Physiotherapy Rehab For A Rotator Cuff Injury
Rotator cuff injuries occur many times in a lifetime, particularly to athletes and the older population. It is an injury in the muscles and tendons of the shoulder joint. It may be debilitating depending on the severity of the injury and can lead to difficulties in performing daily activities that require overhead arm movements – such as combing one’s hair or getting dressed in the morning.
In 2006, about 4.1 million visits to a doctor’s office were regarding rotator cuff injuries. These include injuries such as:
- Rotator Cuff Tendinitis / tendinopathies
- Rotator Cuff Tearing
The rotator cuff is composed of the muscles and tendons of the shoulder joint, including the bones that are held in place by it. The shoulder is a dynamic structure, and its wide spectrum of movements contributes to its risk for injuries. The upper arm bone joins the shoulder blade via tendons and muscles in a ball and socket configuration. Four other muscles –supraspinatus, infraspinatus, subscapularis, and teres minor – help stabilize and participate in arm movements such as raising the arm to the sides, forward or backwards, and over the head. Tendons and muscles have a tendency to slide against the bony prominences of the shoulder blade when the arm is raised over the head repetitively or for a prolonged period of time, potentially leading to inflammation or tearing.
What is Rotator Cuff Tendinitis/Tearing?
Rotator cuff tendinitis or tendinopathies are also known as tennis shoulder, pitcher’s shoulder, or swimmer’s shoulder. It is the condition by which the tendons or the muscles of the rotator cuff become irritated and inflamed, restricting proper range of movement and leading to weakness/stiffness in the arm.
Rotator cuff tearing occurs when a tendon/muscle is either partially torn or completely severed from the bone. It can be either an acute or a chronic condition. Acute tears have been known to increase chances of having a chronic tear.
Signs and Symptoms
Rotator Cuff Tendinitis / Tendinopathy:
- Early mild pain/clicking when lifting arms the shoulder height
- Later pain at rest
- Weakness and loss of range of movement with overhead movements
- Pain at night when lying down in bed
- Pain radiating in the upper arm and sometimes to the sides
- Stiffness in arm movements
Rotator Cuff Tearing:
- Partial Tears
- Pain in arm movement (while bearing weight or involved in resistance-based activities)
- Pain at night
- Shoulder weakness
- Severe/Complete Tear:
- Immediate pain
- Inability to lift arm overhead
- Popping/tearing feeling in the shoulder
- Weakness when moving the arm (lifting/rotating it)
- Greatly limited in range of movement
How does it develop?
Rotator cuff tendinitis:
On the rotator cuff, there is a point where the tendons slip underneath a bony prominence of the shoulder blade called the acromion. When one lifts their arm above their head, these set of tendons have a tendency to slide along the acromion, fraying, and eventually becoming irritated and inflamed. This is rotator cuff tendinitis.
Rotator cuff tendinitis develops as a result of:
- Excessive overhead movements, which is often the case for painters, carpenters, and athletes (pitchers, tennis players, swimmers, weight-lifters, rowers)
- Keeping the shoulder in the same position for long periods of time (e.g. computer work)
- Lying on the same shoulder every night
- Poor posture
- Aging – individuals age 40 and up are at a greater risk for injury
Rotator cuff tearing:
Rotator cuff tears develop when a tendon is suddenly strained causing it to partially or completely rip. Tears can also occur on the supraspinatus muscle of the rotator cuff, where the bony prominences of the shoulder blade can damage the muscle and its soft tissues via physical trauma. These tears can be acute or chronic.
Acute tears are a result of:
- Sudden jerks of the arm when bearing weight/resistance
- Falling onto an outstretched arm
- Lifting heavy items
Chronic tears are a result of:
- Long-term and repetitive usage of the arm for overhead movements (e.g. seen in painters, carpenters, and athletes – pitchers, tennis players, swimmers, weight-lifters, rowers)
- Past shoulder injuries that may have weakened tendon or muscle attachment
- Prior inflammation in the shoulder that have led to the formation of bony spurs (additional prominences of boniness) that may further aggravate the tendons and muscles
- Aging – characterized by decreased blood supply in the rotator cuffs and impaired healing in the tendons
Initially, chronic tears are fairly unnoticeable as the tendon is only beginning to wear down. However, over time, pain, stiffness, and weakness gradually increase, eventually leading to a more painful and extensive tear.
Treatments at Ace Physio
Physiotherapy is commonly cited as an aid for alleviating pain and inflammation caused by rotator cuff injuries.
Ace Physio offers a variety of techniques that can treat rotator cuff injuries:
- Shockwave Therapy
- Shockwave therapy is a therapy that makes use of acoustic pressure waves to increase the quality of healing in injured muscles and tendons as seen in the case of rotator cuff tears and tendinitis. The sound waves generated incites increased blood flow to the site of injury as well as the breakdown of roughly-formed scar/fibrosed tissue that may impede proper repair.
- Ultrasound Therapy
- Ultrasound therapy also makes use of sound waves. However, it provides a gentler approach to promoting tissue healing. It increases blood flow to the site of injury, which reduces inflammation, and at higher frequencies, can provide a thermal effect that reduces pain caused by tendinitis or tear.
- Laser Therapy
- Super Pulsed Laser Therapy is a treatment that recruits the use of lasers with a power level higher than class IV lasers, with a safety level of class II lasers. This procedure strengthens target cells and increases rates of healing. Pain present in rotator cuff injuries can also be reduced by the use of this procedure.
- Therapeutic taping
- Exercises and stretches that help regain range of movement and alleviate pain