Rotator Cuff Rehab
So what is your rotator cuff?
The rotator cuff is a group of muscles that secures the humerus (upper arm bone) in the shallow socket of the shoulder. It is made up of four muscles.
Rotator Cuff Muscles
Subscapularis
Supraspinatus
Infraspinatus
Teres Minor
So what do they do?
Inserting fibres of each muscle blend with and reinforce glenohumeral joint capsule (the ball and socket joint in your shoulder)
Each muscle contributes to dynamic stability – aiding movement and reducing excessive movements
Rotatory force – compresses humerus into glenoid fossa
Infraspinatus, teres minor and subscapularis act against deltoid – forming force couple
And what happens when injury occurs?
When one or more of the rotator cuff tendons is torn, the tendon no longer fully attaches to the head of the humerus.
You can either have a partial tear, meaning damage to the tendon, or a complete tear which separates all the tendon away from the bone.
And why might they get injured on the slopes?
The rotator cuff is mostly damaged by repetitive strain, or a wearing down of the tendon that occurs slowly over time. This degeneration naturally occurs as we age. Rotator cuff tears are more common in the dominant arm.
However, shoulder injuries account for 4 to 11% of all alpine skiing injuries and 8 to 16% of all injuries of all snowboarding injuries (McCall, 2009).
On the slopes, the rotator cuff is injured through direct trauma, for example falling onto your arm. If the force behind this is strong enough, the rotator cuff can become torn or damaged.
Some people are more predisposed of sustaining this injury, due to the underlying condition of the tendon. This means the amount of force needed to acutely tear the rotator cuff tendon differs from person to person. The older you are, the more likely it is that a tear will occur. Another predisposing factor is poor posture.
What will it feel like?
Your arm will be painful, especially around the upper and outside part. This pain is aggravated with certain movements, which could be reaching over your head, reaching backward or moving the arm across the body. Pushing and pulling may also hurt. You may notice a clicking or catching feeling, and the shoulder will feel weak.
The degree of this loss of movement and weakness can allow us as physiotherapists to predict the degree of tear or injury.
What happens now?
If you suspect a rotator cuff injury, ice should be applied for the first 48 hours. This keeps inflammation down around the affected area, and will reduce any pain you are feeling. A sling may also be worn which will allow the shoulder to rest. Then your physiotherapist will assess, and create an exercise programme with the aim to stabilise and strengthen the shoulder.
This will have a gentle start, using passive exercises to maintain range of motions and prevent stiffness.
Then a gradual strengthening programme will be developed, with the aim to stabilise and strengthen the shoulder, giving more support to the shoulder girdle. This will include different types of exercises, such as the isometric one shown to the right.
Keyhole surgery may be performed if it is a full rupture, however there is no high quality evidence that suggests surgery offers a more favourable outcome than conservative treatment (Seida et al, 2010)
How to prevent a rotator cuff injury?
Following an exercise programme before skiing to build up the shoulder girdle will make muscles more resilient.
In particular these exercises…
1. Forward Shoulder Raises
2. Internal and External Rotation Dumbbell curl
3. Abduction Dumbbell curls.
4. High to low rows
Improving overall fitness will also help prevent injury due to fatigue, and tired muscles are more vulnerable.
Staying within your limits and working on your technique will also decrease risk of falling and getting injured.
However if you do sustain an injury, of the rotator cuff or other body part, do not hesitate to contact Action Sportive Physiotherapy. +33 750847724
