Perhaps you have completed your spring clean up, started the weekly mowing, and if you are lucky you may have even returned to the bowling lanes, the tennis courts, the golf course or even the gym. You just now realize that the small tenderness, the miniscule but sharp pinch or even the slight weakness you felt while lifting the leaf bags just hasn’t gone away. In fact, it’s worse … much worse, and ibuprofen isn’t touching it. There are many reasons for this, but unfortunately you may have injured your rotator cuff.
The rotator cuff is composed of four muscles and their tendons within the shoulder. These muscles (supraspinatus, infraspinatus, subscapularis and teres minor) function with the common goal of holding your upper arm bone, the humerus, firmly to the scapula or shoulder blade as if holding a golf ball to tee while being held sideways. The muscles of the cuff counteract the motion provided by the larger muscles of the shoulder allowing us to raise the hand overhead. With any compromise of these muscles you would find great difficulty in moving your arm higher than chest height depending on the severity.
While reaching for the leaves stuck in the bushes or lifting your leaf bags seems to be the cause of your pain, this relatively common injury is often caused from a fall onto an outstretched arm or directly onto the shoulder, lifting, throwing, pulling or repeatedly moving the arm back and forth, especially overhead.
Predisposing factors may expose you to a greater potential of injury of the rotator cuff. Poor postures such as forward or protracted shoulders in combination with any of the listed motions will likely increase the amount of wear and tear creating strain on the muscles of the cuff. Variations in the shoulder structure causing narrowing under the outer edge of the collarbone may also create an impingement. Additionally, repeated trauma, degeneration and some medications may further weaken your tendons and impact your shoulder’s performance.
Once the pain begins it may be difficult to identify the culprit. Potentially injuries may include tendonitis (inflammation of the tendons), bursitis (inflammation of the fluid-filled sacks deep within the shoulder), strain or overloading of the muscles and tearing.
Accompanying your pain you may commonly experience point tenderness to the touch on the outer or upper aspect of the shoulder, weakness, range of motion loss and an inability or unwillingness to move. These symptoms my be most prevalent when washing your hair, reaching for the gallon of milk, putting on a jacket or even sleeping on the affected shoulder. The degree of your injury may be indicated in your pain or functional loss with these types of activities.
If this sounds like you, and you are unable to use your arm for work or play, it may be time to seek help from your healthcare professional. Depending on your complaint of pain, strength and outcome of specialized testing, one may require further testing to determine whether or not the patient is a surgical or non-surgical candidate. It is most common that you will not require surgical intervention. Properly treating your pain and eliminating your condition can take a few weeks to several months
Treatments may include anything from rest, ice/heat, steroid injections, pain relievers or surgery. Commonly NSAIDS and physical therapy can assist you in relieving your pain, restore your range of motion and strengthen areas of deficiency. Determination of the cause and possible risk factors in suffering a rotator cuff injury will guide your treatment with the goal of preventing future injuries.
Effectively preventing rotator cuff injuries begins with proper flexibility and balanced strength. Scapular strengthening of the mid and upper back muscles can ensure proper posture and subsequently optimal mechanical set-up of the shoulder prior to any movement at all. Such simple exercises may be done with the resistance of therapeutic rubber bands in standing or light weights while on your stomach. Internal and external rotation strengthening with the elbow tight to your side will effectively strengthen not only the muscles of the rotator cuff, but also the front of the shoulder and your scapular stabilizers. Additionally, stretching and resistance training overhead are vital to balanced flexibility and strength. Be sure to seek the advice of a professional to assure proper mechanics as poor mechanics may actually create a rotator cuff injury, not prevent it.
If you or someone you know suffers from acute or chronic shoulder pain, it is ill-advised to begin a new exercise program, or return to sports without consulting with your physician, physical therapist, physiatrist or other specialist who regularly treats shoulder pain. It is important to first get an accurate diagnosis for the cause of pain, as the specific exercises recommended will depend on the cause and degree of the injury.
James Markwica, MS PT is a New York State Licensed Physical Therapist at LaMarco Physical Therapy, 417 Geyser Road in Ballston Spa and 538 Maple Ave in Saratoga Springs. For questions or follow-up, contact James at 587-3256 or online at www.lamarcopt.com.
