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Rotator Cuff and Physical Therapy

Rotator Cuff Tear Anatomy of ShoulderThe rotator cuff is one of the most frequently injured parts of the shoulder and requires a very individualized approach for optimal recovery.  The rotator cuff is a group of 4 muscles on your shoulder blade that wrap around and attach to your upper arm on the humerus.  The four tendons of these muscles blend together to form a “cuff” around the upper humerus.  The humerus comes together with the scapula (shoulder blade) to form a ball and socket joint.  The muscles not only help to move your arm, but they stabilize the ball in the socket, which is essential in order to raise your arm.  Although you may not feel lesser injuries with a symptomatic rotator cuff injury you may have pain, lose strength, or lose function in your arm.

For the quickest recovery it is important to figure which part of the rotator cuff is injured.  Usually you will feel pain in the upper lateral arm, but there are other tissues which can cause pain here as well.  Through a series of quick and easy tests we can determine which muscle or muscles of the rotator cuff are injured or if the pain is coming from another area.  Determining the specific muscles/tissues will lead to specific treatments and exercises aimed at targeting those muscles/tissues.  Pain can also inhibit other muscles or make you adapt faulty movement patterns that will need to be corrected before proper movement and strengthening will begin.  

Rotator cuff injuries will usually need a combination of hands on treatment with specific targeted exercises.  Hands on treatment, also known as manual therapy, will be aimed at relieving muscle pain and improving the motion in the joints.  Strengthening exercises will be aimed at creating stability and strength in the rotator cuff and around the joint.  Many of these exercises will be internal and external rotation exercises in various planes of movement.  Exercises will also likely be aimed at the muscles attached to your shoulder blades that run to your spine and ribs.  These muscles help to stabilize the shoulder blade and take load off of the rotator cuff.  Stretching of the chest and upper traps may be added as well.  Less frequent treatments include dry needling and neuromuscular stimulation with a TENS unit to decrease pain and improve movement.  

Treatment for rotator cuff injuries will include a home exercise plan likely aimed at the rotator cuff, scapular stabilizers, improving function, and achieving your goals. Strengthening the rotator cuff is tricky because we need to challenge/strain the muscle without straining it too much, which will make the injury worse.   It is very important that you use good form with most of the exercises in order to make your greatest strength gains, minimize your risk for making the injury worse, and recover as fast as possible.

Timeframes vary widely depending on how bad the injury is and how fast you arrived at physical therapy, but range from a week or two to around 6-8 weeks for serious injuries.  Recovery from rotator cuff surgeries takes considerably longer, up to 6 months, and is a considerably different program.

Jamie Bovay, DPT, MTC, CSCS

PS-Please ask if you have questions.