Rotator Cuff Pain and Firefighters

Pain on movement or sharp pain on lifting can indicate that you have a problem with the rotator cuff muscles, and/or their tendons.


Shoulder Pain in Firefighters

Rotator cuff pain, sprains, and tendonitis appear quite often in firefighters. The job firefighters do requires full range of motion of that ball and socket joint and full function of the muscles around it. Pain on movement or sharp pain on lifting can indicate that you have a problem with the rotator cuff muscles, and/or their tendons. If that is the case, then it would be a good idea for you to see an orthopedist or a very good sports med doc and get it looked at. If they okay it, then you can move on to these exercises. They may have other testing or studies they want you to undergo to rule out more serious problems.

Shoulder Joint Inflammation

The shoulder is an encapsulated joint. Once an inflammatory process starts inside the joint "capsule', the process can be lengthy and painful. In addition to the pain, the mediators of inflammation actually chemically soften the ligaments, tendons and other joint tissues. Thus, activities that challenge those structures can cause more damage than the original injury did.

The supraspinatus, infraspinatus, teres minor and subscapularis are often referred to as the SITS muscles. Each one of these muscles has one end outside of that capsule and one end inside the capsule. The end that is inside the capsule can become very irritated and painful. This pain is a signal that the tendons on the ends of these muscles, and the muscles themselves are more prone to injury at this time. Rest is a good idea at this point. Codman's Arm exercises are indicated here, and your doctor should be able to show them to you. If he or she cannot, Please send me an e-mail.

Because it is an encapsulated joint, the inflammation is tough to flush away. Icing is sometimes not effective (but definitely worth trying). Remember: 20 on, 20 off! Good, deep soft tissue work by an experienced Sports Massage Therapist, Physical Therapist or Chiropractor may help. Ultrasound with both of the above can help even more. Non-steroidal anti-inflammatory meds are often called on too soon, in my opinion. Try the other 3 first: ice, massage and ultrasound. I'd suggest you try Traumeel Ointment. Read more about it HERE. I recommend against Cortisone shots until everything short of surgery has been tried. It can lead to excess scar tissue formation.

Exercises to avoid (See Picture #1)

I do a lot of sports injury rehab work, which entails a lot of shoulder injury work. When someone comes to me, and says they hurt their shoulder working out, I ask what their upper body workout consists of.

All of them do at least one of these exercises:

  1. Behind the neck military press
  2. Behind the neck lat pull downs
  3. Straight bar bench press

This is what I tell them: "Any time you put your shoulder joint in a position that twists the shoulder joint capsule (extreme internal or external rotation, as in all 3 of those exercises) you are ringing it out like a sponge. Then, if you add a load, such as pushing or pulling, you are asking for trouble."

The usual response to my comment, "Yes, Doc, but I feel it here when I do that, and I never get that feeling with any other exercise!" My answer, "That feeling you get is the tearing up of your shoulder joint. You don't want that feeling! Even if you don't have a big injury now, you will! Stop doing those exercises!"

Substitute (respectively): if you know them...

  1. Back flies or upright rows for posterior delts
  2. Swimmer pulls with tricep push down pulley machine (straight armed) for teres/lats
  3. Dumbbell presses and pec flies in a safe range of motion for pecs

I would also train very carefully with your shoulders in the future, no matter who you are. Low back and shoulder injuries are common in Firefighters. Train the rotator cuff muscles specifically with light weight as a warm up on your chest and shoulder days at the gym. (The SITS muscles: supraspinatus, Infraspinatous, subscapularis, and teres minor). There are specific exercises for each. You should protect your future with just a few extra minutes each workout. Below, I will show those exercises!

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