Rotator cuff tendinopathy

What it is

Four small muscles wrap the ball of the shoulder and hold it centred in the socket while the big muscles move the arm. Their tendons, mostly supraspinatus on top and infraspinatus behind, get overworked and their structure changes. Tendinopathy is a capacity problem more than damage from one moment: the tendon has been asked for more than it can currently handle, over and over, and has become painful and less efficient. Older labels like tendinitis suggest inflammation, which is only a small part of the picture.

How volleyball causes it

The swing is a whip. The arm goes back into full external rotation, the internal rotators fire, and after contact the posterior cuff has to brake an arm moving at close to the fastest joint speed in sport. That braking is eccentric and it is where the tendon takes its heaviest load, and a hitter takes anywhere from 100 to 300 of those in a hard session, plus jump serves, plus the overhead press against the net when blocking. It almost always shows up after a jump in workload: preseason, a tournament weekend, a switch to opposite or outside, a beach partner who sets you 200 balls, or coming back from a layoff and hitting full volume in week one.

ServingAttackingBlocking

What it feels like

• A dull ache at the front and outside of the shoulder that shows up the morning after hitting more than during it
• Pain at the top of the swing and through the follow through, while pushing a heavy door or carrying bags feels normal
• The ball dies. Same technique, less speed, and you catch yourself arming the ball instead of swinging
• It warms up during practice and feels better by ball 20, then hurts worse that evening
• Trouble sleeping on that side, or waking when you roll onto it
• Reaching behind you into a back seat or a back pocket feels weak or tender

Stop and get it seen if

• A single swing or a caught arm followed by immediate weakness, so you cannot lift the arm to shoulder height. That pattern fits a full thickness tear.
• Night pain that wakes you every night regardless of position and does not settle over weeks.
• Numbness, pins and needles, or coldness in the arm or hand, or a grip that is suddenly weak.
• Fever, spreading redness, or a hot swollen joint, particularly after a recent medical procedure or a skin infection near the shoulder.
• A visible hollow in the muscle behind the shoulder blade on the hitting side, which points at a nerve problem rather than a tendon.

What recovery usually looks like

Stages, not a schedule. Everyone moves through these at their own pace, and the ranges are wide because real recoveries are.

1. 1. Calming it down

   2 to 6 weeks

   Take out the loads that provoke the tendon while keeping the arm moving and keeping the rest of your training intact

   • No pain at rest or in bed
   • Everyday overhead reaching is comfortable
   • Symptoms no longer carry over into the next morning
   • Low effort contact, like controlled hitting lines, does not flare it

2. 2. Rebuilding capacity

   4 to 12 weeks

   Load the cuff and the whole shoulder girdle deliberately so the tendon can handle more than the sport asks of it

   • Outward rotation strength feels close to matched side to side
   • Overhead loading no longer produces a next day flare
   • Full pain free rotation in both directions
   • Confidence returning at the top of the reach

3. 3. Back to swinging

   3 to 8 weeks

Ready to play again when

• Full, pain free internal and external rotation, matching or close to the non hitting side
• Outward rotation strength that holds against firm resistance without giving way or pain
• A full hitting session at competitive effort with no increase in symptoms the next morning
• Serve and swing velocity back to your own normal, not just comfortable at half effort

Keeping it from coming back

This is ordinary training, so unlike the rest of this page it does tell you what to do.

• Side lying external rotation and prone horizontal abduction with a light dumbbell, two or three times a week year round. The posterior cuff is the brake on your swing and it is almost always the weak link in a hitter.
• Cross body stretch or sleeper stretch on the hitting shoulder after every session while the tissue is warm, to hold onto internal rotation.
• Count your hard contacts. A rough weekly tally, and a rule that you do not raise it by more than about a third from one week to the next, prevents most of these.
• Serratus anterior work such as banded wall slides and push up plus, so the shoulder blade keeps the socket under the arm through the whole swing.
• Train rotation from the ground with medicine ball rotational throws and half kneeling chops, so the arm is the last link in the chain rather than the engine.
• Rebuild volume over several weeks after any layoff, and during a growth spurt in younger players, rather than returning straight to full hitting.