Managing a Climber’s “Tweaky” Shoulder Pain

Managing a Climber’s “Tweaky” Shoulder Pain

Shoulder Pain

Why climbers experience shoulder pain or “tweaky” shoulders

tweaky shoulder pain for climbers
Dr. Sam Watkins, PT, DPT, climbing at a rock gym

Climbers with tweaky shoulder pain is not uncommon. If you regularly go all out while climbing, it’s likely you’ve had a “tweaky” shoulder following a session. So, what is this highly scientific “tweaky” shoulder?

For starters, let’s look at what is NOT. It’s not like the shoulder pain from that fall you took directly on your shoulder when your heel hook slipped. Or the shooting pain you got down your arm when you caught that huge dynamic move with one arm.

“Tweaky” shoulder pain is the mild to moderate discomfort that comes on near the end of or a few hours after a climbing session and likely goes away within 24hours. Unfortunately, once you’ve had it a few times, this discomfort keeps coming back when you climbIt likely doesn’t stop you from climbing or impact your life too much, but it’s annoying and keeps you from pushing yourself in training. This is a “tweaky” shoulder. 

And if you’ve experienced this, you’ve likely wondered what sinister tear/muscle imbalance/tight muscle is causing your pain and what you can do about it. If you or a loved one has suffered from what sounds like a “tweaky” shoulder, read on as I will briefly touch on these questions. 

What could be causing your discomfort

So, what’s going on in your shoulder causing your pain? A “tweaky” shoulder isn’t a diagnosis and it’s not associated with just one pathology. It could be due to a 

  • rotator cuff tendonitis
  • biceps tendonitis
  • subacromial pain (formerly known as impingement)
  • irritation of the labrum
  • SLAP tear
  • rotator cuff tear
  • glenohumeral or acromioclavicular ligament sprain
  • and the list could go on!

How can I tell if it is a tear?

People who have tears requiring surgery are most likely unable to reach overhead and perform daily activities without significant pain and discomfort. So if you are able to climb hard with manageable pain, the good news is that there is most likely not a tear to be worried about and it is highly unlikely that you will need surgery or an injection to get over this. Although it may be a bit frustrating to not have a diagnosis, there are a number of things you can do to address your pain. 

Why am I experiencing shoulder pain or discomfort after climbing?

If there is no tear, then why do you have pain? The answer for most shoulders that are irritated is that various tissues/structures were overloaded beyond their capacity. 

Years of climbing and exercising your muscles/tendons/ligaments/etc means that your shoulders have gradually adapted to those loads. If you were to climb for, say, half as long or as hard as what normally brings on your symptomswould you still have the same level of discomfort? Most likely not.

The fact that you are able to load the shoulder enough to climb at half of your normal training effort without pain indicates that your current level of training has surpassed your shoulder’s capacity of what it can withstand. (If you are having pain that limits your training to less than half of what you normally do, you likely have a more serious injury than just a “tweaky” shoulder).  

What is tissue overload and what does it mean for my climbing?

With climbing being such a fluid and variable sport, understanding the concept of tissue overload can be confusing. Let’s look at a different example involving a runner.

Imagine a runner who routinely runs 25 miles/week without any issue. They then decide to start training for a marathon, suddenly increasing their mileage to 35 miles/week for several weeksWith this 140% increase in mileage beyond what they are used to, they develop some knee pain. Now that tissues in the knee are irritated, they’re more sensitive to load and the runner experiences symptoms even after dropping their mileage back to 20 miles/week.

Now, 20 miles/week is their current maximum capacity. In order to be able to eventually add on more mileage, they first have to allow for the inflamed tissues to calm down. That means limiting their weekly mileage to maybe 15-17 miles for several weeks before building their training mileage again 

What should I do to help my shoulder recover?

To translate this runner’s knee pain back to climbing, consider the example above where climbing for half as long you’re used to doesn’t irritate your shoulder. In order to be able to climb for longer periods, you may first need to reduce your training to 50-75% of normal so that the irritated structures can heal and symptoms can calm down. 

As healing occurs, you’ll gradually be able to increase the duration of your climbs and work back to 100% of your training volume. If your “tweaky” shoulder is impacting your training, reducing the length or intensity at which you climb should be your first step to recovery, but eventually, you’ll want to introduce strength training to increase overall capacity.  

Strength training is for all climbers

Every climber should be doing shoulder strengthening exercises to reduce the risk of injury while at the same improving their performance. If your shoulder pain is significant, you should visit a physical therapist to provide you with specific exercises to avoid worsening of symptoms

“Classic” physical therapy exercises like shoulder internal and external rotation with a band or pulley may be a good place to start if that is all that your shoulder can tolerate without a worsening of symptoms. But in the case of a “tweaky” shoulder, as has been described, higher-level exercises can likely be tolerated.

There is nothing wrong with basic internal and external rotation strengthening, but there is no magic to them. These exercises load the rotator cuff to increase their overall capacity. There are countless studies showing that the rotator cuff and other important shoulder muscles are highly engaged with traditional exercises like weighted rows, push-ups/bench press, and shoulder raises. If these traditional exercises can actively challenge the shoulder muscles, then why not use them?

I don’t know a single climber that actually wants to spend an hour 3-4 days/week doing isolated internal/external rotation, T’s, Y’s, and I’s to manage their shoulder pain and decrease injury risk. 

With limited time to devote to climbing and strength training, use exercises that are known to improve strength while also helping with pain. For example, try adding inverted rows and suspension trainer face-pulls into your training program. They will have a greater impact on your performance as a climber, than internal and external rotation exercises.  

Want even more tips to improve your climbing performance?  

If you are interested in learning how to manage “tweaky” shoulders for yourself or your athletes, click here to register for our climbing clinic, Uplevel Your Climbing and Coaching. It’s hosted by MoveMend and Modus Athletica and features an interdisciplinary team of climbers/coaches, physicians, hand therapists, physical therapists, and strength and conditioning specialists. You’ll learn the best exercises to help improve performance and reduce injury, master taping techniques, and much more. 

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