Riding with a Rotator Cuff Problem
 

I am old (DOB 1949) and have had a slightly problematic left shoulder that was not a big deal ... UNTIL (on advice from the surgical staff helping me deal with my spinal stenosis issues) I started doing planks. It didn't take long for me to figure out that this was a bad idea in my case (shoulder related) and my shoulder has been a much worse problem ever since. And cycling seems to be the thing that creates the most discomfort.

I will be seeing my doctor soon and he will refer me to an orthopedic guy, and then I will get X-rays and probably an MRI, and then back to the ortho guy, and then I will almost certainly get referred to PT where maybe something will actually change. I have been in PT for 3 separate issues in my life and PT did not help any of them, but maybe this time.

In the meantime what has been the experience of others dealing with moderate rotator cuff issues and cycling?

Thanks.

dave

I have had similar issues, but you have a couple of years on me.

Yes, the physical therapy did help with my shoulder. But it does take a very long time. I still do it a couple of times a week, years later. Or maybe it was just time, who knows.

Planks bother me too, but you can do for a shorter duration, or do a modified version on your knees.

I have found that using lighter weights or elastic bands and higher reps works best, for me. That and accepting that I am probably too old to get a pro cycling contract or win the world championship.

I injured my left rotator cuff on August 20, 2015 in the Toronto airport lifting a very heavy bag over my shoulder when coming back from France with my bike. I rode with some discomfort until a couple minor crashes on Trans Am Trail in 2016 (dog and truck issue). It got worse and worse.

It took three different PTs to find one that helped. The last one worked with me for almost a year, 2-3 times per week. It was worth it.

Eventually, I had to get surgery and am very happy with the result. Recently broke the left shoulder blade, collarbone, humerus, elbow, and 5 ribs on the left. All of the rotator cuff pain came back. I saw the same surgeon who did the original work and he said, give it time and PT. He was right, the rotator cuff pain went away. The moral of the story, time and PT might help you. It might help for a while. Or, you might get a lousy PT. I cannot imagine planks being good for a torn cuff.

I injured my shoulder and ignored it for six maybe nine months and suddenly wound up with a frozen shoulder that I couldn't lift my arm outward from my body to even get my hand above my waist. The orthopedic surgeon told me that the injury was healed and there was nothing for him to do. He sent me to Physical Therapy and after what I remember as being twelve weeks, three times a week, I was back to 100 percent motion and haven't had any issue since.

I don't recall any of my shoulder issue giving me pain or bothering me while riding. I still rode all during that time.

so you're looking for an exercise to benefit spinal stenosis issues, without involving the shoulders?

since my AC Joint Sprain, I discovered some tips from this guy. he showed my how to work my shoulders w/ less activation of the AC Joint or with less movement

https://www.youtube.com/c/athleanx/videos

Thanks to all for the helpful input. I think that the message to me is to avoid making this thing hurt while I wait for the medical assessment to play out. E.G., the shoulder was not happy with yesterday's ride (outdoors) and it was still kind of iffy at noon today. So I rode indoors today where it is simpler to avoid shoulder stress.

dave

so hard to rest when I don't want to. sounds like you have a useable, temporary, alternative

Yeah - I think what I will do tomorrow is just go out on my anticipated 30 mile ride and simply do it no hands :-)

dave

If your stenosis is exasperated by the shoulder, as mine was, I would take the pressure off the shoulder and therefore the nerves as they exit the thoracic outlet by riding with just the right arm periodically. I'd let the left arm hang. It helped me.

My spinal stenosis is (AFAIK) totally separate from my rotator cuff problem EXCEPT that the exercise recommended to me to help the stenosis made the shoulder worse.

And yes, letting the left arm hang loose is helpful.

dave

I'm thinking outside the envelope here, but if leaning on the handlebars causes pain, stop doing that and get yourself a recumbent bike or trike. I recently made the conversion to a recumbent trike with e-assist (for health reasons) and I like it very much. I'll admit that I was prejudiced against it, but it's better than riding in pain, or not riding at all, if a traditional DF bike is no longer the optimal tool for the job. Maybe the surgery you're considering wouldn't be necessary, or the recovery time would be shorter before you can ride the trike vs your regular bike.

^^^^ THIS ^^^

I broke my shoulder in a crash that required multiple surgeries and a lot of PT. I had several different PT's until I found Devon. He was a life changer as the doctor told me I would be lucky to get it back to 80% of my strength and range due to how damaged it was. Devon took me on a 6 month trip of pain and agony, but in the long run, it was worth it as I have regained full strength and 98% of my pre accident range of motion. Don't settle, find the person that will actually help you get you back as close to 100% as you can get.

I am the OP in this thread, BTW. Here is an interesting and semi-related anecdote. The symptoms of my spinal stenosis (hip and occasionally lower leg discomfort) showed up basically overnight. On 1/23/2021 I played 18 holes of golf, walked a relatively long course carrying my bag and had zero evidence of hip pain. On 1/25/2021 I was warming up for another round and had huge discomfort just warming up on the driving range. I clearly could not walk and carry my bag and then realized that I could not play a round of golf even out of a cart. After treatment for a incorrect diagnosis of a hip tendon issue (can't blame PT for that one), I got an MRI and the spinal stenosis/foraminal stenosis, and a foraminal cyst was discovered. The PT stuff (mostly elastic band stuff) that I got I ultimately abandoned as it generated discomfort and it just was not clear whether or not this was an issue. I finally decided that it was a problem. The fact that my 'pain management doctor' felt like PT was unlikely to help in my case as a factor.

So on 5/7/21 I got a spinal epidural (even the doc who makes his living doing surgery advocated palliative treatment as a first step) and that got me back to maybe 90% of where I was on 1/23/21. I had been in a good bit of pain since 1/25/2021. That relief lasted 6-8 weeks and then things kind of slowly drifted back to painful. I stretched out the spinal epidural timing to 6 months at which point I could no longer play golf, etc. So I got another epidural in late Nov. And I was expecting the same cycle. What has happened is most surprising. I am now over 4 months post-epidural and am encountering virtually zero pain. I would dearly love to know just what in the heck has happened here. I am guessing that it is a change in the cyst (we really don't know if it is the foraminal stenosis or cyst causing my discomfort). Or maybe it is the core strength stuff that I ended up doing (changed to crunches after my disastrous attempt to do planks). But it would take an MRI to figure that out and I doubt that would be something that a doctor would order at this time. Quite frankly if this pain stays away on a more permanent basis I might pay for one myself just to know what in the heck is going on here.

Two other interesting tidbits. First riding a bike is extremely therapeutic WRT this stenosis/cyst driven pain. A 30 mile ride is kind of like getting a spinal epidural that lasts maybe four hours. Second I think that there is a 'conservation of pain' principle going on here where, once you hit a certain age, no matter what you do the total amount of pain that you encounter is a constant :) .

dave

Don't jinx it, just enjoy being pain free while you can.

My stenosis is upper back. My awareness of back problems came on suddenly, too. I had just finished 12 holes and there was a loud snap at impact on the 13th tee. One of my buddies says, "What was that!!???" and I said, "it was my back, I was 8 under" and Kev says, "Ya, we know....we didn't want to say anything, kind of hard to miss 8 birdies and 4 pars with 6 in a row". I have not played since. That was 2014.

Now there is a golf experience that I have never had nor will I ever have. dave

lucky, it is painful in a different way

No, except for minor sprains PT will not help except to put money in their pocket. I speak from experience, have had both rotator cuffs injured and repaired.

Ask your ortho guy for a cortisone shot, it worked really well for one of my shoulders. The other shoulder just laughed at it.

Eventually the cortisone relief may wear off, then surgical repair is the only solution. Following surgery you will need a full year of PT. Your surgeon might tell you it's only 6 months, but just chuckle and tell him "Yeah, right."

A few years ago I ended up with a rotator cuff injury and to this day I'm not sure how it happened. I do remember how painful it was just getting dressed was a chore with agonizing pain. My Dr. sent me for physical therapy and it took a very long time(months) before I felt better. I still stretch the way I was taught at P.T. and I hope I never revisit that pain again.

I damaged the roator cuff on both shoulders and having visited 4 doctors and spent time with 5 PT people I finally read a newspaper article that explained the nature of the injury. We are like apes and not built for heavy lifting with our upper body. Very little relative strength when a weight or work task has our hands higher than our shoulders.

I was fortunate in that with the second damaged rotator cuff I was treated by a PT who was a former trainer with the Giants pitching staff. He explained that when the pain of the injury causes people to not lift their arm as high that in a matter of weeks the tendons will shorten and then surgery is required. He stretched my arm to get my range of motion back and he went a great deal further than I could have done by myself. Heat and massage and then stretching and then 15-20 minutes with an ice pack. After 4 weeks and 12 sessions my range of motion was back to what it was before the injury and after that I am much more careful about doing overhead work.

It is easy to have shoulder pain from stressing the trapezius muscles with riding and a good approach is to do exercises with lightweigh dumbbells to strengthen these muscles. Planks are good for torso muscles but not that great for the shoulder muscles.

Calsun Thanks for the comments. Interesting and useful. dave

I've had lumbar stenosis and thin discs for what seems like the better part of forever. Also shoulder pain. As usual, I experimented on myself to see what might work as the physical therapist thing was a total bust. I agree that cycling is the best thing for back pain. I couldn't ride for a while due to a severe saddle sore and my back got really bad and turned into sciatica. So I had that to deal with. Anyway, not being prescriptive for obvious reasons, but this worked for me:

Shoulder pain: As was mentioned above, we didn't evolve to carry heavy weights in our hands. We did however hang from our hands. Remember how much fun monkey bars were as a kid? There's a reason for that - we're supposed to hang. So I hung from my hands for 2 X 1' several times a week, that's all. Fixed it. Took a couple months or so, used one of those doorway chin bars or at the gym.

Lower back: I walked a lot, 2-3 miles most days while rolling each hip in an exaggerated circular motion - that's important. Not quite sure what that did, but it fixed me right up. Hurt like the very devil when I started doing it, but only for the first mile, then the pain went away. That's a sign you're doing the right thing. After I could walk pain-free, I got back in the gym doing ATG squats, first no weight, then barbell squats, 3 sets of 12, as much weight as I could handle on the last set. Also stiff-legged deadlifts, same. Also back machine but not with max weight, just lots. Unsupported seated dumbbell presses. Lat pulldowns. Seated rows, I never did crunches, don't think they're a good idea. I did back work. Sure, my back still hurts a lot. Doing dishes is maybe the worst. Any sort of standing for long periods, so I do too much sitting, like this. Bummer, but what can one do? I plank now. Morning stretches, then pushups, then plank and side plank. I can ride however far, no back pain.

Carbonfiberboy I am (independent of your input) coming to the conclusion that the proper treatment in my case is going to involve personal experimentation. However, it is frustrating that in my attempt to improve my back (manifests as hip and/or lower leg pain) I seemed to have injured my shoulder (planks). I have decided that pain that goes away and does not get worse day to day is not necessarily a bad thing - otherwise it is bad. Ultimately that principle ruled out a whole bunch of prescribed PT elastic band stuff and the planks (suggested from outside PT-land).

Hanging is interesting. I will have to try that. I will add that to the range of motion shoulder stuff that I have started trying. Given my experience with planks I am really cautious about anything involving strength. I will be discussing this with my physician in my upcoming annual physical. But strength exercises only work by first breaking things down a bit on the expectation that recovery will make things a big stronger. This is not risk free in my mind.

And I would dearly love to understand why my back issue seems to have almost completely disappeared. I got my second spinal epidural back in Nov. 2021 which was following the same path as the first one - 90-95% relief for a month or two and then slow degradation in the level of relief after that (close to no relief after 6 months). I am now close to 5 months post epidural and my back situation is as good as it has been since before this all started in Jan. 2021. It seemed to have reversed course in the last 6-8 weeks. Maybe it is the crunches that I do - I have no clue and would love to understand. I probably won't get that understanding but I am now religious about crunches. And I have not tried it, but I think that I could walk and carry my golf bag for 18 holes without an issue. Or maybe not ....

dave

Planks are great for the torso and lowere back muscles. Crunches and half squats also are good exercises.

A physical therapist who was working with my rotator cuff injury gave me a 12 foot piece of 3/8" latex rubber surgical tubing (I bought a second piece at a fishing supply store but it is also sold on Amazon) and he made a loop in the middle and I would attach it to a door knob and then use my shoulder musclers to pull on the tubing. I did a series of exercises and I could vary the effort needed by how far I stood from the door. It was something that I took take with me when doing travel for business and continue the exercises in my hotel room.

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I haven't read the entire thread in detail, but here's my experience with both shoulder and lumbar-sacrum disc and debilitating sciatica.

The good news is that cycling didn't' ever make my shoulder hurt even when it was bad enough to require surgery. My rotator cuff issue was mostly weakness and not pain. Yea, it hurt, but the real problem was overhead and other motions that were just extremely weak. Some rotator cuff patients present with constant pain which is the impetus for surgery, mine was on the weakness end of the spectrum. I did have surgery, and after getting permission from my doctor after about 5 months, I have been riding for two years with no issues whatsoever. As an aside I bought (and later sold) a fun recumbent trike for the few months I wasn't allowed to ride a two wheeler.

I've had the rotator cuff injury for probably 15-20 years from the original incident. PT helped very much after the first injury and even after the second. I could definitely live with it. But after the third, about 5 years before I finally had surgery, PT didn't help and the strength of that shoulder just degenerated to the point where I could barely lift about 5 pounds overhead with that arm. I'm not really strong with overhead anyway, but the other arm could do 30+ lbs.

If you're at all on the fence about shoulder surgery, find yourself a genuine expert/specialist in SHOULDERS, above and beyond what a general ortho does, someone who does nothing else. It's a common specialty. Listen to that doctor and take her/his advice. An important fact is that the repair and recovery don't get easier with time, it gets harder. And some tears can progress to not being repairable. It's a crappy recovery, yes, but I would do it again in a heartbeat. I really, really wish I'd had it done 5 or 10 years earlier, but my general ortho was extremely conservative and I got the impression that I could deal with it with PT and the recovery wasn't worth it.

My sciatica was so bad that for several months I could not walk more than about 1/8 of a mile. Seriously. If I was going on a plane ride, I'd have to sit and take breaks between the ticket counter and the gate. At work, I'd get into the "90-90" position two or three times per day (I could do phone calls and laptop work in my office) to relieve the leg pain.

But I was very fortunate that I could ride my bike pretty much as far as I wanted. This was, according to my PT, not that unusual. One thing that helped me on the bike - improving on an OK comfort to totally satisfactory comfort - was to put 5mm longer stems on my bikes, changing nothing else. It caused me to stretch out just a bit more and I think helped my back even more.

But the inability to walk/hike was unacceptable.

For the back, over about 24 months, I consulted with a recommended pain doctor who had a very close reporting association with a PT group. (Some just inject and leave it to you to deal with PT). I had a series of steroid injections, some diligent PT - massage, stretching, strengthening and "mindfulness" (just learning to deal with it and avoid triggers), and time. I can't really say what the key was, probably everything including time and mindfulness, but the bottom line is that except for the effect of my nearly 7 decades of life, I'm very happy with my back.