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You may have heard people talk about a rotator cuff injury and rehabilitation; it’s one of the most common injuries to the shoulder for in both sport and everyday life. Here’s a look at what the rotator cuff actually is, how it works, how it gets injured and how to do a successful rehabilitation.
The definition of the rotator cuff is “A tough sheath of tendons and ligaments that supports the arm at the shoulder joint”. The shoulder is an amazing joint – it can swing a tennis racket, reach behind your back, get things down from shelves and help you to play the piano. It is very mobile and dextrous. But this mobility comes at a price – stability. Unlike the hip joint, which very stable and has a much more restricted range of movement – you can’t get your foot above your head, unless you’re an ice dancer- the shoulder sacrifices stability for mobility. It can do lots. But to allow for all this movement, the shoulder is very unstable. Step in the rotator cuff. Just like the name, these 4 muscles are a natural stabilising cuff that prevent the shoulder from dislocating. If we didn’t have one, when we threw a ball our shoulder would dislocate.
The rotator cuff is made up of four smaller muscles that attach to four points on the outside of the shoulder. They are the sub-scapularis, supraspinatus, infraspinatus and teres minor. Together they help to pull the shoulder in towards you so that it stays in place.
One of the most common causes of shoulder pain, rotator cuff injuries can be both sudden onset and also degenerative. Because of the complexity of the joint and the small spaces that the muscles have to go through, wear and tear over time can cause impingement (rubbing or wearing down) of muscle fibres. This is particularly common for people who do repetitive overhead movements of the arm. In these movements the rotator cuff has to go back on itself, rubbing and impinging on bone and tissue, causing injury.
Injuries can also be more sudden, especially in overhead weighted exercises like the shoulder press.
Rotator cuff injuries are quite easy to spot. symptoms include:
Pain and swelling on the front of the shoulder and side of the arm; this can be vague and hard to pinpoint
Pain on raising and lowering the arm
Stiffness and pain when sleeping
Pain when reaching overhead, e.g. to get something from a high cupboard
Pain when reaching behind you, e.g. putting on a seatbelt.
There are also some quite specific tests that a well qualified PT or physiotherapist can do to identify which part of the rotator cuff you have injured.
In any injury there are three phases; the inflammatory or acute phase, the proliferation phase and the chronic or remodelling phase. During the inflammatory phase (0-48 hours after injury) patient should RICED. That’s rest, ice, compression, elevation and drugs (like ibuprofen). In the remodelling phase (48 hours-21 days after injury) RICED can continue but it’s time to start rehab exercises. Massage can also help to ensure that scar tissue is broken down and new fibres are laid down in line with tensile stress. Otherwise this scar tissue will become a site of weakness. In the chronic stage the rehab exercises can become more challenging and complex. The exercises can now also challenge the muscles around and supporting the injury.
In some cases surgery may be required to remove any impingement to the rotator cuff. This is called a sub-acromial decompression (basically removal of debris and crud that is in the way of the rotator cuff). It os the most common shoulder operation in the UK.
In any rehab, exercise should follow the order of passive (someone moves the joint for you), active (you move the joint) and then resisted. It’s always better to start with a light resistance and more repetitions and then build up as you go.