What is My Rotator Cuff, and Why Should I Care?

Last week, as I was preparing to depart from a flight, I noticed the woman next to me struggling to lift her arm above shoulder height.  I overheard her mention to her friend that she's been struggling with her shoulder for months.  I asked her what was going on with her shoulder after explaining that I am a physical therapist.  She responded that she had adhesive capsulitis, which is a painful condition that restricts movement.  What struck me was that this relatively young woman (maybe 50's?) didn't stand a chance of reaching overhead to get her bag.  It was a clear example of impairment negatively impacting function.  Nobody should have to deal with such a thing, in my opinion.

I am choosing to write briefly about shoulder pain because I've seen a lot of friends dealing with it recently.  The shoulder is a great joint, with a ton of available range of motion that allows us to perform a myriad of tasks.  But the downside of having all this functional movement is that the joint is not necessarily the most stable (as compared to the hip).  In addition, when we lift our arms overhead, or reach in certain positions, a lot of important structures are prone to being impinged (pinched).  If this impingement happens for too long in a repetitive fashion, these tissue can become inflamed and ultimately wear down.  This is where your all-important rotator cuff comes into play.

You've all likely heard about rotator cuff injuries, especially if you are a fan of sports requiring a throwing motion.  But what exactly is it?  The rotator cuff is a series of four relatively small muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) that come together in a common tendon at the top of your shoulder (deep to the large deltoid muscles that give the shoulder definition).  It's main purpose is to center the head of your humerus (the long bone in your upper arm) in the shallow socket in which it resides, called the glenoid cavity.  The shoulder is a ball-in-socket joint.  When you move your arm overhead, or into extension, or to reach behind your back to scratch an itch, the ball has to roll and glide within this shallow socket.  The large deltoid muscles (which give the shoulder it's rounded appearance) is the primary mover of your arm away from your body (along with a bunch of other muscle actions that simultaneously occur).  If the deltoids are overdeveloped from doing a lot of shoulder presses at the gym, they run the risk of overpowering an unfit rotator cuff.  Without the rotator cuff working well to maintain the head of your humerus in it's proper position, the deltoid will end up overpowering it and you'll increase your chances of developing shoulder pain.

As I've stated in previous blogs, these rotator cuff syndromes are more likely to develop in people in their 30's and above.  Tissues are not quite as flexible and extensible as we get older, making them more susceptible to wear and tear.  If the mechanics of the shoulder are interrupted, then these tendons may wind up becoming damaged.  The entire shoulder complex can get thrown out of whack simply by poor habitual posture caused by mundane things such as prolonged sitting (i.e., at work).  Once these tissues become inflamed, simple acts such as washing one's hair or sleeping with your arm raised above your head can become a painful endeavor.  

As always, there is a solution to this potentially painful and limiting condition.  Now, I should say that there are certainly cases where the rotator cuff tendons are damaged to the point of requiring surgical intervention.  Traumatic events such as falling on an outstretched hand can be enough to tear the rotator cuff.  The extent and exact location of the damage plays a big role in determining the type of intervention that may be most effective.  But for non-traumatic shoulder pain, very often some basic strengthening of the rotator cuff muscles can do the trick.  They can be done with a simple tool call a resistance band (Theraband), a light dumbbell, or a cable column at the gym.  These are not exercises that require lifting a lot of weight.  Rather, you'd be better served doing higher repetitions with lower resistance in order to build your rotator cuff endurance.  In cases where the condition is chronic (lasting more than 6 months), it's very likely that restrictive scar tissue and adhesions have developed in the area.  Before undertaking strengthening exercises to improve rotator cuff function, it's important to release those muscles through certain soft tissue techniques.  This will help to restore the proper muscle length in order to train the muscle properly.  I have seen these soft tissue interventions work very effectively in the clinic with great results.

If you are experiencing any pain in you shoulder that is detracting from your life, please feel free to give me a call.  I would be happy to offer you some advice to help you out, or explain how to perform the above referenced exercises.