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Climbing Causes Rotator Cuff Injuries

Diagnosing and Treating Climbing Rotator Cuff Injuries


A climber hangs from jugs on a big roof on Burnt Offerings (7a+) on the Fire Wall at Tonsai Bay.

Athletic routes like "Burnt Offerings" in Thailand put tremendous stresses on your rotator cuffs. Give up if you feel any pain or a slight twinge to keep from tearing your cuff.

Photograph courtesy Matt Robertson
Ian Spencer-Green climbing

Rotator cuff tears are not fun. Use sense when you're climbing hard routes not to strain your shoulder joint.

Photograph copyright Stewart M. Green
Kathleen Dehaven-Staffa at New River Gorge WV.

Climbing overhanging rock stresses the rotator cuff and other muscle attachments in your shoulders and elbows.

Photograph copyright Stewart M. Green

A strained or damaged rotator cuff is the most common shoulder injury that climbers experience. The rotator cuff, simply the attachment that holds the upper arm in the shoulder joint, gets a hard workout whenever we go rock climbing, especially on overhanging routes that require lots of pulling power from the arms and shoulder girdle. Whenever we lift our arm above our shoulder, which we do every time we go rock climbing, we are stressing and straining this group of tendons.

What is the Rotator Cuff?

The rotator cuff is a fan-shaped group of four muscles and their tendons (tendons attach muscle to bone) that surround the shoulder joint and help hold the upper arm bone or humerus in the joint. The tendons and muscles wrap around the front, back, and top of the shoulder joint, creating stability in one of the body’s most important and most used joints. The rotator cuff allows the arm to move freely with a wide range of motion, including up and down and rotating; all important for climbing movement. The four muscles are the supraspinatus, infraspinatus, subscapularis, and teres minor.

What is a Rotator Cuff Tear?

The most common shoulder injury is a rotator cuff tear. These injuries are not uncommon among athletes and climbers are particularly susceptible to these tears with the high forces that the upper arm and shoulder is subjected to when climbing hard routes. A rotator cuff tear happens when one or more of the tendons in the rotator cuff are injured by either small or large tears.

Symptoms of Rotator Cuff Injury

If you’re climbing a steep limestone route at Rifle and your shoulder starts to hurt, then you might have injured your rotator cuff. The main symptom is pain on the top of the shoulder and in the upper arm. The shoulder joint will probably ache and you may experience sharp pains in your upper arm muscles, especially if you lift your arm above shoulder height or if you hang your full body weight on your arms and shoulders. The pain may run down the outside of your arm to your elbow. Another symptom is a general weakness in your shoulder and you probably won’t be able to easily lift your arm overhead or make an extended reach.

Test Your Shoulder at the Cliff

If you are at the cliff, then self-assess to see if you might have a rotator cuff injury. While doing the described movements, stop testing at the first sign of pain. Also assess both of your arms to determine the extent of your injury.

  • First, slowly lift your arm directly out from your side with the palm facing downward. If you have pain in the shoulder as you lift your arm above shoulder height, then you probably have a cuff injury.
  • Second, place your arm in front of your torso as if it was in a sling with the elbow bent at 90 degrees and your lower arm in front of your stomach. Raise your lower arm upward, keeping it in front of your torso in the sling position until it is at shoulder height.
  • Third, with your arm in the position above, have your climbing partner support the elbow and then push gently downward with her hand. If you have pain in your shoulder during both of these movements then you have rotator cuff injury or strain.

Treatment for Minor Cuff Injuries

If you have pain in your shoulder and think you have a possible rotator cuff strain or tear, then quit climbing immediately. Any more climbing could cause a serious injury to occur. If you think you have a minor strain, then rest is the best treatment. Don’t use your arm; don’t go climbing; and don’t lift your arm over your head. All your normal activities, including sleeping, can affect your rotator cuff injury. Pay attention to your daily activity so that you don’t further damage the cuff. Don’t immobilize your shoulder so you don’t develop what is called “frozen shoulder.” Rest also allows inflammation of the injury to lessen. You can also take anti-inflammatory medications like ibuprofen to relieve and control pain. Remember that anti-inflammatories can also inhibit the healing process. Ice packs, including ice wraps made specifically for shoulders, can be applied to reduce inflammation.

Treatment for Major Rotator Cuff Tears

If inflammation and pain doesn’t begin to subside after a few days, then you need to visit a doctor, preferably an orthopedic specialist who deals with sports injuries, since you probably have a cuff tear and not a strain. Most rotator cuff injuries are treated without surgery. A small minority of patients end up needing surgical treatment. The usual non-surgical treatment under your doctor’s care is to completely rest the shoulder, take anti-inflammatory pain medications, use physical therapy to strengthen the rotator cuff muscles, and cortisone injections to settle shoulder inflammation. If your rotator cuff doesn’t heal then surgery is the next step. You will need to talk with your sports physician about this course of action, its side effects, benefits, and if it will be successful.

Recover and Heal with Time and Rest

Rotator cuff injuries take time to heal. A slight strain will probably sideline you for two to six months but the only cure for these cuff strains is time and rest. Even if your shoulder begins to feel better in a month or two, you need to be very careful before you start climbing again to ensure that you do not reinjure the tendons. Severe cuff injuries like tears take more time. You might not climb for a year to avoid injury and then when you do return to climbing and training you need to do strengthening exercises, usually under the guidance of a physical therapist, to properly recover.

Getting Back on the Rock

As the pain of your rotator cuff injury lessens, you usually can begin stretching the muscles surrounding the shoulder joint. Massage is another important tool to aid healing since massaging the muscles can help prevent scar tissue from forming in the tendons and keeping the joint and muscles elastic. Later you can do easy and moderate rehab exercises to strengthen the shoulder muscles. Finally you can return to climbing by doing easy routes on slabs and vertical surfaces. Remember to use your legs as much as possible rather than your arms and shoulders. Get cleared by your doctor and physical therapist before you get back to climbing hard routes and doing serious training. After recovery you will be much more cautious so that you don’t risk having another injury which can only mean more pain, more recovery time, and a lot less climbing.

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