Rotator cuff injuries; so common that even physiotherapists get them
You can get it spiking a volleyball
You can get it painting a wall
You can get it swinging a racquet
A sore rotator cuff needs an in depth assessment
And the best in depth assessment is Fixio
You can get it rowing
You can get it mowing
You can get it any old how
As a matter of fact I’ve got it now.
Rotator cuff pain and injuries are among the most common afflictions treated by sports physios. However, rotator cuff injuries are not just treated by physiotherapists; we can also suffer them ourselves. After a particularly grueling 3 hour straight beach volleyball session, I’ve found myself in the same position as many of our patients; nursing a sore shoulder and wondering what I did to deserve that as my birthday present?!
What Is a Rotator Cuff Injury?
Your rotator cuff consists of four muscles and their tendons – the supraspinatus, infraspinatus, teres minor, and subscapularis, with each attaching to the scapula (shoulderblade) and the humerus (the upper arm bone). These muscles stabilize the shoulder joint, rotate the shoulder and come together to lift your arm above your head. All movements involving the shoulder use the rotator cuff in some way.
Rotator cuff tendinitis is one of the most common forms of rotator cuff injury and typically begins with inflammation of the supraspinatus tendon and can progress from there to affect the three other tendons. Injuries to the rotator cuff usually develop as a result of repetitive motions over time, but can also happen as a result of direct trauma; causing the tendons to tear and become damaged.
The most common signs of rotator cuff injuries are:
- Muscle weakness in the shoulder joint
- Functional impairments; difficulty lifting, pushing and especially overhead movements
- Painful external/internal rotation
- Pain may be present, located either in the anterior or lateral area of the shoulder
What are the most common rotator cuff injuries?
Due to the nature of the Rotator Cuff, location to other muscles, range of movements it is used in and connection to other sensitive areas in the shoulder, there are many different rotator cuff injuries:
- Rotator Cuff Tears; muscle or tendon tears of varying grades
- Rotator Cuff Tendinitis
- Rotator Cuff Tendinopathy due to chronic irritation (ie what happens if you let your tendinitis continue!)
- “Impingement syndrome”
What are the causes of a rotator cuff injury?
If you play sports or have a job that uses repetitive overhead arm motions, you are at a higher risk of developing a rotator cuff injury. People over age 40 and anyone with weakened shoulder muscles from inactivity are also at higher risk of a rotator cuff injury. A rotator cuff injury may be caused by:
- A direct blow to the shoulder
- Repetitive overhead motions of the arm; volleyball, swimming, baseball and tennis are common culprits
- Chronic degenerative wear and tear on the tendons
- Falling on an outstretched arm
How are rotator cuff injuries diagnosed?
Most physiotherapists will be able to accurately diagnose rotator cuff tendinitis and other injuries by performing an in-depth examination and going through your physical history. Your physio will also perform tests for tenderness near the top of the upper arm in the subacromial space and will have you gauge your pain as your arm is lifted and moved in certain ways. Pain associated with normal muscle strength in the shoulder can suggest rotator cuff tendinitis; pain with weakness may indicate a tear.
If you’ve suffered a traumatic injury or if a tear is suspected, your physio may refer you for an x-ray or MRI may be ordered.
How to reduce your chances of rotator cuff injury
The best way to prevent rotator cuff tendinitis is to avoid or limit activities that irritate the shoulder. This one is easier said than done due to how much the rotator cuff dominates the movements of the shoulder. If you have a history of rotator cuff tendinitis, avoiding aggravating activities such as repeated overhead movements can reduce the number of flare-ups.
If you play sports that involve the shoulder, you should ensure that you are using the correct technique to limit irritation as much as possible. Speak to your sports physio about having them conduct an assessment of your movements and technique in order to get a better idea of any alterations you can make in order to help you stay pain free.
You can also help to prevent or manage rotator cuff tendinitis by:
- Stretching the shoulders during the day and before any activity
- Using a good posture when standing, sitting, or walking
- Resting the shoulder as soon as you feel any pain or discomfort
- Sleeping on your back or the unaffected side
- Taking breaks from during activities that use repetitive motions and movements
How do I treat rotator cuff pain?
During the acute phase of rotator cuff tendinitis, apply an ice pack to your shoulder for no longer than 20 minutes every hour. If you are in a lot of pain, ibuprofen may be helpful during this time as well. While you’re in the pain phase, stay away from heavy lifting and reaching out overhead as much as possible. Once you’re through the acute phase it is important to keep the shoulder moving because that can lead to frozen shoulder; a condition that causes the tissues around the shoulder shrink and reduce its range of motion.
Your physio can then begin to work with you and utilise exercises that will aim to fix problems such as stiffness and weakness and correct any other underlying causes. Sports physios are experts in the retraining of movements and activities related to your sport, work and the day to day activities that were aggravating your shoulder so that you can get back to what you were doing before the pain.
Now, back to get the ice out of the freezer!