This is an incredibly common injury across the population but typically more common in people over the age of 30, it is defined as both tears or strains of the muscle bellies and impingements and tears of the tendons as they pass through the shoulder joint. Risk factors include occupations that are heavily repetitive, people who do a lot of overhead work, or throwing. Sports where the rotator cuff is commonly injured includes basketball and volleyball, as well as cricket and baseball. We’re using a broad term for pathology because it’s common that you’ll have more than one thing going on, a tendon issue leading to impingement and vice versa, and it can be any number of the 4 rotator muscles.
This is typically a degenerative injury or an overuse injury, however in cases can happen when lifting heavy things or awkward landings in a sporting scenario.
Signs and symptoms of a rotator cuff strain or tear
- Pain over the top and side of the shoulder
- Popping or tearing sensation at moment of injury
- Pain is aggravated by leaning on elbow and pushing pressure up into the joint space
- Can have swelling on acute injuries – not necessarily chronic or degenerative injuries.
- Pain at night – particularly laying on the shoulder
- Weakness is usually present – may have crepitus (grinding sensation) with movement
Grading of a rotator cuff strain or tear
- Grade 1 – General stretching of the tendon, not much loss of strength or function.
- Grade 2 – There is continuity of the tendon but is more like a frayed rope, or holes in a blanket. The shoulder will have significant weakness.
- Grade 3 – Full rupture of the tendon.
Now here’s the kicker …. Just because you have a rotator cuff injury does not mean you have pain. They are a normal part of ageing! There have been numerous studies that have shown this, one study performed an MRI on participants 50 years of age, and 23% of these people had a torn rotator cuff …. But NONE of them had any pain or discomfort. As the participants get older the numbers only get higher! For more information on the evidence of rotator cuff tears without pain, checkout Osteo Vaughan’s blog here
So why do some people in a lot of pain? Pain is a really poor indicator of how bad the damage is for the rotator cuff, in fact you are likely to have less pain if the tendon is torn all together as opposed to minor damage – the science suggests that the pain is stimulated by the body trying to heal itself for a minor tear and is communicating with your brain that it needs help. Whereas if the muscle is completely torn the body can’t reattach it.
So what if you have a tear and it is painful?
That’s where we come in! through the aid of manual therapy and a strengthening program we will endeavor to get your shoulder strong and functional and of course with less pain along the way.
Shoulders however are notoriously difficult to heal and therefore frustrating for both the patient and I, this is potentially because we can aggravate it by doing so many activities during the day, as well as the tendons getting next to no blood supply.
A typical tendon injury, from experience, can take 12 weeks or more, you’ll have ups and downs, good days and bad, but it will improve! If it is a minor belly strain this may only take 2-4 weeks and you will notice steady improvement with treatment and rehabilitation.
In severe and unrelenting injuries orthopedic intervention may sometimes be required, but we generally treat this as a last resort. Occasionally a cortisone injection may be trialed, however that is a bit hit and miss.
Early on in the injury we’re looking to manage the pain symptoms as much as possible, but we’re also looking to keep our strength, for any tendon and rotator cuff injuries we’re looking to gain some isometric strength – this is using the muscles in a way that the joints don’t actually move, all research suggests that this is a safe exercise even in the painful stages of the injury.
After this we’re looking to progress to getting movement and controlled movement – basic concentric and eccentric exercises are a great way to lengthen and strengthen at the same time and basic concentric exercises for normal function
Finally we’re looking to improve the contractile strength and power of the muscle – this is the ‘conventional’ action of the muscles, as we progress through this we’ll be looking to introduce return to sport or work specific activities – such as throwing. This stage will often include balance, speed and power or endurance, there’s often a big difference between gym strong and sport strong.