Rotator Cuff
Rotator Cuff

If you have a vague pain in your shoulder, you find it difficult to lift your arm at a particular angle, or if you feel a sharp pain while doing some overhead activities, you may be told that you have a “rotator cuff” injury/ tear.

 What is the Rotator Cuff? “Is it a muscle?”, “A bone?”, “A ligament?” You may wonder. It is neither one of these. It is actually a group of four separate muscles that attach the bone of your arm (Humerus) to the wing bone (scapula), support the ball of the shoulder and keep it in the socket, and help to “rotate” your arm. Though they are separate muscles with opposing actions, they all get attached around the head of the Humerus forming a “cuff” with their tendons. They always work together balancing out each others’ actions by cleverly altering the strength of their pull so that the head stays firmly in the socket while the arm moves around freely.

It is obvious then that even a small tear in one of these might disturb the balance in the shoulder and fail to keep the ball of the shoulder in the centre of the socket.

Causes of rotator cuff injuries can be: falling on the shoulder, lifting or repetitive arm activities especially overhead activities like racquet sports or throwing/ bowling. But injury is not the only reason for a malfunctioning cuff. Age related degeneration/ wear and tear of one or more of the tendons may lead to cuff defects or malfunctioning. Poor posture leading to shortening/ lengthening of one or the other of the muscles of the cuff leading to an imbalance in the whole group can cause an “impingement” of one of the tendons and result in damage. A bony defect in the shoulder arch, or a small bone deposit (Calcific Tendonitis) in a muscle may also lead to pain.

The injury to the cuff may range from a mild strain or inflammation of one of the tendons to a partial or complete tear. If you have a pain in the shoulder for more than 2-3 days, it is best to get it checked out by a Doctor. Most cuff injuries might settle well with a conservative approach and a lot of patience especially if they are detected in time. Your Doctor may do an examination and give you a diagnosis, or he might suggest investigations like X-rays or an MRI.

The initial treatment of a Cuff tear is usually rest, some anti inflammatory medication and probably some amount of icing. During this phase it is important to maintain the mobility of the shoulder by doing some simple exercises in the pain-free range as advised by your physiotherapist, and remain very positive. Because the shoulder joint is so complex and so near the cervical spine (Neck), there might be some amount of pain coming from the neck area too. In fact it is almost impossible to get a pure and isolated “rotator cuff” injury. The stage of acute pain may last from 3 days to 3 months and if you really understand your shoulder it might be easier to get through this stage. Remember, the cuff has a lower blood supply and this can get further compromised by age, structure of shoulder arch, exercises, smoking, etc..All these may delay/ prevent healing!!

Some shoulders, especially with complete tears may not respond well to a conservative approach and might require a surgical repair. Before trying surgery your surgeon might suggest a locally injected pain killer or a steroid injection. If you are young, an athlete and need a stable shoulder, your surgeon may not wait long before suggesting a surgery. But if you are above the age of 35 and not an athlete by profession, it is best to wait and try physiotherapy for more than 6 weeks before opting for a surgical solution. Physiotherapy might entail regular electrotherapy sessions, advice on activity modification, and light mobility exercises.

While waiting for your shoulder to heal it is a good idea to continue with a Cardio routine and try to spend some time doing aquatic exercises. Both of these are known to improve the chances of a quick recovery by improving blood supply, creating a feeling of well being and keeping the shoulder mobility good. Once the stage of acute pain passes, a gradual stretching and strengthening program will be planned for you by your physiotherapist, and you will need to follow up regularly to change the program as you get stronger. To plan your program, your physiotherapist will take into consideration the imbalances that existed before your injury, and also the weaknesses that have arisen during your rest period. A badly planned exercise routine at this stage can actually be more detrimental than beneficial.

After working with therabands, you may graduate to free weights and machines, body weight and functional training. Depending on the kind of injury you had you may or may not be allowed to go back to your original exercise/ sport routine. But with sensible modifications you might be able to be even stronger than you were before.

Facts:

Shoulder injuries are more often caused by resistance (strength) training than ANY other reason (even in Sportsmen)! Not because of playing!

Many exercises included in a normal gym workout for “Shoulder days” are not functional and are ONLY used to improve the “LOOK” of the shoulder

The body NEVER uses shoulder to lift weight AWAY from itself repeatedly for several sets and reps as gym exercises require

Even overhead athletes (racquet sports/ bowlers) ONLY use action towards the body when strength, power, speed, are generated: NOT AWAY from the body!

Individual “Cuff Exercises” though can be used when required, are a MYTH!! The shoulder NEVER uses isolated cuff muscles for function!! They are always used in UNISON, and are NEVER prime movers of any shoulder movement..There are larger muscles like Deltoids, Pectorals, Biceps, Lats etc for that!!!

Smoking may delay healing in cuff tears as it hampers blood supply to an already compromised structure!!