The rotator cuff complex is a group of muscles surrounding the shoulder joint. This includes the supraspinatus, the infraspinatus, the teres minor & major, and the subscapularis. These 4 muscles (5 if you count the teres as separate muscles) provide support and stability to the shoulder joint—which is one of the most mobile and therefore unstable joints in the body. If the rotator cuff is compromised, then the joint will likely not stay centered throughout its movement. This can lead to clicking, popping, restricted motion, wear & tear, pain, and eventually degenerative changes. This is why it is so important to ensure proper rotator cuff health or recovery if injured.
The most common cause for rotator cuff damage is overhead lifting. But, there are several more mechanisms of injury and much more at play than you might think. Many times a person will simply overload the rotator cuff causing a rip in the muscle or tendon. This can happen when lifting too much weight upwards, but can also happen while lowering something heavy from a high shelf. Other times, it is a repetitive injury that occurs over time. This can happen at the gym, or during a sport like baseball. The person may feel a discomfort or odd movement at the time of activity, but later feel the injury more severely. Sometimes it takes weeks or months for a person to notice significant changes. This is because while the damaged rotator cuff itself may not produce much pain, the resulting abnormal motion causes stress and inflammation that gets worse over time after the initial event.
Researchers are now providing evidence that rotator cuff injury may not happen in a vacuum. This group of muscles may be predisposed to injury in people who have abnormalities in the position of their shoulder blades. People who roll their shoulders forward and down may be putting their rotator cuff muscles in a vulnerable position where they are loaded under additional stress and therefore are prone to injury. You can see that this is true yourself simply by trying the following: Sit up straight with your shoulders back, then clap your hands over your head. This should be easy (of course unless you already have shoulder problems). Now, roll your shoulders forward and slump in your chair. Clap over your head again. What did you notice? It is much harder to properly move your arms over your head in this position. Why is this? It is because the shoulder blades control the angle of movement of your arms. If your shoulder blades are not positioned correctly, then chances are that your arms are going to have a much harder time moving overhead properly because you are having to fight at an abnormal angle and recruiting additional muscle strength to do so. This puts stress on the rotator cuff and predisposes it to damage.
This is why it is often not just enough to address the rotator cuff, but to also retrain the scapula to work correctly again. If you don’t fix this part, you’re likely going to have another episode in the future and cause more damage. Retraining the scapula usually means getting them to sit flatter on the ribcage along with correcting postural abnormalities of the cervical and thoracic spine (head and upper back). Manipulation of the spine and shoulders along with specific physiotherapy and exercises are the mainstay of our treatment here at Tulsa Chiropractic Rehab. Even if surgery is needed, this treatment is still necessary to retrain the body and correct the underlying issue.