Rotator Cuff Injuries or Tears

Rotator Cuff Tears are very common in a wide variety of sports such as Cricket, Swimming, Football, Hockey, Water Polo, Baseball, Gymnastics and Rock Climbing. In fact, any sport where shoulder use is high, Rotator Cuff injuries or tears will be commonplace. This tends to be due to the unstable nature of these sports and the lack of attention the Rotator Cuff muscles get as an aspect of injury prevention. 

These injuries tend to happen when the shoulder is shock loaded in an awkward position therefore overloading one of the Rotator Cuff muscles. Or they can happen from repetitive movements, where there is some imbalance in shoulder muscle load (eg. swimming).  This load can cause a small tear or irritation to occur in the tendon of the Rotator Cuff muscle. These injuries sound a lot more scary than they are in reality. There are many people who have significant tears or ruptures to their Rotator Cuff Tendons that have no pain and completely normal function. 

Up until recently it was thought that the gold standard for treatment of Rotator Cuff Injuries was surgical repair of the tear in the tendon. However, research is now showing conservative management with physiotherapy has greater short and long term outcomes than surgical intervention. If surgery has been recommended to you, I would strongly advise getting a number of opinions as well as doing your own research into the surgery before going ahead.  

How can I identify it?

You can identify a Rotator Cuff Tear or injury with an acute event of pain in the shoulder combined with consistently painful range of movement. It can be quite a strong ache at rest with less consistent pain patterns than other types of shoulder injuries. Usually, it will feel like an isolated event where the shoulder was injured and have the typical markers of an acute injury. 

What Can I Do?

Often it can be easy to avoid using your shoulder at all for fear of making the tear worse. However, more research is indicating that tendons need load and use to heal properly. The most important part of recovering from Rotator Cuff injury is consistency. Consistent load throughout the process is very important. 

Step 1: Deload – in the first week or two it is important to allow the shoulder to calm down and to get the inflammation under control. This simply means, don’t do anything that hurts the shoulder significantly for the next week or two. This doesn’t mean don’t do anything, any movement that is less than a 3/10 pain, treat it as fine and keep doing it. Try to use the shoulder as normally as possible.

Step 2: Spikey Ball the Culprit – Often the specific muscle that has been injured will be very tight and sensitive to touch. It can be helpful to release this muscle with a spikey ball. This will take some pressure off the tendon that is trying to heal and relieve some of the resting pain. 

Step 3: Specific tendon Load – Tendons love static load to help stimulate healing without overloading and increasing the inflammation. My favourite two exercises to help stimulate the tendon are:

  1. Static 45 second external rotation holds – 3 x 45second holds at 40% exertion or a slight awareness of discomfort. A little discomfort is wanted with this exercise but it’s very important the pain leaves after completing the exercise or doesn’t increase to pre-exercise levels.
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2. Assisted Range of movement exercises with a broomstick – use a broomstick to take the shoulder through full range of movement in all directions. Only use the stick to help through the ranges of movement that are uncomfortable and need a little assistance.

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3. Shoulder retraction – With an elastic band or cable machine at shoulder height. Move from reaching as far forwards as you can to squeezing the shoulder blades together and bringing the arms back as far as you can.

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4. Lat pull downs with band – with a light band do single arm lat pull downs concentrating on shoulder retraction through the entire movement. Your shoulder will want to round towards the bottom of the movement so make sure you concentrate on keeping the shoulder retracted. Then allow the band to pull the shoulder back to the starting position.

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3. Shoulder Press – Immediately follow the lat pull downs with weightless shoulder press on the same side, again concentrating on shoulder retraction throughout the full movement. This is a great way to solidify the new movement pattern for your shoulder.

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Step 4: Increase load – as pain levels permit you want to continue to increase the load through the shoulder with weights and more difficult or stimulating exercises. These changes should be small but consistent. The reason for this is to make sure the tendons heal fully and to the level that you need for your sport. If left to heal on their own the tendon may heal but not with the strength needed to deal with the load required. This increases the chances of reinjuring the same tendon. 

Quick Tips:

  1. Release the Sore Muscle
  2. Use the Shoulder as normally as possible
  3. Slowly Increase load as possible

Final Thoughts – When treating the shoulder or managing any type of shoulder pain it is important to take into account any other factors that could be affecting the movement or load on the shoulder. Because the shoulder is such a mobile joint, very rarely do things happen in isolation and I would always recommend looking at shoulder position, upper back posture and shoulder strength in conjunction with the tips in this article to ensure the best results for your shoulder.

We hope you found this helpful! If you have any other questions please don’t hesitate to Contact Us.

The Climbit Physio Team

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