Physiotherapy For Rotator Cuff Injuries

Rotator cuff injuries and rotator cuff related shoulder pain are some of the most common injuries affecting people in Australia. Current statistics show that anywhere between 7 and 27% of the population are experiencing shoulder pain at any given time, with about 70% of people experiencing at least one bout of shoulder pain during their lifetime. This shows that pain is quite common and if you are experiencing it you’re not alone. Shoulder pain is second only to lower back pain as the most common musculoskeletal issue seen around the world today. The good news is rotator cuff physio can be very helpful for you!

Rotator cuff-related pain or injury can be prevented. There is good evidence to show that having a strong and mobile shoulder can provide some protection from getting pain in the future. This can be through regular exercise using your shoulders or a specific program written by your Physiotherapist targeting at strengthening the small muscles. Other lifestyle factors such as nutrition, stress, sleep and smoking can also have a large effect on your pain so managing these is a useful way in preventing or minimising your risk of experiencing shoulder pain.

Types of rotator cuff related injuries

There are several different types of rotator cuff related shoulder pain and injuries. They are all slightly different but at the same can have a lot of the same signs and symptoms. Read on for a brief overview of the most common types.

Rotator Cuff Tendinopathy

This condition occurs when the rotator cuff tendons are either acutely or chronically overloaded.  In the case of acute tendinopathy, the tendon has usually been irritated by a sudden increase in training load or activity that the tendon wasn’t ready for. It can also happen after a return to activity after a long lay off. In chronic tendinopathy, usually some parts of the tendon have started to weaken and can cause some pain when the tendon is placed under load.

These injuries usually feel sore, but can “warm up” during exercise, before becoming sore again once you have finished and cooled down. The good news is, they can be very easily treated with a targeted rehabilitation program aimed at strengthening the muscles of the rotator cuff and increasing the tendons ability to handle load.

Rotator Cuff Dysfunction

The rotator cuff muscles work together in order to stabilise your shoulder joint. When they don’t work as well as we want them to, it is common to feel an ache to the front of your shoulder or pinching doing overhead movements whether that be shoulder pressing at the gym or reaching in the top shelf to grab your favourite beer glass.

This condition is typically diagnosed by a lack of evidence on scans (no real tissue damage) and is just a lack of coordination and activation of the shoulder muscles when performing a movement.

Rotator Cuff Tears

A tear occurs when the rotator cuff muscles, which work to support your shoulder joint, are overstretched or placed under a load too big for them to handle. In younger populations these injuries can occur as a result of direct contact to the shoulder or arm, falling on your shoulder or your shoulder failing under load during an activity such as doing resistance training in the gym.

These tears can also occur in older populations however they are usually caused by non contact situations. Poor muscle strength and movement patterns contribute to overloading the tendons until they fail. Some tears will require surgical repair, however more research suggests that we can still function normally by strengthening the unaffected muscles around the injury – this is where we can help! Whether you are going down the surgical or non-surgical path, you can never go wrong with getting strong!

Shoulder rehabilitation exercises

To help with your injury, whether it is traumatic or not,  your physiotherapist will help guide you through a targeted exercise rehabilitation program. The aim of this program will be first to settle down the initial injury and inflammation (if acute) or provide some pain relief using manual therapy (if chronic). The program will aim to strengthen the small muscles of the rotator cuff, these being the supraspinatus, subscapularis, teres minor and infraspinatus. This in terms provides more strength and stability to the shoulder joint, and has been shown to provide significant improvement long term to your shoulder function. 

Exercise therapy is the most effective treatment of shoulder injuries. The program will aim to increase your shoulder movement and shoulder mobility, as well as increasing strength and stability of the shoulder blade. Exercise has been shown to be just as or even more effective than operative management in both the short and long term.

At first, your physiotherapist will prescribe you relatively gentle exercise depending on how painful and irritable your shoulder is. More often than not, the first aim is to increase your shoulder movement with a variety of stretches and other muscle release techniques. The most common stretches are the crossover body stretch, lat stretch and pec stretch. The aim of these stretches is to loosen the muscles around the area to give you more shoulder mobility. Secondly, you will start some strength exercises to increase the strength of your shoulder muscles and tendons. Depending on how much pain you are in, the first exercises you will start with usually consist of gentle band exercises focussing on external rotation of your shoulder. 

As you continue to progress with your rehabilitation, your exercises will continue to get harder. The exercises will continue to work you through more range of motion and continue to strengthen the muscles of your shoulder and upper arm. During this phase you will more than likely start using dumbbells and other pieces of equipment to place more load on the muscles and tendons. The exercises may also aim to increase the stability of your arm bone in the socket. This will usually involve body weight exercises or using equipment such as kettlebells.

During this whole process you should be doing exercises specific to the task you want to get back to, whether that be lifting your upper arm over shoulder height again or getting back to bench pressing 100 kg.

  • Your rotator cuff is a set of four small muscles that originate on your shoulder blade and attach on the head of your upper arm bone. They are important for all shoulder movements.

  • A rotator cuff injury will be diagnosed by your physiotherapist after listening to the history of your pain and after conducting a thorough physical assessment of your shoulder. They can also be diagnosed with scans such as ultrasound and MRI.

  • Rotator cuff injuries are treated by initially trying to let the injury calm down and your pain settle. Your physiotherapist will prescribe gentle exercises and may use manual therapy in this stage. From here your physiotherapist will prescribe progessive strengthening exercises for your rotator cuff.

  • A direct trauma to your arm or shoulder, such as falling on it at sport, or more commonly, gradual overuse often result in injury.

  • The most common symptoms of a rotator cuff injury include pain in your shoulder and upper arm, pain when lifting your arm out to the side or out in front, and weakness when contracting these muscles

  • Initial assessment with a physiotherapist includes a thorough discussion of the nature of your pain (where, type of symptoms, duration and intensity of symptoms) as well as a bit about you! We can’t help you get better if we don’t know what it is you want to get back to! So we will also discuss your work, physical activity and other life demands to determine what management you need to get back to those things even stronger and more robust than before!

    Your therapist will then conduct a thorough physical assessment. This will involve both hands on assessment from the therapist but also practical assessment. This will include things related to your specific history, for example: Throwing, catching, chest pressing and shoulder pressing. We will also make sure we keep track of how things are changing and add or subtract things from your program when necessary to make sure you’re always getting the best care possible! We’ll provide you with a management plan to help you understand your condition and your path forward to become pain free!