So, what is the rotator cuff and what is its role?
The shoulder joint is made up of the end of the humerus( humeral head), the scapula( shoulder blade) and the clavicle( collar bone), ligaments, all the muscles surrounding the joint, as well as connective tissue that forms the shoulder capsule. The shoulder, however, is not a stable joint. When compared to the hip( which is a ball-and-socket type of joint, with a deep socket), the shoulder joint has a very shallow socket, and the ball of the humerus sits atop this shallow socket.
So, unlike the hip joint, the shoulder relies on the external structures such as ligaments and muscles in order to create stability. The benefit of a less stable joint is that it provides plenty of mobility( and enables us to reach up, down, and side to side with our arms). However, when the external structures( capsule, ligaments, muscles) are compromised, this is when the shoulder can be in big trouble and lead to pain, discomfort and difficulty with overhead activities. The rotator cuff is comprised of four muscles: the supraspinatus, infraspinatus, teres minor, and subscapularis. These four muscles work in unison to maintain the head of the humerus in the socket as we move our arms up and down.
At the top of the shoulder, there is a roof-like structure called the acromion, which is the end portion of the shoulder blade. There are structures( supraspinatus tendon, subacromial bursa, articular capsule) that pass under this shoulder“ roof.” When one of the rotator cuff muscles is compromised, these structures under the acromion get pinched with active motion( usually above shoulder height), which can give you pain. This is called secondary impingement of the shoulder.
The medical literature tells us that in about 80 percent of cases involving the rotator cuff, the supraspinatus muscle is the one that is injured. If you look at a picture of a shoulder joint, you will see that it passes just underneath the acromion, which is why this muscle can easily get pinched in that space.
The most common signs and symptoms associated with rotator cuff pathology are pain in the upper arm( often along the biceps or in the deltoid area), pain at nighttime, difficulty / pain with overhead activities, difficulty / pain with reaching out( such as reaching for a parking garage ticket out of a car), difficulty / pain reaching across your body, weakness of the shoulder with certain motions, and increased pain and tenderness in the back of the shoulder and upper trapezius muscle.
So, what should you do if you are experiencing these signs and symptoms?
The best thing to do when experiencing pain in your shoulder is to not ignore it. Most people think the pain will eventually go away and continue with their regular activities. After a few months, the problem usually will not have resolved on its own, and the condition may now be much worse.
The best approach is to consult a healthcare professional( ideally a physical therapist) as soon as possible when you start having pain in your shoulder. While the signs and symptoms are common, it is important to consult an expert to determine the cause of your pain( since there could be other causes) and start you on the appropriate program for recovery.
Your physical therapist will be able to identify impairments and build an individual program for you that can get you back on the courts. The best approach to treating rotator cuff injuries is using a combination of hands-on manual techniques such as mobilizations, dry needling, and IASTM( instrument-assisted soft tissue mobilization) with targeted functional exercises. •
If you’ d like to learn more, you can contact“ The Pickleball Doctor” at noe @ moveitpt. com. He is the owner of Move It Physical Therapy in Chapel Hill, NC. Free 10-minute consults are available, as well as virtual sessions. Movement screens can also be performed virtually, and Noe can provide guidance to help make sure you are ready to play this sport we all love!
Noe Sariban is a doctor of physical therapy and works with pickleball’ s No. 1 player in the world, Ben Johns. He is also a founding member of Train100, an online fitness training company geared toward pickleball players. If you’ d like to learn more, email Dr. Noe at thepickleballdoctor @ gmail. com. The Pickleball Doctor teaches pickleball camps all over the U. S. and internationally, and incorporates his knowledge and background as a doctor of physical therapy into his expert coaching.
IF YOU HAVE A QUESTION FOR DR. NOE SARIBAN, PLEASE EMAIL US AT
@ EDITORS @ PICKLEBALLMAGAZINE. COM.
SEPTEMBER / OCTOBER 2026 | MAGAZINE 59