Rotator cuff issues related to riding

[weisan]

I have never had any rotator cuff issues before...until recently. And I wonder whether it's related to riding too much. Over the last few months, I have been riding almost daily instead of 3-4 times a week previously. Now, I am experiencing pain from shoulder impingement on the left side especially when I raise my hand.

[rnhood]

I have found its usually only rest that calms it back down. Do your elbows stick out much when riding? If so, then raise the bars and ride the drops more (shallow drop bars are better). its rotates the arm slightly to a more relaxed position. Anyway, it's more of a guess as I'm no expert. I have had impingement issues off and on but, normally its swimming that exacerbates mine - the backstroke in particular. Ibuprofen can help a little, but it's rest that does the most good.

[veloduffer]

I don’t think riding would cause an issue. Rotator cuffs problems are usually associated with rotational movement, like throwing or serving in tennis.

But, if you’re older (>50 yrs) most people develop rotator cuff issues from a lifetime of wear & tear.

There are exercises with rubber bands that can help strengthen the shoulder muscles. If you look online, there are lots of info on these exercises. I’ve done physical therapy for my rotator issues from years of baseball and tennis, and it was primarily rubber band exercises.


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[merlinmurph]

My guess is that you're aggravating a previous injury, possibly even an injury you didn't think was that bad.

Not a doctor, just a guy that had shoulder issues and rotator cuff surgery.

[weisan]

Thanks for the contributions so far, all on point. I have thought about these things too.

Rest only helps - but I don't want to stop riding altogether.

Turning 50 this year - this body has definitely seen better days.

Old injury - crashed on the bike 2 years ago, landed pretty hard on the left shoulder

Therapy - saw a bunch of recommended exercises on youtube, been doing some of them, will try the elastic band ones soon.

[paredown]

Thanks for the contributions so far, all on point. I have thought about these things too.

Rest only helps - but I don't want to stop riding altogether.

Turning 50 this year - this body has definitely seen better days.

Old injury - crashed on the bike 2 years ago, landed pretty hard on the left shoulder

Therapy - saw a bunch of recommended exercises on youtube, been doing some of them, will try the elastic band ones soon.

50! Pshaw!!!

You're just a youngun!

I've been dealing with shoulder issues--root cause was a crash at speed that caused a partial separation (probably as many years ago as you are old come to think of it)--and it definitely gets better or worse depending on usage.

The exercises are key--and it was after a lot of years that I finally went to a physiotherapist--who took me through a full series, and taught me motions for strengthening and stretching that I got a long stretch free of pain and with full motion.

Of course, being of the "spit and rub a little dirt on it" school of treatment, I didn't actually go to the therapist until I couldn't lift my hand above my head..

So my suggestion--find a good physio and make an appointment today. (Don't be like me.)

Edit to add:

Weisan emailed me, and I sent him a PDF of the exercises the PT gave me--basically some photocopied sheets--numbers in circles are the ones that I have been doing. Shared for anyone else interested.

Still think it is a good idea to get checked out first!

[weisan]

Ok!

Thanks old fart.

[NHAero]

This is timely, I'm having the same issue for the first time in my life, and had 2,630 miles in this year at the end of May - probably roughly what I rode all last year. Any preferred links for the exercises?

[OtayBW]

I am undergoing treatment with a PT for rotator cuff injury right now. The injury is, IMO, completely unrelated to and is not exacerbated by cycling. The PT has been very effective, but I have a 'long way to go'. We'll see over time what kind of range of motion I can achieve, but the last thing in the world that I want to do is to be laid up for a long time after surgery. Like I siad, though, the PT has been surprisingly effective thus far.

[thwart]

Had a bad episode of rotator cuff issues in '09, lasted most of the year. Definitely exacerbated by cycling. At the time I had my saddle tilted slightly forward on my bikes and a significant saddle to bar drop (~10 cm or more).

Multiple PT sessions and changing bike settings to rotate my body back and take some weight off my hands/shoulders eventually (and very slowly) led to improvement.

[OtayBW]

Had a bad episode of rotator cuff issues in '09, lasted most of the year. Definitely exacerbated by cycling. At the time I had my saddle tilted slightly forward on my bikes and a significant saddle to bar drop (~10 cm or more).

Multiple PT sessions and changing bike settings to rotate my body back and take some weight off my hands/shoulders eventually (and very slowly) led to improvement.Sorry to hear that. I have no issue with riding, nor have other colleagues with the same situation.

[thwart]

Sorry to hear that. I have no issue with riding, nor have other colleagues with the same situation.

Thanks!

Many possible causes for rotator cuff problems (one might even say it's a badly designed joint structure... ;)). Cycling is on that list.

[benb]

I've had this the last few years, although it's 99% better right now.

I'm going to be 43 next month. Been riding ~5k miles per year for the past 20 years, some years more, some years less.

I think an awful lot of this for me was just from riding being such a stationary position for the arms. Tight triceps & pecs after years.

A few years ago I really noticed it starting to do some other activities with my kid. He is naturally inclined to rock climb.. first time I tried that it was like my shoulders absolutely hated being extended up. It was like even just having my arm extended overhead was bad before I even started to try and pull.

The "sleeper" stretch is the one that's been most helpful for me.. but also cross training like crazy.

No rock climbing at all this year but doing that + doing all the exercises that one does to get better at that had been a great antidote.

Pullups, rows, pushups, overhead press, all really helpful.

I did talk to my doctor at one point.. shoulder seems to be about the most common thing that lands people in PT, it seems like lots of doctors & PTs are very well versed with this and will get you on the right track quickly. The PT exercises & stretches were the starting point, picking up doing other activities that use arms & shoulders in more healthy ways was the extra thing on top that's really helped going forward.

[CTracer]

I would recommend getting the issue diagnosed since the recommended treatment will depend on what the issue is. I thought I had a rotator cuff issue a number of years ago and it ended up being "frozen shoulder". I could barely raise my hand above belt level and I could not even get food out of my jersey pocket. It usually results from another injury and basically a bunch of scar tissue builds up. The less you move the worse it gets. After a lot of PT I have a hard time remembering which shoulder is the "bad" one. I did have it flare up again after a bad crash a few years ago but good to go now after more PT.
Good luck with your recovery!

[54ny77]

VERY helpful thread. Great tips here! :cool:

[OtayBW]

Thanks!

Many possible causes for rotator cuff problems (one might even say it's a badly designed joint structure... ;)). Cycling is on that list.
I certainly agree about it being a poorly-designed joint. However, I do respectfully disagree that cycling is a significant contributor to rotator cuff injury based on personal experience over many years and conversations with 3 orthos, 2 PT, and 2 radiologists (and yes - I know you're an MD). I just have been dissuaded by too many people whose opinion I value that rotator cuff injuries are common from cycling (crashes notwithstanding), especially where bikes have been set up for proper weight distribution (non-aggressive riding position) such that the arms don't continually push up into the shoulder socket. etc. Too many other things can compound or mask the situation: repetitive motion, impingement from arthritis/scar tissue, etc. Again, nothing personal and with respect, my opinion will diverge on this matter.

[benb]

Well the whole crash thing can't be ignored.

Crashing is part of cycling, just like aggressive positions. If you race these two things are very likely to be in the picture. Casual cyclists who ride a couple hundred miles a year on hybrids with an upright position probably don't end up with rotator cuff/shoulder impingement from cycling.

The crashes were definitely part of the picture for me. No cycling would very likely have meant not hitting the ground hard over the years.

There's zero chance I would have been playing tackle football or something if I hadn't been cycling.

We crash and then we go back to our activity which does very little to strengthen and rehab our arms. Usually we go back too quickly. We end up with muscle imbalances & scar tissue and all that.

How many cyclists do you come up behind and their riding position looks super wacked with one shoulder way jacked up in the air compared to the other? It's not all shoulder.. maybe some hip stuff causing part of it too, but hips get jacked up by crashes too.

We all seem to become less and less functional over years of cycling as a result of doing the same thing over and over again.

[Alan]

I have some rotator cuff tendon issues that are causing problems for me now. Am going to PT and riding in the basement as the trainer seems to cause no more pain. Riding outside for more than 2 hours seems to bring on a lot of pain and I ride with not much drop from saddle to bars.

I really like the book linked below and have been doing a lot hanging from a chin up bar.

https://www.amazon.com/Shoulder-Solution-Prevention-Revised-Expanded/dp/1589096428/ref=sr_1_1?keywords=shoulder%20pain%20solution%20a nd%20prevention%205th%20edition&qid=1573129382&s=books&sr=1-1

Any tips on how to get back outside? My plan will be to start very gradually outside after my PT gives me the OK to start. I do a have a good brace which seems to help.

Alan

[NHAero]

Thanks for the tip, just ordered this book. Would like to get full use of my shoulder back!

I have some rotator cuff tendon issues that are causing problems for me now. Am going to PT and riding in the basement as the trainer seems to cause no more pain. Riding outside for more than 2 hours seems to bring on a lot of pain and I ride with not much drop from saddle to bars.

I really like the book linked below and have been doing a lot hanging from a chin up bar.

https://www.amazon.com/Shoulder-Solution-Prevention-Revised-Expanded/dp/1589096428/ref=sr_1_1?keywords=shoulder%20pain%20solution%20a nd%20prevention%205th%20edition&qid=1573129382&s=books&sr=1-1

Any tips on how to get back outside? My plan will be to start very gradually outside after my PT gives me the OK to start. I do a have a good brace which seems to help.

Alan

[thwart]

I have some rotator cuff tendon issues that are causing problems for me now. Am going to PT and riding in the basement as the trainer seems to cause no more pain. Riding outside for more than 2 hours seems to bring on a lot of pain and I ride with not much drop from saddle to bars.

I really like the book linked below and have been doing a lot hanging from a chin up bar.

https://www.amazon.com/Shoulder-Solution-Prevention-Revised-Expanded/dp/1589096428/ref=sr_1_1?keywords=shoulder%20pain%20solution%20a nd%20prevention%205th%20edition&qid=1573129382&s=books&sr=1-1

Any tips on how to get back outside? My plan will be to start very gradually outside after my PT gives me the OK to start. I do a have a good brace which seems to help.

Alan
One obvious question is whether the bike you ride on the trainer is the same one you ride outside... if so, that would eliminate bike fit as a significant exacerbating factor. Length of ride may be a factor, as most cyclists do not ride the trainer for two hours.

Outdoor riding involves a lot more vibration, bumps and such. Your plan to return to things gradually (and change your position frequently... drops, bar tops, drops, etc) seems wise.

PT’s are frequently asked how to return to ‘normal activity’, so seek their opinion.

[weisan]

Thank you for reopening this thread...a quick update with my frozen shoulder.

Instead of going the route of PT, I chose to go to a chiropractor. He uses percussion method. For the first 2 months, almost nothing happen, no progress, still a lot of pain, can't sleep at night. He was just as frustrated.
Then one day, he said he's gonna try something different. He began to focus on my clavicle, behind the shoulder blade, mid way down my hand... the receptors. He hit them hard, it hurts a lot. He is trying to break up the scarred tissues. After two sessions, things began to move, I regained some mobility and flexibility and from then on, it gets better and better. Now, after three months I can sleep without pain, I don't even notice unless I try to raise my hand way up high or twist my shoulder all the way back... it's not 100% but at least 85-90%better. I put a rope & pulley up on my door to start doing up down exercise a few times a day and I am gonna start using the elastic band to do strengthening exercises.

I am very grateful for the huge improvement. I thought I have to wait longer, like I was told 6-12 months at the beginning. This is the best Christmas and new year gift I can ever receive.

[charliedid]

I have some rotator cuff tendon issues that are causing problems for me now. Am going to PT and riding in the basement as the trainer seems to cause no more pain. Riding outside for more than 2 hours seems to bring on a lot of pain and I ride with not much drop from saddle to bars.

I really like the book linked below and have been doing a lot hanging from a chin up bar.

https://www.amazon.com/Shoulder-Solution-Prevention-Revised-Expanded/dp/1589096428/ref=sr_1_1?keywords=shoulder%20pain%20solution%20a nd%20prevention%205th%20edition&qid=1573129382&s=books&sr=1-1

Any tips on how to get back outside? My plan will be to start very gradually outside after my PT gives me the OK to start. I do a have a good brace which seems to help.

Alan

Lower your bars and determine that your setback is correct as well as cleat placement.

You're bracing yourself against your bars.

I already regret posting online about fit issues but tis the season to be jolly.

:)

[jr59]

Thank you for reopening this thread...a quick update with my frozen shoulder.

Instead of going the route of PT, I chose to go to a chiropractor. He uses percussion method. For the first 2 months, almost nothing happen, no progress, still a lot of pain, can't sleep at night. He was just as frustrated.
Then one day, he said he's gonna try something different. He began to focus on my clavicle, behind the shoulder blade, mid way down my hand... the acupoints. He hit them hard, it hurts a lot. He is trying to break up the scarred tissues. After two sessions, things began to move, I regained some mobility and flexibility and from then on, it gets better and better. Now, after three months I can sleep without pain, I don't even notice unless I try to raise my hand way up high or twist my shoulder all the way back... it's not 100% but at least 85-90%better. I put a rope & pulley up on my door to start doing up down exercise a few times a day and I am gonna start using the elastic band to do strengthening exercises.

I am very grateful for the huge improvement. I thought I have to wait longer, like I was told 6-12 months at the beginning. This is the best Christmas and new year gift I can ever receive.

That’s GREAT!
I understand your pain, as I have had a bad shoulder injury before and went through multiple years of PT before just to get it back to where I could grip the bars a pull.

And now I have hurt it again, badly. Getting hit by a car stinks. But it’s not nearly as bad as last time, 6-8 weeks is what by Dr says.

Heal quickly and well my friend

[Ken Robb]

When I told my orthopod my shoulder felt like I was being stabbed from the inside he said "that is because you are". Calcium deposits had built up in the joint. Not caused by trauma. Impingement syndrome. Surgery to remove the sharp growths fixed it. Get a diagnosis before assuming it's a rotator cuff problem.

[weisan]

That’s GREAT!
I understand your pain..
Heal quickly and well my friend

Thank you my friend!

[ridethecliche]

Sounds like they're doing graston which PTs can do as well. Surprised you didn't pursue pt after 2 months of no progress. Glad it's getting better now.

[paredown]

<snip>

I am very grateful for the huge improvement. I thought I have to wait longer, like I was told 6-12 months at the beginning. This is the best Christmas and new year gift I can ever receive.
Glad you are on the mend!

[Seramount]

just got home from PT for rotator cuff issues on BOTH shoulders.

right side had a grade 3+ separation following being struck by a car in 2016. just about the time it was healing on its own, I hit a stealth pothole and violently jarred it (which is likely when the tear occurred). just when that was feeling better, I voluntarily ate pavement rather that hit an elderly woman who stepped directly in front me, banged the shoulder pretty good.

injured the left one 30 years ago lifting weights. it's been mostly pain-dormant until recently...guess it decided that since the other side was jacked, it wanted attention too.

have only had 2 sessions so far, therapist said the RCs are slooow to heal...

[wc1934]

Tore my rotator cuff years ago (when I thought I was still a kid and could throw to the plate from centerfield). It healed on its own and I was good for 20+ years. Fast forward to 2 years ago when I re-injured it. I could not even lift my arm to change the station on the car radio. PT helped (muscles surrounding the cuff are pretty small so you dont need to lift heavy weights - bands work the best).
To my dismay, I was on a steady diet of naproxen - aleve just so I could get a few hours of sleep. Nightime was bad but I was pretty good in the daytime - not sure why.
In any event, I have settled for getting cortisone shots every 6 months and they have worked great. (I am not a fan of shots or drugs, but it is the only thing that works) - Doc said he would't try to repair it as the tendon is so short it would only tear again - only other option for me is a shoulder replacement.

Riding is possible, so keep the faith!!

[Alan]

See link to video from Bob and Brad that advocates hanging to cure rotator cuff issues. It is worth a watch. Their channel is very good for PT related issues. So far this is working for me as have been doing this over the last week or so. I bought a chin up bar that goes over the door frame for $30 on Amazon and it works well.

https://youtu.be/bI9KZVdFSmQ

[ridethecliche]

Just a word of warning that one size does not fit all for shoulder issues. So while some of the list of exercises may help many or most of those facing issues, some are likely to exacerbate things as well.

Go see sports med or PT to get set up.

Glad weisan is finding some benefit from things but a chiro is 100% not the way I would go, especially after no benefit for two months followed by a revelation of using graston to break up scar tissue. Puhlease.

[Alan]

Have continued my PT visits and doing the Dr Kirsch exercise hanging from a chin up bar 4-5x per day and am feeling much better with no shoulder pain. PT is helping to get my rotator cuff muscles strengthened and making progress.

Have been riding in the basement on TrainerRoad and have missed being outside and the Rapha 500 but more than maintaining conditioning. TR is hard and unforgiving on an erg trainer. Not hard to see people increasing FTP substantially.