The Rotator Cuff
When is it time to get off the water?
As some of you will already know, I recently sustained a pretty substantial shoulder injury which ended up requiring extensive surgery. Subsequently I’ve been asked to write a piece on my experience with shoulder injuries, in particular the rotator cuff and knowing when to get off the water.
The rotator cuff is something that most sports people have heard of, especially if your sport involves lots of arm-over-head movement, like kayaking. Although most of us are aware of this anatomical structure, we tend to avoid doing concentrated training. And the reason for this is that it’s no where near as fun as going kayaking. And anyone that knows me- I am the worst. I’ve had multiple kayaking-related shoulder injuries, which instigate the ‘I’m going to rehab properly this time’ line, but as soon as I gain enough function I’m back on the river and the injury is forgotten about. Until the next injury that is.
What actually is the Rotator Cuff?
A group of muscles, which are so small they are more like tendons, join together to form a cuff-like structure around the shoulder. The shoulder is referred to as a ball and socket joint and in simple terms the rotator cuff helps to keep the ball in the socket, whilst still allowing maximal, free movement. The muscles that form the cuff include the Supraspinatus, Infraspinatus, Subscapularis and Teres Minor.
These muscles are not only responsible for strength and stability, they also play a huge part in facilitating optimal shoulder-girdle function. A disfunction in the rotator cuff can give way to mechanical obstruction and dramatically reduce the range of movement possible at the joint.
We rely on our shoulders for strength, power and endurance. Big water fun on the Futaleufú.
Preventing injury- The 'Pre-hab'
A happy rotator cuff, and therefore a happy kayaker, is one that is strong yet supple. Simple. So strengthening exercises and stretches will be key.
- Specific strength and endurance training to help these muscles withstand the demand put on them whilst paddling. Don’t expect to be using the biggest weights in the gym though, these muscles are small and generally develop better with the less weight-more reps approach. Small dumbbells, therabands and static contractions are going to be the key elements to your pre-hab training.
- Keep everything moving freely and smoothly. This means spending some time stretching and maintaining good joint mobility. In particular the pectoral muscles (across the chest and front of the shoulder) tend to be tight in a lot of kayakers, which contributes to rounding of the shoulders and higher risk of rotator cuff impingement injuries.
- Posture. You can spot a kayaker a mile off. Obviously there’s the well recognised funky board shorts and helmet look; but the real giveaway is the Hunchback of Notre Dam who is slightly bent towards their boat-carrying side, with their shoulders that come round the corner before the rest of their body. Posture correction, stretching and exercise regimes such as yoga or pilates can be very beneficial.
It can be easy to ignore little niggles, especially when the rivers are up, but when is it time to get off the water and give your shoulders some TLC?
Paddling through injury has backfired on me a couple of times, including pushing an acute soft tissue shoulder injury until it resulted in subluxing my collar bone and most recently, continuing to paddle through pain, later to realise I had a full-thickness rotator cuff tear and detached labrum (cartilage); consequently needing surgery.
Reoccurring pain in a particular area is the sign that something is struggling. Sounds obvious, but we are all guilty of not responding correctly to the early signs. If it is just an occasional niggle then paddling at a lower demand (i.e. shorter sessions, less powerful rapids, less frequency) or taking a short rest may reduce some the strain enough to allow recovery and repair to take place, but you should also start incorporating some more specific strengthening exercises.
If it is more than just an occasional problem, then it’s likely that you need to stay off the water for at least a couple of weeks, possibly longer depending on the extent of repair needed.
1. Work out what the aggravating factors are
-Cut them out whilst rehab-ing
-Does your technique or posture need altering?
2. Get the balance right
-We will never be 100% symmetrical but we can reduce significant imbalances in muscle strength and flexibility. Are the muscles at the back much weaker than the front? Do you feel tighter and more restricted across the front of your shoulder?
3. Target problem areas
-A muscle may give you pain if it’s doesn’t have the necessary strength or endurance to cope with the demands put upon it. This training needs to be specific and built up gradually.
4. Additional holistic therapies
-Ice/ cold therapies can decrease pain and inflammation in the earlier stages. Whereas, therapies such as heat and massage can be helpful with tight, aching muscles but are generally not encouraged with acute injuries and will likely increase inflammation if commenced too early.
5. Core, Core, Core
-Having good core stability helps our body to move more efficiently and with less stress through our spine and limbs. It will also help you to be less wobbly in your boat!
6. Gradual re-integration of kayaking/ aggravating activities
-Re-introduce kayaking by gradually building up duration, frequency and difficulty. If it hurts go back a stage and allow more time.
If in doubt, get checked out
Although hopefully helpful to some people, all this information is based on my own personal experiences. It definitely isn’t as effective as a thorough, individualised assessment and treatment program provided in-person by a trained professional. Performing exercises or stretches incorrectly can cause injury, so if you aren’t certain see a professional for a correct technique and appropriate training programs. If you’re not seeing improvements or you think you’ve done something serious get it looked at asap.
Thanks for reading!
Disclaimer: The above is a guide only and does not substitute a full assessment and individualised treatment program provided by a trained professional. If you think you have sustained a serious injury you should medical attention immediately. Information based on experiences of the writer only.
Many thanks to Casey Bryant Jones, Curtis England and Drew Smith