Over the years we’ve seen countless rotator cuff injuries across both our clinics. Some respond well to some simple strengthening exercises. Yet others refuse to get any better. Some even get worse when you try to strengthen them. Why would this be? In this article we give you the benefit of our experience looking beyond the obvious. Looking past the muscles that are causing the pain and onto the reasons why they are over worked in the first place. Finally looking into what you can do about it to help yourself.
What Are The Rotator Cuff?
Rotator Cuff Muscles
In short the rotator cuff are small intrinsic muscles that co-ordinate the movement of your arm bone (humerus) in relation to your shoulder blade (scapular). They do the little movements that allow you a full free flowing shoulder movement.
There are 4 of them. I shall forgive you in you’ve not heard of any of them. Supraspinatus, infraspinatus, teres minor and subscapularis (not shown). The one most people have heard of is supraspinatus. Simply as this is the most commonly injured one. Or at least most commonly blamed.
How Do You Injure Your Rotator Cuff?
As with any injury. There are two kinds of injury that affect the rotator cuff. One is where something goes twang, snap or pop. You will certainly know about this kind of injury. It hurts a lot and is quite debilitating. This is especially true in rotator cuff issues. This will however get gradually better.
The second type is one that we actually see more of in the clinic. The ones that have come on gradually. Perhaps over the course of weeks, months, even years. These are generally termed chronic injuries. All this means is that it has been around for more than 6 weeks.
I talked in detail about the difference between these 2 types of injury at recent presentation I did at our local F45 gym here in Brighton. You can watch at the following link.
From a grading perspective the first kind of injury described here can turn into a chronic condition – if it lasts longer than 6 weeks. With rotator cuff issues it commonly does. Probably because the discomfort is significant enough to force you to alter the way that you move to avoid pain. When the tissues that were damaged have knitted back together again that movement pattern stays as it was leaving you with a painful movement pattern.
What Not To Do With Your Rotator Cuff Injury
I talk about one of the most commonly given physiotherapy exercises for rotator cuff injury and why I don’t like it in this video here:
The reason I don’t like it is that I’ve seen so many people make their condition worse by doing it. I’m sure it works for some people. Remember the people I see at the clinic are very skewed towards people who have tried the standard stuff and it’s not worked for them.
But why might this exercise make some people’s symptoms worse? For me the rotator cuff is usually a poor scapegoat. It does lots of good solid work but it is quickly over powered by bigger stronger muscles when they don’t behave themselves.
So if your movement pattern means you are already overusing a muscle should you try to strengthen it? Surely that just means you’re using an overused muscle even more? Of course we are blessed by being a private practice. We can make the time to work out what is happening for each individual. Rather than having to go with what is going to work for most people in the majority of cases due to time and budget limitations.
That said there are way too many people to my mind dishing out these kinds of exercises in private practice and in the fitness industry. The case in point being this bunch of exercise. Yuck. They just look like they’ll overload your overload!
To Operate Or Not To Operate: That Is The Question
Being the ‘last resort’ clinic that we are we see a lot of people who have had persistent problems and are considering surgery. I would always say be wary surgery. As I said previously the people we see are skewed. We are more likely to see people who surgery didn’t work out for than we are to see people who surgery worked beautifully for. But there are inherent risks and no absolute guarantees of success.
Equally what we do has no guarantee of success. But it doesn’t involve opening you up and is very unlikely to make things worse and doesn’t cost the NHS thousands of pounds! My message here is not one of brand promotion – although indirectly it is. More of a message of try absolutely everything you can from every available kind of therapist before you go under the knife. You will quickly know if an approach is right and working for you without investing excessive amounts of money.
Also beware what scans tell you. This very interesting piece of research here tells us that only 50% of findings on MRI scans were actually confirmed when going in for operation. As in what they were expecting to find wasn’t what they found. Research, an excerpt of which is shown in the table to the left shows how we can exist symptom free when we have all kinds of issues in our low back. The same is true for degeneration of rotator cuff tendons and even partial ruptures of tendons. Anecdotally I have seen a few clients over the years who have ruptured their rotator cuff tendons and not noticed. Saying they thought ‘something felt a bit funny.’
Be wary the standard MRI finding: wear and tear of the supraspinatus tendon. Pretty much every MRI report I have read in the last 15 year has this finding. In my experience when your body is lined up correctly and you are in a good place emotionally this should be a non finding. As in completely symptom free.
What You Can Do About Your Rotator Cuff Injury?
Before we go into the good stuff I feel obliged to put in the usual disclaimer. Obviously the best thing to do is come and see us at Brighton Sports Therapy. We can assess what works and what doesn’t for you. With our treatment we can work out what is the most effective combination of treatment and exercises specifically for you.
Now of course I would say this because I own an injury clinic that specialises in injury treatment. But there’s a very good literature review to say the best way forwards for impingement (you can read that as rotator cuff injury) is a combination of exercise and hands on treatment (manual therapy). You can read the abstract here.
The next best thing if you live a long way from us is to contact your local therapist. Have a chat with them over the phone and ask them how they can help you. Personally I would be wary of any therapist who only mention ultra sound or exercises. The reasons for which we speak about in our previous posts: Top 5 Physio Myths and Does Exercise Based Physiotherapy Actually Work?
If you don’t have any cash to invest in your well being then here’s our best generic tips that should help most persistent rotator cuff problems. All of them should be performed painlessly!
Lumbar Extension
This is where we find a lot of limitation in our treatments that can often lead to a dramatic improvement in symptoms. If you are limited through your stomach this may increases the load on the rotator cuff muscles and in so doing cause pain.
The single best way to release this off is do the opposite of closing it down. Open it up! Start just by lying on the edge of your bed and having your arms over head and progress to arching back over a Swiss Ball. If your shoulder is too painful to have the hands above the head simply bring it back to a level that is comfortable.
Half Moon
It’s a little known physio fact that the obliques are continuous with the lats as shown in this great picture from Grey’s Anatomy. When the lats are tight the rotator cuff are in a mechanically weakened position and so have to work too hard. So another potential cause for pain.
To stretch the obliques simply lean over to one side with the arms above the head and make like a half moon. To increase the range of your stretch take some deep breaths into your rib cage to open out the ribs. You should find you are able to move further into the stretch comfortably after doing so. Again, if pain in the shoulder limits how much you lift your arm just take the arms as high as you are comfortable with.
Lats
Billed as the ‘Best Stretch Ever’ here. That might be a bit grand but it’s certainly very good and great for a variety of conditions for lots of different reasons. Tight lats leads to extra work for the rotator cuff. Again breathe into the rib cage on this one to give you an extra sense of opening.
Pecs
Pecs are important for rotator cuff issues for the same reasons as lats. They pull the shoulders inwards. If you have round shoulders, a predisposing factor in rotator cuff injury, then it’s likely your pecs will be tight. Try taking the stretch in the video below to a point where you feel a nice stretch. Not pain.
Scapular Stabilisation
So far we have focused on tight muscles that pull the body forward and in so doing increase the amount of work that the rotator cuff muscles have to do. If we flip reverse this we look to strengthen the muscles that pull the shoulder blades backwards and give us a more stable base from which to work.
They’re not the easiest muscles to train without access to gym equipment sadly. Here’s some of personal favourites with varying degrees of equipment. I’ll do a video of an excellent no equipment exercise you can do at home. Watch this space… or our YouTube Channel.
Rotator Cuff Stretch
Finally. This is unlikely to fix the underlying cause of the problem but sometimes it just feels good to stretch the bit that hurts. This will be useful for temporary symptomatic relief. The previous exercises are more important for a long term solution.
Simply stand and pull the arm across the body as show in the video below. As always make sure you don’t take this to the point of pain:
Conclusion
So there you have it. As always we’ve looked to bust a few out dated myths. As mentioned above strengthening your rotator cuff in isolation may help the condition but we’ve seen many cases where it’s had little of no effect. Even making some cases worse rather than better.
The best solution is to combine the exercises above with our hands on treatment and help you change those movement patterns. This will help reduce the load on those poor over worked rotator cuff muscles and hopefully stop them screaming at you. For those that can’t get to us hopefully these exercises are a stepping stone to less rotator cuff pain, improved function and a happier you!
If you’d like to speak to one of our therapists about how we can help with your rotator cuff problem call us on 01273 921831 or email info@BrightonSportsTherapy.co.uk. If you can’t get to us, get to somewhere else! Don’t suffer in silence. Lots can be done about these types of conditions even if previous approaches haven’t worked.
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