The Dreaded Rotator Cuff – A Simple Guide To Help Minimise Your Pain
You may have heard the term ‘rotator cuff’ if you’ve had a shoulder injury in the past, but you might not be sure of what it is. The GP may have briefly mentioned it, or a Physiotherapist could have described it to you in the past, but the information hasn’t quite stuck!
Typically, when you injure your shoulder there is a high probability that the rotator cuff will be involved, and this is because it is so integral to the function of your shoulder. It can also be a key reason why your shoulder will develop pain due to the structures that are involved.
If you have a current shoulder injury or you are just keen to remain injury free, our guide to the rotator cuff, as ever, will show you what it is, what it does and how to keep it healthy!
Anatomy & Function
Our shoulders are an extremely capable joint which have the ability to move in many directions, mainly due to it being a ball and socket joint. This is the same joint as the hip, which has similar movement, however there is a key difference in their structures. The joint of the shoulder is more capable as the socket (from the scapula) that the head of the humerus sits on to is flat, compared to the hip socket which is much more enclosed. Now that is a benefit of the shoulder in terms of movement, but it also makes the shoulder more unstable and prone to injury.
Our hips suffer far fewer problems and injury in comparison to the shoulder, because the head of the femur is well enclosed and stabilised within the acetabulum (socket). There is a huge amount of muscle sitting around the hips and buttocks to make it function.
The shoulder must then rely on the rotator cuff to provide the extra security for its stability, strength and function. Obviously, like any other joint the shoulder has ligaments and cartilage to help stabilise and hold the joint together, but the rotator cuff is vital to your shoulder function and health.
The rotator cuff refers to 4 muscles in the shoulder which are responsible for its movement and stability:
- Infraspinatus – turns the arm out (lateral rotation) and away from the body (horizontal abduction)
- Supraspinatus – helps to lift arm away from side (abduction), assisted by the deltoid
- Subscapularis – turns arm inwards (hand behind back movement – medial rotation)
- Teres Minor – turns the arm out (lateral rotation) and partially moves arm towards body (adduction)
All four rotator cuff muscles and tendons help to prevent dislocation of the humerus when influenced by the larger muscles of the shoulder. This is why they are so vital to work in unison to stabilise and secure your shoulder.
Rotator Cuff Injuries
Common injuries to the rotator cuff include:
- Impingement – part of the rotator cuff can become pinched between the head of the humerus and top of the scapula. This can cause pain, weakness and reduced movement. Caused by poor posture and lack of shoulder conditioning.
- Tendonitis – the tendon develops pain due to a change in its state, typically caused by overload of the tissue or it being strained.
- Bursitis – the fluid filled bursa that helps to cushion the shoulder joint can become compressed and painful. It is similar to impingement in how it is caused.
- Calcific Tendonitis – calcium deposits develop in the tendon which make the tendon tougher and less elastic and can prevent it from performing properly whilst developing pain. Develops typically between 30-60 years of age, but the cause is not clear.
- Rotator Cuff Strains & Tears – partial and full thickness tears are the more serious injuries and may require attention from a shoulder specialist. Tears are common in over 60’s and very common in over 70’s. Tears can happen if the tendon is not in good condition and it has too much load exerted through it or an unexpected trauma like a fall.
Maintenance & Rehabilitation
Keeping your rotator cuff in good condition is a must, especially as we age. A big part of rotator cuff health is that the large majority of the cuff is made up of tendons and their attachments to the bone. The tendons are vital for helping to generate force and prevention of dislocation, so keeping them happy and in great condition is key to remaining functional and pain free.
Tendons are a structure which receive less blood supply than muscle, which means they do not recover as quickly and need different methods to help them recover and stay in good condition. Resistive training or weight training is the perfect way to do this (see next week’s tendinitis blog for more info) by stimulating the tendon for sustained periods of time with a light weight, helps to draw blood to the rotator cuff, aids healing, increases strength and essentially maintains a better integrity of the tendon tissue. Below are some examples of elastic band exercises for the rotator cuff that you can perform if you are injured or even if you aren’t – you may experience some mild discomfort in the shoulder but this is normal and to be expected.
Passive treatments for the rotator cuff are extremely helpful to help the shoulder remain balanced. Due to habit and posture our shoulders can become dominant and tight in certain areas. To avoid pressure building up on the shoulder and its structures, keep it relaxed with sports massage, deep tissue massage or percussive therapy on a regular basis. This aids pain management, reduces tightness and increases circulation to the rotator cuff, helping us to maintain a better posture.
Rotator Cuff Injury Prevention and Conditioning Plan
Rotation with a Dowel Rod Sitting
Rotation with Dowel Supine
External Rotation with Band
Internal Rotation with Band
Ascended 90 Degrees Internal Rotation
Ascended 90 Degrees External Rotation
Band Flexion 90 Degrees
Take care of your rotator cuff, it’s responsible for the stability of the shoulder joint and also its diverse movement and strength. Take care of your posture, exercise regularly and give it some TLC with treatments to ensure your shoulder complex stays in the best shape.
All of our exercise prescription photos and videos in this blog came from our clinical software Rehab My Patient.