Published on November 24, 2014
Rotator Cuff Tears and Surgery:
Shoulder pain and rotator cuff tears are a common complaint seen by clinicians. Rotational sports such as golf and tennis are a leading cause of this problem, as they require the repetitive use of the shoulders, which can cause dysfunction and pain. Patients often think that surgery is the answer. However; this is not always the case. Most shoulder/rotator cuff injuries are degenerative in nature and do not occur by an acute traumatic injury. Research now shows that most degenerative shoulder injuries and rotator cuff tears can be fixed by following a strict exercise program that addresses: proper posture, functional range of motion and scapular stabilization (strengthening the muscles between the shoulder blades). Patients often think that having surgery is a quick fix and neglect that there is a long rehabilitation program to follow. Furthermore, surgeons are agreeing that conventional rehabilitation programs should be tried, as they want to avoid failed surgeries.
As we age, many physiological changes occur in our body. Our tissues become less pliable and begin to show signs of wear and tear. Research has shown that smaller degenerative rotator tears can be very painful and are commonly due to a lack of stability in the shoulder joint. This irritates the surrounding nerves creating heat, subsequent inflammation and pain. Full thickness tears are less painful as the stimulation to the nerves are completely cut off and feeling is lost. Therefore, when seeing a therapist, your program should address the instability issues by working on strength, range of movement and stability, in order to manage the pain.
One of the best shoulder stretches to do when experiencing shoulder pain is called Codman’s pendulum. In this exercise, you should bend forward with your knees slightly bent and allow your arms to hang in front of you doing small clockwise and counter-clockwise rotations. This will allow the rotator cuff to traction and relax preventing the shoulder from losing mobility and the muscles from going into a protective mode and into spasm. For addition relief, I recommend using heat before and after this exercise is performed.
It is also very important to focus on postural re-education. Standing with a neutral spine and with the base of the shoulder blades squeezed together will help stabilize the shoulder. This also helps to start early activation of the inter-scapular muscles, whose primary job is to help hold the shoulder blade in place preventing degeneration of the rotator cuff tendons.
The majority of sports played utilize the muscles in the front of our body. Thus, when we exercise it is very important for us to train the muscles in our mid back. This helps keep us from being in a hunched position causing the shoulder to internally rotate, which can lead to rotator cuff pain and instability of the shoulder blades.
Another very important area to train is the hip. This is where most of the power should come from when doing any type of sport. They help stabilize the body in order to ensure that our smaller muscles, like the shoulder, aren’t overworked. And lets not forget about our core- these endurance muscles need to be activated all the time to help keep our body in the right posture, working with the hips to keep us strong and stable. Research has shown that if we initiate power from the shoulder first, instead of moving from the hips and core, excessive loading to the rotator cuff occurs, straining the already degenerative tissue.
Exercises for strength:
Single leg squat: At our clinic, we will often address the hip muscles and core function before strengthening the shoulder muscles by doing this exercise. If the hips and core are not strong, they will not be able to stabilize the pelvis and spine. This in turn causes the rest of our muscles to have abnormal movement.
The single leg squat: helps to activate the glutes and teach the body how to stabilize on one leg.
Supine gluteus bridges: also another very good exercise to specifically target the gluteus muscles.
Planks: planks are a great core exercise that targets the abdominal wall. Make sure you brace your core with a neutral spine.
Once the above exercises have been learned, it is important to move onto scapular stabilization exercises. These are designed to strengthen the muscles between the shoulder blades and prevent an upward and forward rotation of the scapula preventing pinching of the rotator cuff tendons. It is best to start these exercises lying on the floor in order to prevent over-activation of your upper trapezius muscles, which contribute to the anterior tilting of the scapula.
To start, try holding each shoulder contraction exercise for approximately 5 seconds and repeat 5 to 10 times:
- Prone shoulder extensions – lying on your stomach with a towel underneath your forehead to keep your neck neutral position, shoulders by your side in a neutral position, squeeze your shoulder blades down and back while raising the arms slowly off the floor.
- The same as above but have the arms at approximately 30 degrees to the side or in a T-position whichever is most comfortable for you.
- Practice pulling your shoulder blades down in back as if you are rowing and squeeze your shoulder blades together.
Research now supports that surgery is not the answer for rotator cuff degeneration/tears. Changing the shoulder biomechanics by increasing the stability and mobility of the shoulder joint along with strengthening of the large muscles groups can definitely help fix many of the issues.