By John Crawley, PT, DPT, OCS
Hurt shoulder, what is it?
As athletes that use their arms to complete a wide range of movement patterns to ascend rock climbing walls, they are susceptible to developing shoulder related injuries. If you are finding it difficult to determine the exact cause of your shoulder pain, you are not alone. Shoulder pain can be hard to figure out because a number of tissues including the glenohumeral joint, rotator cuff, biceps tendon, poor biomechanics, and the neck can all cause it. Having the right diagnosis is paramount in being able to resolve the pains you have. Two common causes for shoulder pain that can be hard to differentiate between are proximal biceps tendinopathy and shoulder impingement.
Understanding the Basics
Biceps Tendinopathy
Biceps tendinopathy refers to the irritation or inflammation of the long head of the biceps tendon, which runs over the front of the shoulder joint. This condition often arises from overuse, repetitive strain, or sudden increases in climbing intensity.
Shoulder Impingement
Shoulder impingement, on the other hand, involves the compression of the rotator cuff tendons and subacromial bursa within the shoulder joint. Climbers frequently engage in overhead movements, making them susceptible to impingement as the structures within the shoulder become pinched or irritated.
Figuring it out
Biceps Tendinopathy:
Dynamic Arm Movements: Aggravated by dynamic arm movements such as reaching overhead or locking off.
Climbing Holds: Pain may be triggered when using certain climbing holds and positions. Movements that can be particularly painful are underclings and side pulls.
Shoulder Impingement:
Overhead Reaches: Repetitive overhead reaching and lifting during climbing may exacerbate impingement.
Cross-Body Movements: Pain may arise during cross-body movements, like reaching across the body to grab a hold.
Symptoms
Biceps Tendinopathy
Anterior Shoulder Pain: Pain localized to the front of the shoulder.
Weakness and Fatigue: Weakness and fatigue in the arm during climbing activities.
Shoulder Impingement
Pain with Overhead Activities: Pain exacerbated by reaching overhead or engaging in activities with an elevated arm.
Weakness: Weakness, especially during abduction and external rotation of the shoulder.
Things to try
Biceps tendinopathy
Eccentrics: complete bicep curls as the muscle lengthens. Weight should be difficult as it takes a considerable amount of weight to stimulate tendons to adapt. Try using a 3×15 set to rep program for 6-12 weeks.
Shoulder impingement
Shoulder flexion: Initial loading should be light and pain free. To gain control of the muscles try a 3×20 daily for 2-6 weeks.
Shoulder external rotation: Initial loading should be light and pain free. To gain control of the muscles try a 3×20 daily for 2-6 weeks.
Reasons to See a Physical Therapist
Accurate Diagnosis: A physical therapist can perform a comprehensive assessment to accurately diagnose the specific condition, differentiating between biceps tendinopathy and shoulder impingement.
Individualized Treatment Plans: Physical therapists can create personalized rehabilitation programs tailored to the climber’s specific condition, addressing strength imbalances, flexibility issues, and movement patterns contributing to the injury. There is often more than one impairment contributing to the pain process that limits your ability to climb pain-free.
Preventive Strategies: A physical therapist can guide climbers in implementing preventive strategies, such as proper warm-up routines, strengthening exercises, and technique modifications, to reduce the risk of recurrence.