Why does a shoulder injured during exercise keep flaring up?

Key points in 30 seconds

1. Pain stopping and a tendon healing happen at different times.
2. Not being able to lift your arm because it hurts is different from not being able to lift it because there's no strength.
3. If you lose strength, or your arm suddenly won't go up after an injury, we recommend imaging.
4. Muscles are sensitive to temperature — warm up longer in winter.
5. Lifting weight overhead is the very last movement we add back.

What we often hear

• "Ever since I got hurt working out, it keeps flaring up."
• "When it gets a bit better, the same spot hurts again."
• "I'm starting to wonder if I should quit exercising."

Why does a shoulder injured during exercise keep flaring up?

Because once it stops hurting, people put weight on a tendon that is still healing. Pain stopping and a tendon healing happen at different times.

The first thing people who exercise ask is, "When can I start again?" We understand that feeling. But rushing here makes the same spot keep flaring up.

What part of the shoulder is the problem?

The four muscles that connect the upper arm bone to the shoulder blade and rotate the arm, and their tendons. These can become inflamed or partly torn.

These four muscles together are called the "rotator cuff."

Think of it like a rope. Many strands come together to make one rope. If a few strands get damaged, the rest take on their share of the load. If you keep lifting heavy things in that state, the remaining strands snap too.

So stopping at the early inflammation stage and going past it into a tear make a big difference to what comes after.

What signs should I watch for?

Pain that's especially sharp at a certain angle when you raise your arm to the side, pain that wakes you at night, and weakness in the arm.

Of these, weakness is looked at differently. Not being able to lift your arm because it hurts is different from not being able to lift it because there's no strength. If it's the latter, there may be a tear, so we recommend an ultrasound or MRI.

If your arm suddenly won't go up after an injury, don't wait on that either.

Why do injuries happen more in winter?

Because muscles are sensitive to temperature. When they're cold, they have less room to stretch, so the same force injures them more easily.

When we use a heat lamp in the treatment room, it's not just to make you feel good; it's a step to prepare the tissue before stimulating it. A warm-up before exercise does the same job.

In winter, your body takes longer to warm up. The same warm-up time as in summer isn't enough.

When can I start exercising again?

Not when it stops hurting, but after your strength comes back while it's pain-free. What you do in between is holding exercises.

When you go back, don't jump straight to the weights you used to lift. Start light, watch for a few days, and if no pain lingers the next day, increase little by little.

Lifting weight overhead comes last. We add that movement back at the very end.

What are the limits of this assessment?

If the tear is large, it's hard for us to turn it around. In that case, a surgical consultation comes first.

One more note. It's hard to tell you exactly from the start how long it will take to get back. We decide step by step as we watch your condition.

We start by finding out why the same spot keeps flaring up. The answer differs depending on whether the tendon hasn't healed yet or the way you use it hasn't changed.

If your shoulder flares up again every time you exercise, come see us. If rest doesn't solve it, there's somewhere else to look.

Results differ from person to person depending on how badly they were injured and the exercise they do.