Rotator cuff Injuries

Rotator cuff Injuries

Rotator cuff tears and injuries usually occur in the tendon of the rotator cuff as opposed to the actual muscle itself. Trauma or injury is the cause of most rotator cuff tears in the younger population whereas degeneration and impingement is the cause in the older population.

The rehabilitation process for rotator cuff injuries usually addresses 4 key phases as follows:

1. Acute phase rehabilitation:

The RICE principle should be adhered to and started as soon as possible after the injury has occurred.

R: Rest – do not do any movements that cause pain or discomfort. This will only aggravate the injury and prolong the recovery process
I: Ice – icing the injury for 10-15min every few hours will assist in reducing the pain and inflammation.
C: Compression – this will also increase the recovery time for the inflammatory phase. Cold compression packs can be purchased which will do both the cryotherapy as well as the compression.
E: Elevation – although normal elevation probably won’t be comfortable for a rotator cuff injury (elevation reduces blood flow to area thereby reducing swelling and inflammation), this principle can be substituted by ‘offloading’ the shoulder, i.e. by wearing a sling.

2. Identifying possible causes of the injury:
If the cause was a traumatic experience, then the cause is obvious but often it can be due to underlying issues which can result in the recurrence of the injury. They could be any of the following:

• Instability in the shoulder is caused by muscular weaknesses around the joint and results in excess movement of the shoulder joint. This needs to be assessed to ensure the joint stability is optimal.
• Incorrect training techniques or program design, over training or incorrect training loads are all causes that can result in rotator cuff injuries.
• Poor posture and biomechanics. The ‘global’ picture of the body is just as important as assessing the immediate area around the injury and can be the cause of uneven loads/stresses on the shoulder joint.

3.Returning to full range of movement and strength:

• This usually happens after a few days post injury depending on the severity of the injury.
• First priority is to get back to full ROM as soon as possible. This is achieved through mobility exercises and stretching the musculature around the shoulder joint. All exercises and stretches should always be pain-free.
• Sports massage is beneficial in facilitating the joint mobility and flexibility and improving the joints response to the strengthening regime to follow.
• Strengthening exercises usually focus on three areas but could include others (depending on what instabilities were discovered during the assessment): the external shoulder rotators; scapular stabilizers; and secondary overall strength work for the whole joint and girdle.

Functional rehabilitation
Specific stability and strengthening exercises are required if the person injured has any additional requirements outside of usual daily activities. This would most often be in the sports arena i.e. a tennis player would require more stability as the ROM during a service action is far greater than the usual ROM a shoulder would be expected to move through. This final phase is essential as one could almost 100% guarantee re-injury if this functional phase is not adhered to.