinitis pain typically occurs during exercise and can continue afterward when performing activities using that muscle or tendon. For example, tendinitis of the kneecap tendon (patellar tendon) is frequently seen in athletes who do jumping or squatting activities. The pain is made worse with these activities, but the pain may continue after sports activity when climbing stairs or getting out of a chair. In more severe cases the tendon may become swollen and any movement of the tendon or knee joint can hurt.

The bones likewise need time to respond to new stress. When bones see increased amount of stress, such as an increase in running when preparing for a marathon, they respond by putting more bone in the areas of the bone that are seeing more stress. This response is called remodeling and strengthens the bone. However, if the area of bone sees stress too fast, the bone will actually begin to fail. The first sign of this stress reaction is pain along the bone, which occurs with activity. As the situation worsens, a stress fracture can develop. This may result in a limp and even pain at night. If untreated the bone can actually break, which can be a severe injury.

Cartilage also needs stress applied very gradually. Cartilage is the slippery white tissue on the ends of the bones in the joint that allows the bones to glide and move smoothly over one another. As a person matures, it is common for the cartilage to see some wear and tear so that it is not perfectly smooth. When the cartilage sees too much stress too rapidly, it can result in pain and fluid in the joint. Swelling in a joint is a worrisome sign meaning that the cartilage is irritated. If the joint is not rested, the pain and swelling can increase and result in functional problems.

How can this pain be treated?

The treatment for any ache or pain after exercise is to cut back on the exercise for a period of time. How long to rest the area depends upon the severity of the pain. Typically we tell patients not to do anything that hurts. For casual athletes this is easier to do than for highly competitive athletes. It is important to maintain aerobic capacity or stamina when resting a body part, so other exercises that do not cause pain are usually acceptable. For example, if your knee hurts, it is usually reasonable to continue exercising your upper extremities or even to do lower extremity exercises like swimming or aqua jogging that do not aggravate the problem.

The second way to treat a painful area is by icing. Ice should be used after activity with an ice pack or ice massage for 20 minutes. This also can be done daily after exercising for several weeks. The old standard of ice for 48 hours followed by heat is no longer recommended. We believe that ice is your friend. However, if pain persists despite the use of ice, more serious problems may exist and you should consult your physician.

The third thing to do if you have aches and pains after exercise is to continue to move the joint or extremity to avoid stiffness. If the joint becomes stiff over time it will affect the ability of the joint to function normally and may affect athletic performance as well. Range of motion exercises or stretching to maintain the motion of the joint should not be confused with exercising the joint, which tends to stress the structures and make the pain worse.

The fourth way to treat aches and pains is with over-the-counter pain relievers or anti-inflammatory agents. These medicines include acetaminophen, ibuprofen, naproxen and aspirin and are believed to be effective at decreasing pain and swelling. If you do not have any contraindications to taking these medications, we suggest following the instructions on the label. If you have any questions, speak with your trainer, pharmacist or physician. If these medicines do not substantially improve the pain over a few days then you should consider consulting a health care professional.

In summary, if you develop pain after exercise, you should rest or decrease the activity that is causing the problem, ice the painful area, keep moving the extremity but not stress it and consider over-the-counter medicines to treat the pain and inflammation.

When should I be concerned about bad pain?

There are several things you should look for when judging how concerned to be about your pain. First, the pain should not last long after exercise. Pain that begins to affect your sports performance is not normal, and this may be more of a problem early in an injury for a high-caliber, competitive athlete than for the casual athlete who can more easily rest the injured part. Pain that does not go away with rest is not normal. Pain that begins to affect your function outside of sports, such as walking or sleeping, is not normal. Pain that is constant or increasing over time and does not go away is not normal. Pain that does not improve with treatment may be something to be concerned about. Pain that requires increasing amounts of pain medication over time is not normal, and you should consider seeing a physician. Pain that begins to wake you from your sleep is also a concern, especially if it increases over time.

Another sign that may indicate a more serious problem is the development of weakness. The development of tingling or numbness, which is the feeling you get when your hand goes to sleep or when you hit your funny bone, is also not normal and may indicate nerve problems. If you notice that you are gradually losing motion of the extremity you should also seek treatment.

Fevers, chills or severe sweating at night are not normal and you should consider seeking evaluation right away.

What about the pain that occurs with an injury?

It is often difficult to know if an injury due to an accident or trauma is serious or not. Signs that the injury is more serious include severe pain that makes the individual nauseated or very uncomfortable, deformity at the site of injury, immediate and marked swelling at the location of the injury, loss of function of the part that is injured, tingling or numbness of the extremity and inability to move the fingers or toes of the involved extremity.

We tell athletes that pain always occurs for a reason. More severe injuries have more swelling and pain. Injured areas that turn black and blue over time indicate that blood vessels have been broken and that there is the possibility of an injury to the bones, ligaments, tendons or cartilage. In most cases where a joint becomes swollen, painful and incapable of movement after an injury, it is not possible to tell if there is a fracture without an X-ray.

If you have any question about whether an injury is serious or not, you should seek treatment. Sometimes this is done sooner rather than later in athletic individuals who have a more pressing need to know the severity of the injury, thereby allowing quicker return to sport.

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No pain, no gain. It’s a common phrase most lifters live by. But when it comes to lifting and shoulder pain, it could signal something more serious than the run-of-the mill muscle soreness you’d experience after a tough workout.

One big one? An injury to your rotator cuff, a group of four muscles and tendons that keeps your shoulder’s ball joint centered on its socket joint. Its primary function is to help initiate movements of larger muscles, like your deltoids, says Christopher Camp, M.D., an orthopedic surgeon at the Mayo Clinic. It helps you rotate and raise your arm.

You don’t need to be a world-class athlete—think major league pitcher—to develop some serious issues with your rotator cuff. Even casual lifters can fall prey to rotator cuff injuries.

So here’s everything you need to know about them—and how you can stop your shoulder from hurting, fast.

Related: The Best Exercises For Your Shoulders

Rotator Cuff Injury Symptoms

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If you’re experiencing any shoulder pain, it’s a sign something is wrong.

“It is critical for weightlifting enthusiasts to know that any pain in the shoulder is not normal, especially acute pain that occurs after a single lift,” says Dr. Camp. That means any pain that rears up after something specific—say, a lateral raise or shoulder press—could be signaling an injury to your rotator cuff.

The pain you’d feel would be like a toothache, according to the Cleveland Clinic. That means it would be a radiating discomfort, usually from your outer arm to a little below the top of your shoulder. It’s usually made worse if you raise your arms above your head or reach behind your body, like if you were passing a belt through your belt loops. You might even hear a clicking noise when you lift your arms, too.

Related: 12 Sounds You Don’t Want Your Body to Make

Unlock Your Shoulder Mobility With This Simple Stretch:

How to Know If You Tore Your Rotator Cuff

Getty

But don’t jump to the assumption that you necessarily tore your rotator cuff, a severe injury that occurs when your tendon is actually ripped away from your bone.

In fact, the most common kind of injury to the rotator cuff in casual lifters is something called rotator cuff tendinitis, an inflammation or swelling of the tendons connecting your muscles and bones in your shoulder, says Lawrence V. Gulotta, M.D., an orthopedic surgeon at the Hospital for Special Surgery in New York City. It often occurs due to overworking your delts at the gym, like with too many or too heavy rear delt flys or shoulder presses.

If you had an actual rotator cuff tear, your pain will be more severe.

“Symptoms that would point to a tear are severe pain and weakness. The pain is typically located on the outside of the shoulder,” says Dr. Gulotta. Plus, it’s usually worse at night, and you might not be able to lift your arms above your head or lift things away from your body.

Related: 5 Surprising Body Parts That Are Extremely Sensitive to Pain

How to Prevent Rotator Cuff Injuries

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You can prevent rotator cuff tendonitis by balancing your workout.

“The rotator cuff and deltoid muscles are antagonists and should always be worked out in combination with each other,” says Dr. Gulotta. “Failure to do so may lead to imbalances around the shoulder that cause tendinitis from overuse of the rotator cuff.”

That means for every set of exercises that targets your rotator cuff—say, a dumbbell external rotation—you should do one that targets your delts, like a front dumbbell raise.

When it comes to avoiding rotator cuff injury when lifting, it’s all about using the appropriate weight and form.

“Although rotator cuff injuries can happen a number of different ways, they most commonly occur when trying to lift heavy weights overhead,” says Dr. Camp. “For weightlifters, bench press and overhead (military) press are probably the most common culprits.”

Now, that doesn’t mean you shouldn’t do these lifts, of course. Just make sure that your form is on target—say, you’re keeping your elbows at an angle in front of your body instead of directly out to the sides when you’re pressing. Going wide will allow you to press more weight, but will add stress to your rotator cuff.

And stay on form throughout your entire set, too: “In my practice, the most common way people tear their rotator cuff while working out is when they do not pay attention to their form while trying to get one last rep in,” says Dr. Gulotta. “The one thing they all have in common is that the main muscles lose control due to fatigue, putting a lot of stress on the rotator cuff causing it to tear.”

It’s not just about form, either—you need to make sure you’re lifting a safe amount of weight. Plus, since your shoulders are endurance muscles, you don’t need a lot of weight to make them grow, says Dr. Camp. Lighter weight, higher reps can do the trick, and keep your rotator cuff safe at the same time.

Plus, make sure you’re not overworking them, either. Stick to training shoulder twice a week, says Dr. Camp. (You’ll still be working your shoulder muscles when you do other lifts, too, like arm and back exercises like seated cable rows).

Related: The 21-Day Metashred—the At-Home Workout Plan From Men’s Health That Will Fry Fat and Build Muscle

How to Treat Rotator Cuff Injuries

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When shoulder pain develops, the best thing to do is back off lifting for a while.

Avoid upper body lifting and apply ice two to three times a day for about 20 minutes. Take anti-inflammatory meds like ibuprofen or naproxen to relieve pain, especially if your injury is tendinitis-related, says Dr. Camp. Most milder shoulder injuries will resolve with this kind of treatment.

Related: Why Every Man Should Take a Rest Day

If pain fails to improve with these approaches after a couple weeks, something more sinister may be at play, especially if you have weakness in your arm or can’t lift it. This could be signaling a full-on torn rotator cuff, says Dr. Camp.

So see your doctor if you develop those symptoms or if the pain persists after a few weeks, he says.

Your doctor can help you pinpoint the problem and provide you with a specific diagnosis based on your symptoms, physical examination, X-rays and/or MRI. He or she can work with you and a physical therapist or trainer to develop a comprehensive treatment plan tailored to your specific problem, says Dr. Camp.

“Although most patients with rotator cuff tendinitis can be treated without surgery, those with real tears in the tendons often require surgery,” says Dr. Camp. If you have a full-blown tear, surgery usually is necessary, and recovery can take about six to nine months.

Bottom line: “With the rotator cuff, an ounce of prevention is definitely worth a pound of cure,” says Dr. Camp. So to avoid an extended hiatus from lifting, make sure to lift smarter—with better form, safer weights, and less excessive volume—to prevent a rotator cuff injury from occurring in the first place.

Emily Shiffer Emily Shiffer is a former digital web producer for Men’s Health and Prevention, and is currently a freelancer writer specializing in health, weight loss, and fitness.

All CrossFitters quickly grow accustomed to feeling some pain the day after a WOD. Whether it’s climbing out of bed or putting on a shirt, something will remind us that we’ve been pushed to our limits again. And we accept that, knowing full well that muscle soreness is an expected, natural and even beneficial response to a training session. However, because we feel this soreness as pain, how can we tell whether it’s just regular old delayed onset muscle soreness (DOMS) or an injury?

Well, here’s how. Evaluating the differences takes some awareness and experience, but doing so can help you prevent major injuries and downtime.

Onset of Pain

DOMS is caused by micro-tears in the muscle, which cause swelling and pressure on pain receptors. This pain can begin anywhere from two to 24 hours after a training session. However, normally DOMS kicks in about 12 hours after a WOD and peaks at about 36 hours. An injury, on the other hand, will likely be painful immediately after training.

Length of Pain

Normal muscle soreness should begin to abate within two to three days. Even in the case of major DOMS, which could take up to seven days to fully heal, the pain should change in intensity over that week. Pain from an injury will not abate in a few days. If pain following a workout does not go away, that may be your first clue that you should seek medical attention.

Type of Pain

What exactly are you feeling? DOMS will cause muscles to feel tight, tender to the touch and dully achy. When exercising, sore muscles will seem tired or burn. An injury is associated with pain that is more sharp and acute, often akin to a stabbing sensation.

Location of Pain

Can you pinpoint the pain with one finger? Does the pain involve a small area that hurts when palpated or pressed? Or is the pain located in a tendon, bone or joint? If you answered yes to any of the above, you may be dealing with an injury. DOMS normally involves a larger or broader area of musculature, such as the muscle belly of the quads, hamstrings, calves or pecs.

Symmetry

Pain from DOMS is typically symmetrical. That is, it will be present in both legs equally. Typically, injury pain is asymmetrical; it will be present in only one leg, shoulder, etc. The exception would be an athlete who uses just one limb in an activity, such as a one-arm throw.

When You Feel Pain

Injuries are normally painful throughout the day, even when you’re not moving. Muscle soreness will usually not cause pain when you are sedentary.

Pain Improves

Besides pain-alleviating medications, injury pain will improve with ice and rest. DOMS, on the other hand, will improve with stretching after movement.

Pain Worsens

Pain from normal muscle soreness will worsen after you have been immobile or sitting for a while. Pain from an injury will get worse with continued activity; the pain doesn’t seem to improve during the warm-up or WOD.

Swelling

While DOMS includes some swelling, it’s typically over a diffuse area and is not focused on a small area or particularly noticeable. If the swelling is obvious and in a localized area, there’s a good chance you have an injury.

Sounds

Did you hear anything? Athletes often (but not always) hear a sound during an injury. That’s not the case with the normal muscle breakdown associated with DOMS. Torn muscles pop (especially hamstrings), and snapping or cracking noises can occasionally be heard when incurring an injury.

Shoulder pain working out

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