The rotator cuff are shoulder muscles comprising of four small muscles which originate from the shoulder blade and attach onto the tip of the shoulder. They are the deepest muscles of the shoulder and help to stabilize the shoulder joint. They are activated with any shoulder and arm movement and prevent the joint from dislocation while it functions.
Injured or overworked rotator cuff may cause shoulder pain and weakness, and sometimes pain and numbness radiating down the arm.
Rotator cuff injury is also known and can be diagnosed as shoulder impingement syndrome, rotator cuff tendinopathy, rotator cuff tear, and subacromial pain syndrome. They all essentially refer to the rotator cuff type of injury.
How to we diagnose rotator cuff problems?
MRI is a common tool used for diagnosing rotator cuff problems. However, caution is needed to interpret MRI findings. Minor tears of the rotator cuff tendons are a common age-related problem. When we aged, we all develop grey hair right? But ask yourself, does gray hair cause any pain? Certainly not!
Similarly, when we age, our rotator cuff tendons start to have small wear and tears as part of the natural aging. They may appear on your MRI report, but they usually don’t cause any symptoms. Problems only surface when the tear is large. Thus, seeing a tear in the MRI of the shoulder does not mean that it is the cause of the symptoms. It is no absolute indication for surgical repair of the tendon.
In fact, MRI is generally not indicated in the early stage of the condition. A diagnosis can be made based on the symptoms and a basic physical examination in the doctor or physiotherapist’s clinic.
Once the rotator cuff is diagnosed to be the cause of the symptoms, conservative management including medication and physiotherapy are prescribed. MRI is only indicated if 6 weeks of conservative management does not provide relief of the symptoms. Unnecessary MRI taken at early stage of the condition may not change how the condition is managed and create additional anxiety in patients due to commonly found minor tears.
Why do I get rotator cuff problems?
The main culprit of rotator cuff injury is our posture and lifestyle.
Our modern lifestyle creates a lot of muscle imbalances in our body. Firstly, most of us no longer use our upper limbs for heavy duty tasks as frequently as our ancestors once did. We just sit the whole day! This sedentary lifestyle will lead to deconditioning of our upper body and arms strength.
When a weakened muscle is suddenly required to do extra work, it may not be able to tolerate the workload, and thus develops pain. Example of such extra work may be carrying of heavy grocery from panic shopping, spring cleaning during Chinese New Year, or sudden increase of resistance in upper limb exercises.
Hours spent hunched over the desk creates a forward shoulder position which puts the entire arm and shoulder in a biomechanically poor position. This position tends to stress the rotator cuff muscles a lot whenever we do any overhead tasks!
Many muscular gym-goers get shoulder pain as well, despite doing regular shoulder strengthening exercises. They should be strong right? It all boils down to inappropriate training. We frequently see many gym-goers focus on strengthening the chest muscles (the aesthetic PECTS) without adequate stretching. They then find the chest muscles becoming too tight which draws the shoulders forward. At the same time, the muscles on the upper back are neglected (because it is not as aesthetic) which leads to a forward and rounded shoulder position.
So our deskbound office workers and the enthusiastic gym goers both will end up with a poor posture that ultimately put quite a bit of stress on our poor rotator cuff, leading to overuse and injury.
How does physiotherapy help with rotator cuff problems?
Physiotherapists are experts in diagnosing and managing shoulder pain, whether it is from sports injury or daily repetitive overuse. Manual therapy is a good way of releasing the tension in the overworked muscles and provide instant pain relief. However, without identifying the underlying muscle imbalances and posture issues, the pain would recur sooner or later. As part of BMJ physiotherapy session, we will also address the underlying causes by prescribing specific stretching and strengthening exercises.
What is the role of physiotherapy after rotator cuff repair surgery?
Some patients with rotator cuff tear will need to undergo rotator cuff repair surgery. Physiotherapy for shoulder pain is absolutely necessary after the operation to ensure the recovery of the shoulder’s movement and strength. The operated shoulder needs to undergo 4-6 weeks of controlled immobilization after the operation, meaning the movement of the shoulder needs to be minimized. This is to optimize healing at the operated site.
However, immobilization will lead to stiffness and weakness of the shoulder. Surgical scarring also creates pain and stiffness. Physiotherapists make use of manual therapy and exercises to tackle all these problems. The rehabilitation after the operation will take at least 6 months, depending on each individual’s different rate of progression and goals.
In a Nutshell
In summary, rotator cuff injury is often a condition that can be managed conservatively and best when it is treated early at a physiotherapy Singapore clinic. It can be as simple as correcting a poor posture and understanding the biomechanics of the shoulder movement. With our quick muscle release manual therapy technique, we are often able to achieve pain free movement within a few sessions.