What is the rotator cuff?
The shoulder is the the most unstable joint in the body and comprises by 3 main parts the glenoid, the humerus and the scapula (shoulder blade). The shoulder joint is stabilised by several structures; ligaments, capsule and the tendons of the rotator cuff. The rotator cuff is made up of 4 muscles, SUPRAPINATUS, INFRASPINATUS, TERES MINOR and SUBSCAPULARIS. These muscles work together to rotate the arm inwards and outwards and also work to take the arm away from the body to the side. These muscles can be injured in several ways with repetitive movements, trauma, muscular imbalance or adaptive postures.
Why is it important?
The 4 rotator cuff muscles work together to stabilise the shoulder joint and allow for smooth movement in all directions, therefore allowing you to reach over head whilst rotating the arm in and out. If we did not have a well functioning group of muscles the shoulder would dislocate very easily.
How does it become injured?
When tissues become irritated this changes the way the muscle can function and as a result changes our movement patterns. When the rotator cuff function alters this changes the way the shoulder blade moves and also the position the top of the arm maintains in the joint. This can lead to the space within the joint narrowing and we can impinge on the tendon structures during movement leading to an issue known as ‘Shoulder Impingement Syndrome’. If this is left untreated the tendon can become chronically irritated, and can in severe cases become degenerative and can lead to tearing of the structure. However, if this is managed appropriately with Physiotherapy, exercises can work very well to retrain the movement pattern, address pain and regain function. .
Strengthening of the the inferior rotator cuff muscles works to draw the top of the humerus down in the joint and can significantly reduce pressure on the tendon structure. This in turn allows a restoration of normal shoulder function and will help to reduce pain.
When the tendon is chronically degenerative or irritated we know the tissue has a reduced blood supply and as a result can be more painful, this can make it difficult to perform certain exercises and the muscles can become further inhibited. This leads to a negative cycle and can alter the way the humerus behaves during movement through the joint. When the movement is altered over a longer period we start to learn new ways of moving and compensating to put up with this change. This is an area in which Physiotherapy can help to restore normal movement, often this requires some adaptation to normal tasks for a short spell but in the long run this can help to make a significant improvement.
Do I need a scan?
Very often with rotator cuff injuries a scan does not give us any more information that we can gain from a high quality Physiotherapy assessment. If we scanned every shoulder we would find many false positives and this does not address the underlying problem. As we age it is not uncommon for the rotator cuff muscles to become torn, 65% of 65 year olds will have a rotator cuff tear, however a vast majority of these will not present with symptoms and will not impair shoulder function. Not every torn rotator cuff muscle needs to be repaired. Andre Agassi won Wimbledon whilst playing with a rotator cuff tear.
What can we do to help?
Physiotherapy is recognised as the best management for shoulder pathologies, particularly when managing symptoms related to rotator cuff pathology. We can help with reducing pain, improving movement, regaining strength and rehabilitation to get you back to your desired level of function.
How can you help yourself?
Posture management- this does not mean sitting upright for hours on end, all this encourages you to do is change your posture regularly as this allows the muscles to regulate themselves.
Exercise regularly- 5 sessions of 30 minutes of exercise throughout the week is recommended by the Government Health Board. This again allows muscles to regulate themselves by allowing them to stretch and strengthen with movement.
Avoid repetitive tasks with one arm where possible- depending on jobs and hobbies we may have tasks that require us to use one arm, where this is happening for a long spell try to vary the arm you use to avoid strain and overload injuries.
Pilates- this is a great way to get the deep shoulder stabilising muscles of the rotator cuff activating and working to your best advantage.
If you are struggling with a shoulder complaint do not suffer, get in touch with Peak Physio today and our team of Physiotherapists will be able to get you back on the road to recovery!
Scott McCreadie, Senior Physiotherapist, BSc, MISCP