This information has been prepared to help you fully understand your condition so you will be in the best position possible to work with your physio and follow the steps to your full recovery. Understanding the goals of your treatment and having complete confidence in your physio are vital elements of your recovery plan, so if you have any questions then please feel free to ask your physio.
Rotator cuff disease means damage or degeneration of any of the 4 rotator cuff muscles of the shoulder. It is a relatively common problem and may be from age-related wear-and-tear or due to trauma.
The rotator cuff is a group of 4 muscles that provide stability and movement in the shoulder joint. Their main job is to hold the ball at the top of the arm bone (humerus) centred in the socket on the outer shoulder blade (scapula). The 4 muscles are the infraspinatus and teres minor which help to turn the arm outwards, the subscapularis which turns the arm inwards, and the supraspinatus which moves the arm out to the side.
Rotator cuff disease is one of the most common causes of shoulder pain. It can occur through degeneration with ageing or inflammation due to arthritis, bursitis or pinching of the cuff tendons between the top of the arm bone and the shoulder blade. Shoulder trauma is also a significant cause, for example, falling on an outstretched arm. People who do a lot of repetitive overhead movements are at risk and this includes racquet sports, throwers, swimmers and some manual jobs where significant reaching up and out is needed.
The most common symptom of rotator cuff disease is shoulder pain. The pain may initially be mild and intermittent, and then usually gradually increases in frequency and intensity until treatment is started. It may take weeks or months to gradually appear, or may start suddenly after a specific trauma like a fall. The pain is usually felt at the front and side of the shoulder, and then may spread down the arm. It is aggravated by moving your arm away from your body, and when the pain is bad enough it will significantly reduce the amount of movement that is possible. It is often uncomfortable to lie or sleep on the painful shoulder.
Movements reaching behind your back, like putting your bra on or reaching for the seatbelt, will become difficult or impossible. If your rotator cuff is torn, then as well as pain, you will often also feel very weak. You will have trouble holding your arm away from your body, and movement is also greatly reduced.
Left untreated, rotator cuff disease tends to progressively worsen and will become more and more disruptive to your daily activities. Tears of the cuff may appear and worsen and this may need more invasive treatments such as cortisone injections and surgery.
Starting treatment early is very important because it means a faster recovery and also less chance of needing cortisone or surgery. It also reduces the risk of other associated problems like neck pain or frozen shoulder.
Your physio has been extensively trained to thoroughly assess and diagnose your injury. They will give you a step-by-step recovery plan to make your treatment easier for you to understand. The most common phases, or steps, that you will go through during your recovery plan are outlined below. The order and timing of the phases are tailored individually for you and so may vary form this list. Please feel free to ask your physio if you have any questions about your recovery plan.
Inflammation is the redness and swelling that occurs whenever you injure yourself. Our bodies need inflammation to start the normal healing process but we also need to control it. Reducing the inflammation associated with rotator cuff disease can help reduce the ‘throbbing’ pain that clients describe, and reducing inflammation also allows your physio to work more intensively on your shoulder to restore your movement.
The techniques your physio may use to manage your inflammation include specific rotator cuff massage and muscle releases, shoulder joint mobilisations, ice and stretches. Importantly, they will also guide you on modifying your current activity and exercise to ensure that you are not continually reaggravating your pain as this will significantly slow your recovery.
When your muscles are tight they put stress on tendons (the ends of muscles) at the point where tendons attach to the bones. Tight muscles can make the job of other muscles harder and cause too much load on joints, and they also change the way you move and can stress other parts of your body. Therefore it is important to get your full muscle length back to stop this from happening.
Your physio may use techniques including stretches, muscle and soft-tissue releases, and specific exercises to help regain your flexibility. They may also show you how to use a foam roller or trigger-point release ball at home to allow you to work hard on restoring your muscle length as fast as possible.
As your pain reduces we need to restore your full range of movement. If your shoulder has been sore for a while then some structures will have become stiff and tight, and this means that even when your pain reduces your range of motion can remain limited. Other areas around the shoulder, for example your thoracic or cervical spine (neck and rib cage), may have stiffened up due to changes in your movement patterns while you have been sore, and these may need mobilising as well.
Restoring your range of movement involves getting your joints, muscles and other soft tissues
back in balance. Your physio will achieve this by using a combination of soft-tissue releases, contract/ relax stretches and joint mobilisations. Your home program may include and muscle stretches and releases as well as self joint mobilisation techniques.
Your shoulder relies heavily on there being correct balance within your rotator cuff group of muscles to hold your shoulder in the correct position. The muscles that control your shoulder blade (scapula) are also critical for correct shoulder function and preventing future problems. Pain and injury alter the function and timing of these muscles so the next big goal of your recovery plan is to get your rotator cuff and scapula stabiliser muscles back in balance.
Your physio will guide you through specific exercises to strengthen your rotator cuff and scapula stabiliser muscles. We often use videos to help you see how you are performing your exercises to make sure you are doing them correctly and to help you feel and understand the correct technique.
Rotator cuff disease often leads to improper co-ordination of the muscles in and around the shoulder when doing tasks such as reaching, lifting and carrying. This is often identified by shoulder “hitching” where the upper part of your shoulder blade is raised towards your ear to allow for above shoulder level movement of the arm. This leads to tight muscles at the top of the shoulder and further muscle imbalance.
Your physio may use taping, biofeedback/EMG, muscle activation techniques and specific exercises to correct your movement patterns. You will be guided how to switch the right muscles on at the right time to retrain correct movement and this is very important for resolving your current pain as well as reducing your risk of future problems.
This is the last phase of your journey to full recovery. When you are returning to your activity you must be able to do it at full speed and resistance before being back in the game. You need to be able to apply your speed and force with the correct technique in training first to prevent another injury. In this phase we tailor exercises specifically to your activity by doing advanced sports-specific strengthening and high speed movements combined with rapidly changing directions. This phase is essential both for getting your back to your full level of performance, and also for preventing re-injury due to persisting background weakness or reduced co-ordination of muscle contractions.
Many clients find that seeing one of our Exercise Physiologists, Strength and Conditioning coaches or Personal Trainers is a great way to build strength, ability and confidence for a smooth return to full sporting activity. If Pilates is more your style then our great Sports Pilates program is an ideal way for you to continue to build your stability and strength. As well as being an important part of your rehab program these services can help you lift your sports performance whilst staying safer and reducing your risk of future injury.