A rotator cuff tear is a common cause of pain and disability among adults. Over 2 million people a year report rotator cuff injuries. This injury most often occurs in people who repeatedly perform overhead motions, progressive degeneration, wear and tear of the tendon tissue, family history (a common occurrence in some families), and heavy lifting over an extended period of time. Rotator cuff injuries have the risk of increasing with age. Many people recover from rotator cuff injuries with Physical Therapy exercises that increase the strength of the muscles surrounding the shoulder joint and to improve flexibility. There are occasions that the rotator cuff tear can result from a single injury. This should be addressed immediately. Extensive tears may require surgery, but with early intervention and strengthening the muscles with therapy, you have a great chance of avoiding surgery. The two types of rotator cuff injuries are acute tears that result when you fall on your outstretched arm or lift something too heavy and/or degenerative tears that result as a wearing down of the tendon. Degenerative tears usually occur in your dominant arm, and there is a likelihood of this injury being in your opposite shoulder even if you don’t experience pain.
Prevention is key to any injury, but daily shoulder stretches and strengthening exercises can help prevent future injury of the rotator cuff. The issue with preventative care is that people tend to resort to their exercises when they are in pain. It is imperative that stretching and strengthening is done every day at home and not only when you are at the therapy office. Physical Therapy will help alleviate the pain, and your therapist will work with a variety of modalities while you are in the office, but you must continue your plan of care to achieve optimal results and be pain and surgery free. Keeping your shoulder immobilized (without movement) for prolonged periods of time can lead to the thickening and tightening of the the connective tissue causing further complications (frozen shoulder). It is important to not only strengthen and exercise the front muscles, but you must work the entire shoulder area, front and back, to get and keep your muscles balanced.
Anatomy Of An Injury
Your shoulder is made up of three bones: your upper arm bone, your shoulder blade, and your collarbone. The shoulder is a ball-and-socket joint. The ball of your upper arm fits into the socket of your shoulder blade. Your arm is kept in this socket by your rotator cuff. The rotator cuff consists of four muscles and their tendons that stabilize the shoulder. Your shoulders allow you to do many things that are taken for granted: lifting your arms above your head, combing your hair, playing catch, swimming… just to name a few. There is also a sac called a bursa that allows your arm to move freely. When the rotator cuff is injured or damaged, the bursa becomes inflamed and painful.
Symptoms of a rotator cuff injury are as follows:
- Increased pain when you move your shoulder away from your body
- Pain that spreads down your arm and even into your elbow
- Difficulty lifting your arm above your shoulder
- Difficulty holding your arm up for extended periods of time
- Pain when performing simple tasks such as combing your hair
- A clicking or crackling sensation when moving the shoulder
- Increased pain and stiffness with tenderness in the inflamed area of the shoulder
- Disturbed sleep, especially if you lie on the affected side
- Arm weakness
Physical Therapy improves strength, flexibility, and function. Therapy will help alleviate some of the pain, and your therapist will work with you with a variety of modalities while you are in the office, but you must continue your plan of care to achieve optimal results and be pain and surgery free. Keeping your shoulder immobilized (without movement) for prolonged periods of time can lead to the thickening and tightening of the the connective tissue causing further complications (frozen shoulder). It is important to not only strengthen and exercise the front muscles, but you must work the entire shoulder area, front and back, to get and keep your muscles balanced. It is imperative that stretching and strengthening is done every day at home and not only when you are at the therapy office.
Rest and ice help decrease pain and inflammation and give the torn tendons time to heal.
Nonsteroidal anti-inflammatory medications to decrease inflammation and pain.
- Doorway stretch – Grip the sides of the doorway with each hand at or below shoulder height and lean forward through the doorway until you feel a light stretch. Keep a straight back and shift your weight onto your toes, but do not overstretch. This is a light stretch. Do this 10-20 times.
- Side lying external rotation – Lie on the side opposite your injured arm with knees bent and injured arm across your abdomen at a 90 degree angle. Keep your elbow touching your side, and with a light dumbbell, slowly raise the dumbbell toward the ceiling. Stop rotating your arm when you feel the strain. Repeat 3 sets of 10. When this becomes easy, increase to 20 reps.
- Reverse flys – Stand with your feet shoulder width apart and your knees slightly bent. Keep your back straight and bend forward slightly at the waist. With a light weight in each hand, extend your arms away from your body. Squeeze your shoulder blades together. Do not raise your arms above shoulder height. Repeat 3 sets of 10.
- Lawn mower pulls – Stand with your feet shoulder width apart. Place one end of a resistance band under the foot opposite your injured arm. Keeping your other hand on your hip and without locking your knees, bend slighting at the waist. As if starting a lawn mower, straighten upright while pulling your elbow across your body. Keep shoulders relaxed and squeeze blades together. Repeat 3 sets of 10.
- STOP any of the exercises if they are causing you pain
- Manage your pain
- Increase mobility
- Strengthen and improve flexibility
Also keep in mind that healing properly from a rotator cuff injury can take a very long time. Be patient and stay committed to your physical therapist’s advice on how to care for your injury.