The shoulder joint is blessed with great flexibility, being the most flexible joint in the body. We’re able to reach for, grasp and transfer objects in various locations, exert significant force against resistance, or engage in various sports like tennis or basketball. However, great mobility comes at the expense of stability.
Since the shoulder joint is formed by two bones whose ends (articulations) don’t fit securely together, our muscles act as important stabilizers. A group of muscles collectively known as the Rotator Cuff complex plays a vital role in maintaining shoulder stability.
What is the rotator cuff?
The rotator cuff rotator cuff is a group of four muscles that originate from our shoulder blade (scapula) and attach to the upper arm( humerus) forming a covering or “cuff” like structure that provides strength and more importantly stability about the shoulder joint.
How does the rotator cuff provide stability?
The rotator cuff muscles provide stability by working together in harmony as a group to “fine tune” shoulder movements. Such coordinated activity ensures that the upper arm is centered relative to the shoulder blade, during shoulder movement, allowing the generation of well-balanced forces. This is important for efficient muscle activation without overloading our shoulder muscles, especially in explosive or repetitive activity over time.
However, problems can result due to –
- Repetitive activity that results in overuse and fatigue
- High intensity overhead upper limb activity
- Chronic fatigue and improper use of muscles
- Acute injuries resulting from falling onto and outstretched arm or directly onto the shoulder joint
When this happens
Improper muscle activation of the rotator cuff leads to abnormal positioning of our upper arm. This places excessive stress on the tendons of our muscles and surrounding structures that help our muscles to function properly. As a result, the following problems can occur –
- Shortening of overactive & lengthening of weak muscles
- Irritation of tendons and joints
- Inflammation of fluid filled sacs (bursa) that help to alleviate friction around muscles
- Decreased movement about shoulder joint
All these factors may eventually lead to irritation, inflammation, stiffness and shoulder pain. Recent studies have shown that shoulder pain can affect up to 26% of the general population in western countries. The most common problem associated with shoulder pain is injury to tendons associated with the rotator cuff muscles. (Desmeules et al., 2016).
In most cases the injuries to the rotator cuff complex, can be managed with conservative treatment which is the “gold standard” for sports related injuries. This usually involves a graduated comprehensive rehabilitation program, the use of anti-inflammatory medication and in some cases corticosteroid injections (Weiss et al., 2018).
Early intervention is key to recovery
Physiotherapy is an important component of conservative, and early rehabilitation is key to recovery. Treatment is aimed at reducing pain and restoring normal shoulder range of movement. Physiotherapists are specialists in combining manual therapy techniques, advice and targeted exercise regimes in managing rotator cuff injuries. Recent studies show that patients who have participated in a physiotherapy rehabilitation program have reported high levels of satisfaction, improved function and success in avoiding surgical intervention (Edwards et al., 2016).
DESMEULES, F., BOUDREAULT, J., DIONNE, C. E., FREMONT, P., LOWRY, V., MACDERMID, J. C. & ROY, J. S. 2016. Efficacy of exercise therapy in workers with rotator cuff tendinopathy: a systematic review. J Occup Health, 58, 389-403.
EDWARDS, P., EBERT, J., JOSS, B., BHABRA, G., ACKLAND, T. & WANG, A. 2016. EXERCISE REHABILITATION IN THE NON-OPERATIVE MANAGEMENT OF ROTATOR CUFF TEARS: A REVIEW OF THE LITERATURE. International journal of sports physical therapy, 11, 279-301.
WEISS, L. J., WANG, D., HENDEL, M., BUZZERIO, P. & RODEO, S. A. 2018. Management of Rotator Cuff Injuries in the Elite Athlete. Curr Rev Musculoskelet Med, 11, 102-112.