,So I recently had a patient whom I had seen years before for a different injury. She came in with shoulder pain that began about 2 years ago. The pain was on the outside are of the shoulder and had symptoms consistent with rotator cuff irritation. She want some rotator cuff exercises to help her shoulder.
Her husband (another former patient of mine) told her that it couldn’t be her rotator cuff because she hadn’t injured it in an accident and doesn’t play sports. This however is not true. The vast majority of rotator cuff injuries are not traumatic. Most rotator cuff tears are degenerative from long-term wear and tear. Also, not all rotator cuff injuries are tears. Let’s delve a little bit more into what the rotator cuff is, how it commonly gets injured, and how to prevent such injuries.
What is the rotator cuff?
The rotator cuff is a group of muscles that have attachments on
the shoulder blade and on the top of the upper arm bone. The purpose of these muscles is to stabilize the joint. The shoulder joint has the most mobility of any joint in the body which allows us to move our arms in all kinds of ways. However, because of this mobility, it is inherently unstable – meaning that the joint does not always stay where it is supposed to. The main shoulder joint, known as the glenohumeral joint, is a ball and socket joint. Think of a golf ball on a tee. The golf ball is the head of the upper arm bone, and the tee is part of the outside part of the shoulder blade. The goal of the rotator cuff muscles is to keep the golf ball on the tee. See the video below for further explanation.
How the rotator cuff gets injured
The shoulder joint usually does not out and out dislocate but the ball part of the ball and socket will wander around enough to start causing problems. It will most likely start migrating up and forward. When the ball starts wandering up it will tend to pinch one of the rotator cuff tendons in between it and another bone.
This will cause tendinitis in the tendons of the rotator cuff muscles. Tendons connect muscle to bone and are prone to irritation. This injury usually occurs from repetitive movement such as raking, shoveling snow, or lifting overhead.
When the ball of the upper arm starts to migrate forward, it stretches the rotator cuff muscles and prevents them from being able to do their job properly. This is most likely due to poor posture. When a person slouches, which most of us do, our shoulders round forward and our upper back also rounds. This puts the shoulder joint in a more forward position on the body and stretches out our rotator cuff muscles as well as some other stabilizing muscles of the shoulder joint. The more we slouch, the more the shoulder joint gets used to being in a forward position and the weaker our stabilizing muscles become. As the rotator cuff works harder to stabilize the joint, it will more quickly fatigue, become irritated, and allow the joint to move around.
Most injuries to the rotator cuff are tendinitis and not tears. This is especially true if the injury is not traumatic and occurred after doing a repetitive activity. For instance, we just had some really nice weather and I expect to start seeing some new patients in the following weeks for shoulder pain after doing yardwork and putting out mulch. The tendons of the rotator cuff will get inflamed after being repeatedly pinched or impinged upon. Now I also want to point out that it is also true that rotator cuff tears are somewhat common especially above the age of 60 where over 25% of people have tears. However, these tears may not be symptomatic and therefor would not require surgery or physical therapy unless they become problematic.
Preventing rotator cuff injuries
So how do we prevent rotator cuff injuries? To keep our rotator cuff healthy and our shoulders happy, you need to consider 3 things
- Strength of the rotator cuff
- Strength of scapular stabilizers
- Posture
The rotator cuff is made up of 4 muscles – the infraspinatus, supraspinatus, teres minor, and subcapularis. These muscles stabilize the shoulder joint but also perform rotation. So, to strengthen the rotator cuff you can perform exercises aimed at shoulder rotation. See the video below for some examples.
The scapular stabilizers are the muscles that attach to the shoulder blade and keep that bone in place while the arm moves. Having increased stability at the shoulder blades gives increased strength to the arm and also decreases risk of injury. See the video below of some scapular stabilizing exercises.
Having resistance bands can help build strength and increase the difficulty of the exercise. You can change the resistance when the exercise is no longer challenging. An exercise should be moderately difficult but not so hard that you have to change your form to complete the exercise.
Having good posture is actually the best way to prevent shoulder 
injury. The shoulder blades should be held down and back like the shoulder blade is trying to go into the opposite back pocket of your pants. This brings the shoulder joint back which will decrease the risk of irritating the rotator cuff tendons and activate the scapular stabilizers which will add strength to the arm. It is very difficult to change your posture. I have had a few patients use a posture brace which they find helpful. I have mixed feelings on the brace. It will keep you in correct posture for the shoulders which helps your brain know what correct posture feels like, but you are not using your postural muscles as much which limits how much they will strengthen.
What if I have already hurt my shoulder?
If you currently have pain and think that it might be a rotator
cuff injury, you can try these exercises and watch your posture. However, if these do not help or you are in the type of pain that is preventing you from lifting your arm, reaching behind your back, or sleeping, you should visit your local orthopedic physical therapist. They can help!
Key points
- You are more likely to hurt your rotator cuff with repetitive activities than accidents.
- Most rotator cuff injuries are not tears.
- To prevent injury to the rotator cuff:
- Strengthen the rotator cuff
- Strengthen the scapular stabilizers
- Improve your posture
If you have questions about the content of this post or any other musculoskeletal questions, please e-mail me.
Additional resources
https://www.ncbi.nlm.nih.gov/books/NBK554518/
https://www.physio-pedia.com/Rotator_Cuff
https://www.choosept.com/guide/physical-therapy-guide-shoulder-impingement