Everyone has heard of a rotator cuff injury and knows someone who has “done” or “torn” theirs. What is a rotator cuff? What is a rotator cuff injury? What can you do if you have a rotator cuff injury? Exercises for rotator cuff injuries? This article answers all of these questions
In fact, rotator cuff tears are statistically one of the most common shoulders conditions. The numbers show that by age 50, 10% of people that don’t even have shoulder symptoms still have some form of rotator cuff tear present, so it’s no wonder there’s so many people complaining about theirs.
The rotator cuff is made up of a group of four relatively small muscles that sit on both the front and back of your shoulder blade (scapula). They include the supraspinatus, infraspinatus, teres minor, and subscapularis muscles.
Each of these is made up of a muscle belly (the part that contracts to produce movement), and the tendons that attach them to the shoulder blade and humeral head (the top part of your upper arm bone).
Because these muscles attach at different spots around your humeral head it allows your rotator cuff to perform different shoulder movements; including rotating your arm in, out, and lifting it away from your body. Even when you’re not performing these specific movements, these muscles are still very active in controlling and stabilizing any arm and shoulder movement.
Most rotator cuff injuries come in the form of damage to the tendons along their path from the shoulder blade to your humeral head. This is technically called tendonitis or tendinopathy, although there are other closely related conditions like shoulder impingement and bursitis that are also often involved with this type of injury.
The most commonly involved tendon is that of the supraspinatus muscle due to the pathway of the tendon between two surfaces of bone, predisposing it to being pinched or “impinged” when the arm is lifted up and moved around in an improper way. This is also why most rotator cuff injury symptoms are experienced when the arm is lifted up to the level of the shoulder and above, where this space for the tendon is narrowest.
This tendon damage can be as little as repetitive wear and tear with some inflammation and micro-tearing, or it can be much more debilitating. You might hear tears graded I-III referring to the severity of the muscle or tendon damage in a rotator cuff injury:
As the condition is degenerative and strongly related to consistent wear and tear, this damage tends to be more severe and of a higher grade in older sufferers, with the exception of those that occurred through sudden trauma.
Rehabilitation exercises are great for encouraging tissue repair and strength, however you may be fighting an uphill battle if there are underlying structural issues that are setting up your rotator cuff for injury in the first place.
Poorly moving and dysfunctional joints from your spine, ribs, collar bones, neck, and shoulders can all directly predispose your muscles and tendons to injury. These structures can be forced to perform on compromising angles and maintain a constant level of tightness as a response to poorly moving shoulder mechanics and irritated ligaments that hold your joints in place.
More often than not, the patients we see with these rotator cuff issues have dysfunction in this skeletal structure that has likely been contributing to wear and tear on those muscles and tendons for many years before they first recognize a problem.
In practice, chiropractor’s address the full body regardless of the presenting complaint, and rotator cuff cases are no different. Your chiro will assess the body using a grid system that addresses issues in your body’s structure in an order of priorities to best suit your body’s ability to heal in gravity.
Everything from your pelvis upwards including the shoulder, relies on a stable hip and pelvic dynamic to provide a level foundation for the rest of the body to work from. Addressing any leg length differences and pelvic torsions as part of the rotator cuff treatment eliminates the possibility of ongoing compensations affecting the risk of re-injury and rate of healing as a result of dysfunction and asymmetry from the ground up.
Once the structure is functioning optimally, then rehabilitation exercises are recommended.
Over the long-term, consistent rehabilitation exercises have been shown to greatly improve both symptoms and function of damaged rotator cuff muscles. There are plenty of effective exercises that you can do at home that don’t rely on more than some light weights or resistance bands:
The first 4 moving exercises are most effective when you perform the eccentric part of the movement (when you bring the weight back down, or let the band come back towards the wall) SLOWLY, over the count of 3-4 seconds. This type of emphasis has been shown to be most effective in stimulating tendon recovery.
All these exercises and stretches should only be performed pain-free, taking note of any pain or soreness during or after and adjusting the number or reps, sets, and time appropriately. Also, while the problem shoulder should be the priority, doing the exercises on both is highly recommended as the research shows individuals with one affected shoulder have a much higher chance of developing issues in the other side too.
If you’re suffering from shoulder issues, it’s advised that you speak to a practitioner (chiro, osteo or physio) about addressing any underlying causes before diving into rehab, so that they can ensure you’re ahead of these problems and performing well structurally before tailoring a safe and effective healing and exercise program to you.