Shoulder pain is one of those annoying things in sports. At a minimum, it's painful and you cannot perform at your best. If you aren't careful, it can get worse and consequently you may be completely out of the game or it can get chronic. Then you have to live with it.
If that's you, I completely understand. I do suffer from chronic calcific tendonitis in my shoulder. But I am constantly working on it and in the last couple of months it got a lot better and I can do (almost) all exercises without problems. In this article, I want to share my own experience about different healing techniques including shoulder exercises, foods, electrical muscle stimulation (EMS), physical therapy, and more that help me significantly reduce my shoulder pain.
Please note: This post is meant for informational purposes only, and should not be taken as medical advice. If you struggle with chronic pain, please speak to your doctor.
What Is Calcific Tendonitis?
Calcific tendonitis (also referred to as calcific tendinitis) is the condition when calcium deposits build up in your muscles, tendons, or ligaments. This can happen anywhere in the body but most often it occurs in the shoulder, specifically in the rotator cuff. The rotator cuff is a group of tendons and muscles that surround the shoulder joint, and connect your shoulder and shoulder blade with your upper arm bone (humerus). Eighty percent of all calcific tendonitis cases appear in the supraspinatus tendon, which is part of the rotator cuff.
The exact causes for the calcification process are not entirely clear. Genetics, abnormal cell development, or metabolic diseases (like diabetes) seem to be common causes. However, the most important contributor is tissue wear and tear from working a lot with your arms overhead like playing basketball, swimming, weightlifting, gymnastics, or CrossFit.
Calcification is normally a slow process where the calcium deposits build up over time in three stages:
- Precalcific: Cellular change slowly begins but it's pain-free.
- Calcific: This is characterized by three phases: formative, resting, and resorptive (the last is the most painful).
- Postcalcific: The degeneration of the calcium deposit starts in a painless manner.
People report different shoulder pain experiences and symptoms. For some it's just a light, nagging pain, for others it's severe to a point where it impacts sleep and daily activities. I recommend — from my own experience — that as soon as you notice discomfort, immediately do something about it. This will help you avoid the risk of chronic shoulder pain, or even worse, shoulder impingement or a frozen shoulder.
Although the pain may feel similar, calcific tendonitis must not be confused with bursitis. Between our joints, we have sacs (called bursa) filled with fluids that act as a cushion. An inflamed bursa is called bursitis. The treatment is different from tendonitis.
How To Diagnose Shoulder Tendonitis
An easy way to self-diagnose as a first step is to extend your arms in front of your body and hold a full bottle of water. You should be alarmed if you feel pain in your shoulder.
Another way to test is to extend both arms to the side of your body and then make small but fast, backward circles with your hands. If any of that hurts or if it hurts in your shoulder when you turn around at night, I strongly recommend seeing your doctor who would then conduct a physical exam with you. These are normally complemented by imaging tests such as an X-ray and ultrasound to identify any calcium deposits or other abnormalities.
I will discuss later what you can do for shoulder tendonitis and how to speed up the healing process. First, let's take a look at what we can do to avoid shoulder tendonitis in the first place.
How To Avoid Shoulder Pain
"Prevention is better than cure," as the proverbial saying goes. It's always better, faster, cheaper, and certainly less frustrating to avoid injuries and the need to go into rehabilitation in the first place. The majority of sports injuries can be avoided by incorporating some proactive pre-rehabilitation (prehab) activities into your routines.
This is especially true for shoulder tendonitis. To avoid injuries and shoulder pain you need to actively work on improving shoulder mobility and stability. Unfortunately, they are both on the opposite ends of a spectrum and there are not really any exercises that will help you improve both at the same time. The good news is that you can save time by simply incorporating the relevant exercises into your warmup routine.
Top mobility exercises for shoulder pain prehab:
- Stretching your chest using a long foam roller
- Stretching your lat muscle with an elastic band (like a TheraBand)
Top stability exercises for shoulder pain prehab:
- Rotator cuff strengthening exercise with elastic band
- Isometric band pull-apart exercise for shoulder blade stability
A special case related to stability is when you have strength imbalances. That means one side of your body is stronger than the other. If you are right-handed, for instance, then your right arm is typically stronger. When you then work with a barbell using both hands, one side would have to compensate for the other. This can lead to overuse over time and injury.
I strongly recommend finding out if you have any imbalances. A great way to do this is by getting a DEXA scan done as I described in my article, “What Is a DEXA Scan and How To Boost Your Fitness.”
Six Ways To Treat Calcific Tendonitis
If your doctor diagnoses you with calcific tendonitis in your shoulder, they will suggest a treatment plan that may or may not include surgery and/or medications. You can also create your own treatment plan by combining some of the options that I outline below.
Here I am not covering surgery (like arthroscopic or open surgery) to remove calcific deposit because that's really the last resort and hopefully you can avoid that. I am also not covering cortisone injections or medication (like anti-inflammatory medication such as ibuprofen) because I prefer to handle everything naturally for as long as possible.
Let's take a look at the things I did to successfully treat my own shoulder tendonitis.
1. The Best Treatment No One Likes: Rest
The absolute best and most effective way to execute or speed up the healing process is to rest. To stop. To do nothing.
But, of course, that's not what we want to hear. At least I don't. And not exercising, doing any other sports, or following an active lifestyle has too many other negative consequences I don't want to accept. The good news is, we don't have to.
Sure, you should totally give your shoulders a break and do less of the movements that hurt or use much less weight. Instead, you can focus on your lower body (do more legs) or your core for a couple of weeks. For sure, you can always do more HIIT or LISS cardio (like walking) during this period.
As frustrating as it may sound, I strongly recommend taking a step back and focusing on your health and getting rid of your tendonitis.
2. Electrical Muscle Stimulation (EMS)
With the growing availability of affordable, portable electrical muscle stimulation (EMS) devices, this type of pain relief treatment is becoming mainstream and very popular. EMS devices send electrical impulses to your muscles to promote muscle contractions. These contractions increase blood flow and nutrient absorption, which helps the body recover faster and perform better. It also reduces the risk of soft tissue injuries.
Two typical treatment types are Transcutaneous Electrical Nerve Stimulation (TENS) and Neuromuscular Electrical Stimulation (NMES). Both can aid in the injury recovery process by reducing pain and inflammation, speeding up the recovery process, and improving performance.
One EMS device that is popular especially in CrossFit communities is the PowerDot. I used the PowerDot myself to treat my own shoulder tendonitis with very good results. PowerDot explains how to use the device to treat shoulder pain on their site. Because this product works, I contacted them to establish a partnership. PowerDot got acquired by Therabody. I am a member of the Therabody Network. Contact me directly for a 10% discount on Therabody products.
It's inexpensive and portable. It simply connects to your mobile phone. You don't need a medical center but can do your treatment anytime and anywhere. It just works.
A related treatment in the field of electrotherapy is shock wave therapy where electromagnetic pulses of high energy are delivered to the affected area. This creates microtrauma which initiates a healing response by the body. It is quite painful and requires special equipment typically only accessible in medical centers.
It is important to note, however, that electrotherapy alone is not enough but it is part of a more holistic treatment plan that also needs to include a combination of all the elements on this list.
3. Nutrition That Heals
The right type of nutrition will not solve all your problems but it is a significant contributor to the quality and acceleration of your healing process of any injured tendons or ligaments.
Tendonitis is an inflammation. So any anti-inflammatory food is absolutely recommended. Eat more fish (for omega-3), berries, greens, nuts, extra virgin olive oil, and turmeric. Even coffee has some anti-inflammatory compounds.
On the contrary, there are some foods that prolong the healing process as they induce inflammation. These foods include sugar (most soft drinks), trans fats (donuts, french fries), refined carbs (white bread, pasta), alcohol, processed food in general, and (very unfortunate for me) red meat.
As a general recommendation, following the Mediterranean diet has been proven effective against inflammation. Bone broth is very high in collagen, which is a protein known to support the healing process of tissue in your body. Finally, magnesium and zinc are minerals that aid tendon and muscle repair.
4. Physical Therapy
Next to the previously mentioned treatment elements, physiotherapy is very often recommended by a doctor after calcific tendonitis is diagnosed.
Typically a physiotherapist would go through a combination of massages, stretching, mobility exercises, or pressure point treatments. The goal is to relieve pain and restore the full range of motion of the tendons of the rotator cuff and loosen up the rotator cuff muscles. More alternative treatment methods may include acupuncture or dry needling.
5. Increase Blood Flow
Generally, increasing blood flow and circulation is a good thing in the healing process because the exchange cycles of blood and the nutrients with it are sped up.
How can we achieve this?
One treatment option that worked very effectively for me was muscle flossing. This works on the principle of blood flow restriction.
To do this you can wrap a latex rubber band (floss band) around your shoulder joint. Wrap it quite tightly. Then go through various light shoulder exercises like arm circles for about five minutes. This is quite inconvenient as your shoulder muscles are screaming for blood. When you are done, remove the band and you will feel your blood shooting into the wrapped area, hence increasing blood flow and ideally accelerating recovery.
6. Active Recovery
As you may know by now, I am not a big fan of doing nothing. Being active during recovery (in a careful way) is one key thing I do. Even though I do recommend resting (see the first point in this list) or at least really slowing down, you still can train other body parts or other aspects such as cardio, balance, flexibility, or mobility.
I also mentioned prehab earlier. In a careful way, you can apply the same exercises that I introduced above for rehab even after you are diagnosed with calcific tendonitis in your shoulders.
In the recovery phase, a very diligent warm-up is even more important. Make sure that all your joints and muscles, especially the injured ones, are warm and activated. If you do use strengthening exercises, I'd recommend smoothly going through isometric movements, and slowly moving through the full range of motion exercises.
There are lots of shoulder self-mobilization exercises available (typically following the Mulligan technique, which leverages mobilization during movement). Another classic is the infraspinatus exercise, or using a shoulder pulley for rehab or and strengthening the rotator cuff. A final secret tip is the dead hang for shoulder pain recovery. It's one of the exercises that worked best for me (simply hanging from a pullup bar, ideally for a minute) and it feels surprisingly nice.
Regardless of what you do, do something. Stay active and go out. It's good for circulation and mood. Don't underestimate the mind-body connection. Get that sunshine and happiness vitamin D.
Enjoy Your Active Lifestyle Without Calcific Tendonitis of the Shoulder
There is hardly anything more annoying than being injured, not being able to exercise, and not following an active lifestyle to pursue health and happiness. I have been there. I had calcific tendonitis and by now have almost completely cured myself. In this post, I shared the top techniques that I used during my own healing process.
If I'd have to pick my favorites it would be nutrition first. No big surprise there: Choosing the right nutrition is the top technique to improve health and fitness. Second, I'd choose electrical muscle stimulation (EMS) because it is inexpensive and easy to use everywhere. I used different recovery and strengthening programs of the PowerDot device (contact me for 10% discount) on a daily basis very effectively. Finally, and in retrospect, I highly recommend incorporating prehab exercises into your routine. It may appear to be a bit boring, but it's totally worth it.
For prehab as well as rehab I recommend a balanced approach leveraging all 4 Legs of Fitness, which is inherent to all of my programs.
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This is fabulous information. Just got diagnosed. I’m coming off codeine, hate it. Taking control now. I’m in more pain, should I exercise gently? Or rest til inflammation is down further?