Blog 3: The Rotator Cuff Fix
Part 3: How Rotator Cuff Injuries Happen Common Sports, Risk Factors & Who's Most Susceptible
Welcome back! You now understand what the rotator cuff is and the different types of injuries. Now let's talk about HOW these injuries actually happen and who's most at risk.
As your Oakville chiropractor who treats a lot of shoulder problems, I can tell you that rotator cuff injuries rarely happen "out of nowhere." There's usually a perfect storm of factors that create the problem.
The Two Main Ways Rotator Cuff Injuries Develop
Acute Injuries (The Sudden "Oh No!" Moment):
These happen from a specific incident you can usually pinpoint:
- Falling onto an outstretched arm
- Lifting something very heavy incorrectly
- Sudden jerking or pulling motion
- Direct blow to the shoulder
- Throwing with maximum effort (especially if you're not warmed up properly)
Chronic/Overuse Injuries (The Slow Burn):
These develop gradually over time from repetitive stress:
- Thousands of overhead movements in sports or work
- Poor posture creating impingement
- Muscle imbalances that overwork the rotator cuff
- Gradual degenerative changes as we age
- Combination of multiple small stresses that accumulate
The truth: Most rotator cuff injuries I see are a combination of both—chronic wear and tear that makes the shoulder vulnerable, then an acute event that's the "final straw."
Sports & Activities with Highest Rotator Cuff Injury Risk
Let me break down the sports and activities that beat up your rotator cuff the most:
Very High Risk (Overhead Athletes):
Swimmeing /Triathletes:
- Thousands of repetitive overhead strokes
- Especially freestyle and butterfly
- Poor technique makes it worse
- "Swimmer's shoulder" is basically rotator cuff impingement/tendinopathy
- Can develop from inadequate rest between training sessions
Baseball/Softball (Pitchers especially):
- Extreme forces during throwing motion
- Repetitive overhead throwing
- Pitchers are at highest risk
- Velocity and volume both matter
- Poor mechanics increase risk dramatically
Tennis & Racquet Sports:
- Repetitive overhead serving
- Powerful groundstrokes
- Poor technique compounds the problem
- More common in competitive players
- Dominant arm takes most of the stress
Volleyball:
- Repetitive spiking and serving
- Explosive overhead movements
- High forces through the shoulder
- Both shoulders at risk (hitting and blocking)
- Common in both setters and hitters
High Risk (Overhead + Power Activities):
Weightlifting, CrossFit & Hyrox:
- Overhead pressing movements
- Heavy loads on the shoulder
- Poor form or too much weight
- Kipping pull-ups (controversial!)
- Muscle-ups and overhead squats
Rock Climbing:
- Overhead reaching and pulling
- Sustained positions with arms overhead
- Dynamic movements create sudden loads
- Both acute injuries and overuse issues
Golf:
- Rotational forces through the shoulder
- Repetitive swing mechanics
- Lead shoulder (left for righties) especially vulnerable
- Poor swing mechanics increase risk
- High volume of practice swings
Moderate Risk:
Hockey:
- Slap shots and wrist shots
- Body checking and falls
- Repetitive stick handling
- Both shoulders at risk
Basketball:
- Shooting motion (especially from three-point range)
- Overhead passing
- Falls onto outstretched arms
- Contact with other players
Martial Arts:
- Punching and striking
- Grappling and throws
- Falls and takedowns
- Both acute trauma and overuse
Occupational Risk Factors
It's not just sports! Many jobs put your rotator cuff at risk:
High-Risk Occupations:
- Construction workers (overhead work, heavy lifting)
- Painters (overhead painting)
- Electricians (overhead wiring)
- Hairstylists (arms elevated all day)
- Mechanics (overhead work under cars)
- Teachers (writing on boards, carrying materials)
- Warehouse workers (overhead stocking)
The Office Worker Problem:
This is HUGE and most people don't realize it! Sitting at a desk all day creates:
- Forward head posture
- Rounded shoulders
- Weak, stretched-out rotator cuff muscles
- Poor shoulder blade positioning
- Then you go play tennis or swim on weekends = recipe for injury!
At Endurance Therapeutics, I see this pattern constantly in Oakville: desk job + weekend warrior sports = rotator cuff problems.
Age-Related Risk Factors
20s-30s:
- Usually overuse injuries from sports
- Acute trauma from accidents or falls
- Generally healthy tissue that heals well
- Injuries often from training errors (too much, too soon)
40s-50s:
- Starting to see degenerative changes
- Combination of overuse and age-related wear
- May have years of accumulated micro-trauma
- Still heal reasonably well with proper treatment
60s+:
- Significant age-related degeneration is common
- Tears can happen from normal activities
- May have tears without symptoms
- Focus shifts to maintaining function rather than "perfect" structure
Important note: Age itself isn't the problem—it's the accumulated wear and tear over decades of life!
Biomechanical Risk Factors (Why Some People Are More Vulnerable)
Shoulder Blade (Scapula) Issues:
- Poor scapular control and positioning
- Weak muscles that stabilize the shoulder blade
- Creates abnormal rotator cuff mechanics
- One of the BIGGEST risk factors I see
Muscle Imbalances:
- Tight chest muscles pulling shoulders forward
- Weak upper back muscles
- Imbalance between rotator cuff muscles themselves
- Weak core affecting shoulder mechanics
Poor Posture:
- Forward head posture
- Rounded shoulders
- Changes the space available for rotator cuff tendons
- Creates impingement and abnormal loading
Joint Stiffness:
- Tight thoracic spine (upper back)
- Reduced shoulder mobility
- Forces rotator cuff to work harder
- Common in desk workers and older adults
Hypermobility (Too Much Flexibility):
- Yes, you can be TOO flexible!
- Shoulder moves too much, rotator cuff can't control it
- More common in younger athletes, especially females
- Need extra strength work to compensate
Genetic & Anatomical Risk Factors
Some people are just dealt a tougher hand:
Bone Shape Variations:
- Hook-shaped acromion (the bony part above your rotator cuff)
- Naturally narrower space for tendons to pass through
- More susceptible to impingement
- Nothing you can do about this, but awareness helps
Gender Differences:
- Women have different shoulder anatomy (generally smaller joint, different angles)
- May have more joint laxity
- Hormonal factors might affect tendon health
- Need sport-specific training considerations
Family History:
- Tendon quality can run in families
- Some people naturally have "weaker" connective tissue
- If your parents had shoulder problems, you might be at higher risk
Training Error Risk Factors (The Preventable Ones!)
These are the ones that frustrate me because they're SO preventable:
"Too Much, Too Soon":
- Rapidly increasing training volume
- Starting a new sport without proper preparation
- Going from couch to intense workouts
- Not building up gradually
Poor Technique:
- Bad throwing mechanics
- Poor swimming stroke
- Incorrect lifting form
- Not getting coaching when learning a new sport
Inadequate Recovery:
- Not taking rest days
- Playing through pain
- Not allowing time for tissue adaptation
- Back-to-back tournaments without rest
Lack of Strength Training:
- Only doing your sport, no conditioning
- Weak rotator cuff muscles
- Poor shoulder blade control
- Muscle imbalances
At Endurance Therapeutics I see this one very often!
Neglecting Warm-Ups and Cool-Downs:
- Jumping straight into intense activity
- Not preparing muscles and tendons
- Inadequate recovery protocols
- (Hey, we covered this in our warm-up and cool-down series!)
Lifestyle Risk Factors
Sleep:
- Poor sleep affects tissue healing
- May increase injury risk
- Affects recovery between training sessions
Nutrition:
- Inadequate protein for tissue repair
- Poor hydration
- Insufficient overall calories if training hard
Stress:
- High stress increases injury risk
- Affects recovery and tissue healing
- May lead to muscle tension and poor movement patterns
Smoking:
- Reduces blood flow to tendons
- Impairs healing
- Increases risk of tears
- Significantly worse outcomes if surgery is needed
Previous Injury Risk
Prior Shoulder Injuries:
- Previous rotator cuff injury increases re-injury risk
- Incomplete rehabilitation leaves you vulnerable
- Scar tissue can alter mechanics
- Compensation patterns from old injuries
Other Body Injuries:
- Neck problems affecting shoulder function
- Opposite shoulder injury causing overuse of the "good" side
- Lower body injuries changing throwing or swimming mechanics
The Perfect Storm: Multiple Risk Factors
Here's what I see most often at Endurance Therapeutics:
Example 1: The Weekend Warrior
- 45-year-old desk worker (poor posture all week)
- Plus plays tennis on weekends (overhead sport)
- Plus doesn't warm up properly
- Plus has been increasing play time recently
- All = Rotator cuff injury waiting to happen!
Example 2: The Youth Athlete
- 16-year-old baseball pitcher
- Plus year-round throwing (no off-season rest)
- Plus poor pitching mechanics
- Plus also plays quarterback in football
- Plus inadequate strength training
- All = High risk for rotator cuff injury
Example 3: The Masters Swimmer
- 55-year-old swimmer
- Plus age-related degenerative changes
- Plus swimming 5-6 days per week
- Plus poor stroke technique
- Plus desk job creating poor posture
- = Classic swimmer's shoulder scenario
Who's MOST at Risk? The High-Risk Profile
You're at highest risk if you:
✅ Are over 40 (age-related changes)
✅ Plus participate in overhead sports regularly
✅ Plus have poor posture from desk work
✅ Plus don't do specific shoulder strengthening
✅ Plus have had shoulder problems before
✅ Plus train intensely without adequate recovery
Have 3+ of these factors? You need to be proactive about prevention!
The Good News About Risk Factors
Here's what's encouraging: MOST risk factors are modifiable! You can't change your age or genetics, but you CAN:
- Improve your posture
- Strengthen your rotator cuff and shoulder blade muscles
- Use proper technique in sports
- Warm up and cool down appropriately
- Manage training load intelligently
- Address muscle imbalances
- Get treatment for early symptoms before they become major problems
When to Be Extra Careful
Pay special attention to your shoulders during:
- Start of a new sports season
- Returning after time off
- Increasing training intensity or volume (Check out our Aerobic Base Training blog series)
- Learning a new sport or skill
- After an acute shoulder injury (even minor ones)
- During periods of high stress or poor sleep
- When you notice early warning signs (minor pain, stiffness)
The Bottom Line
Rotator cuff injuries happen from a combination of factors:
- Overhead sports (swimming, throwing, racquet sports) create the highest risk
- Poor posture from desk work sets you up for problems
- Age-related changes increase vulnerability over time
- Training errors (too much, too soon, poor technique) are often the final trigger
- Multiple risk factors combine to create the "perfect storm"
The good news: Understanding your personal risk factors allows you to take preventive action!
Coming up in Part 4: How Dr. Keirstyn treats rotator cuff injuries using soft tissue therapy, manual techniques, and comprehensive care at Endurance Therapeutics!
Want to assess your rotator cuff injury risk or have symptoms evaluated? Dr. Keirstyn specializes in shoulder injuries in Oakville athletes and active adults. Schedule your assessment today!