You’ve been doing Olympic lifting for a while. Or stocking tall shelves. Or cheerleading, throwing your partners overhead. Everything was great! Until suddenly, it wasn’t. Ice and ibuprofen didn’t quite do the trick, so you visited the doctor. And lo and behold, you’ve got a rotator cuff injury and two questions:

How did this happen?


What do I do now?

You and your shoulder: it’s complicated!

The bones.

Despite all falling under one general name, the “shoulder” actually consists of four (or maybe five) different joints. The sternoclavicular joint is where your collar bone connects to your breastbone. The acromioclavicular joint (which even doctors just call the AC joint, because nobody has time for all that) is where the very top of your shoulder blade connects to the far end of your collarbone. The glenohumeral joint is where the top of your arm fits into the bowl of your shoulder blade. And then there is another joint (or maybe two, depending on who you ask) that is a “false joint” as well.

The muscles.

On top of this complicated structure is a whole host of muscles. There are chest muscles that move the shoulder. There are back muscles that move the shoulder. And there are even muscles of the arm that help move the shoulder, even though that sounds weirdly like trying to pull yourself up by your own bootstraps. We haven’t even gotten to the rotator cuff muscles, yet!

The primary job of the rotator cuff is to keep your shoulder stable. These four muscles (yep, four) are the supraspinatus, infraspinatus, subscapularis and teres minor. If you feel like those all sound like fun spells you might learn at Hogwarts, you’re not alone. These four muscles keep your arm from dislocating when you lift it over your head or move it around. Which is kind of magical, if you think about it.

How rotator cuff injuries develop.

When you work to strengthen all muscles that lift and move your arms at the shoulder, this allows you to lift more. Strengthening these muscles without strengthening the rotator cuff muscles puts a lot of extra stress on these shoulder stabilizers. This can cause the rotator cuff muscles to fail in their job. When these stabilizer muscles are a lot smaller (weaker) compared to all the other muscles that move the shoulder this allows:

  • the shoulder capsule to stretch (not good),
  • the top of the arm starts to migrate out of its spot in the shoulder (kind of bad),
  • the muscles of the shoulder literally shearing off from the bone (DEFINITELY bad).

Other injuries caused by overloaded rotator cuff muscles include tendonitis and nerve impingement.

So … I messed up my shoulder.

Go see your doctor. Seriously.

Ice and ibuprofen will get you some relief, but as mentioned earlier, shoulders are incredibly complicated. The chances of your being able to accurately self-diagnose your specific problem are slim to none. And if you’ve got a serious tear going on, waiting to have it repaired will only lead to further degradation of the joint. If you don’t have arthritis yet, that’s like begging for it to start. Nobody’s excited about a trip to see their physician, but just go.

Okay, okay. But then what?

It totally depends on what kind of injury you have going on. It might be the sort of thing that taking a break from strength training for a while can fix. You might need injections. You might need surgery. There will probably be physical therapy involved, to strengthen your shoulder stabilizers and correct any outsized range of motion. But regardless, you’ll need to be more mindful of how you use (and abuse) your shoulders in the future.

Actually, it turns out my shoulder is fine. But how can I prevent rotator cuff injuries in the future?

Get serious about form.

Yes, if you work out, it’s fun to see if you can do things as quickly as possible, but that’s also the fastest path towards injury. Working with a trainer or coach and really nailing down the details of form before increasing the intensity and speed of your exercise will help keep your shoulders working properly. If you’re working out your arms, make sure to address your shoulder stabilizers too. Working with a personal trainer (or, if you’re already experiencing problems, a physical therapist) can help you get on the right track with a routine to gradually build up more stability in your shoulders.

If you don’t really need to be reaching overhead, don’t do it.

Climb up on a stool when you’re pulling down boxes in the garage. Get a good stepladder when you’re painting your dining room. Reaching overhead is the toughest movement on your shoulder muscles, and adding weight or resistance to that only increases the strain. It only takes a minute to be kinder to your poor shoulder joint.

Can massage help with rotator cuff injuries?

Well, it’s not going to fix your shoulder.

BUT, there is a small but growing body of research that shows massage can help with shoulder pain, especially in conjunction with physical therapy. So if you’re already recovering from your injury, getting a massage can help you to feel better while you regain your range of motion and strength.

If you’re an athlete or work in a field requiring a large amount of physical labor, it’s also natural to feel some degree of anxiety about being injured. This is an area where massage really shines, helping you relax and cope with the stress that comes along with injury.