John took the kids to the park and decided to show off for his kids. He cocked his arm back and launched the football nearly 40 yards, and for a brief moment he was reminded of his glory days. Unfortunately for John, this was his first time throwing anything for months, and his shoulder was not ready for it.

This article will discuss rotator cuff injuries. We will cover the anatomy, common symptoms, how we help at the clinic, and some of the movements patients are shown to do at home. 

This article is meant for educational purposes and should not be used for diagnosis or self-treatment. If you are experiencing pain, please contact the clinic. If you’re not sure if you’re having shoulder or upper back issues, check out the blog on Upper Back Strains for help.

Rotator Cuff Anatomy

The rotator cuff refers to four different muscles that surround the shoulder joint. The four muscles of the rotator cuff include the supraspinatus, infraspinatus, subscapularis, and teres minor.

The primary goal of these muscles is to stabilize the shoulder joint by keeping the arm snug in the shoulder socket.

The rotator cuff is functional in all movements of the arm and shoulder. We help with a lot of rotator cuff injuries in our swimmers, golfers, and weightlifters.

Common Rotator Cuff Injuries

Common rotator cuff injuries include:

• Strains. The muscles of the rotator cuff can be overworked and become irritated. Sometimes this is related to overuse, poor movement patterns, or starting new sports or activities without adequate time to prepare for the stress.

• Impingement. Historically, it was believed that certain muscles could become pinched between some of the bones in the shoulder area, causing irritation. There has been compelling evidence recently that demonstrates that impingement pain is likely related to poor function of the rotator cuff, not bones squishing muscles. This is good news because it’s easier to change function than it is to remodel bones without surgery.

• Tears. When patients are over 40, it is more common for the supraspinatus to tear. This is something that can still be rehabbed and many patients are able to return to meaningful activity and sport.

Chronic Shoulder Pain

Rotator cuff injuries are painful and frustrating, but rarely life-threatening conditions.

Unfortunately, many patients suffer from chronic shoulder pain. Something we often see in the clinic is that patients will completely rest the shoulder when it is sore and then return to their favourite activity when it feels better. This approach often increases our risk for re-injury because our shoulder will not be adequately prepared for our goal-activity. At the clinic, we focus on strength and mobility to reduce the risk of re-aggravation for rotator cuff injuries.

Treatment Strategies for Rotator Cuff Injuries

It is important that treatment is based on each individual patient’s symptoms and the findings during the history and physical exam.

The goal of treatment is to reduce pain while improving the long term function of the shoulder. Sometimes this means taking a break from certain activities while we build the shoulder back up. We do our best to help patients continue the activities they like, with modifications as necessary. Some of the things we offer in the clinic that can help with symptoms include:

• Soft tissue therapies including trigger point release and muscle release therapy

• Spinal manipulation therapy targeted at stiff thoracic joints

• Gentle joint mobilizations in the upper back and neck

• Acupuncture to reduce pain sensitivity and help with tension

As with any condition, it is important that patients are educated about the condition, given a reasonable timeline for recovery, and provided tips on what they can do on their own to optimize recovery.

Nearly every patient with a rotator cuff injury is assigned homework. Strengthening the shoulder, building muscle, and improving mobility are all important targets for longterm shoulder health.

Assigned homework may change dramatically depending on the patient. A teenage weightlifter preparing for competition will likely have a different plan than a busy mom with three young kids. The exercises should be chosen thoughtfully to meet each patient where they are at and provide the best chance of successful recovery.