Rotator Cuff Dysfunction

Have you ever said, or heard someone say that they have injured or torn their rotator cuff? 

As a massage therapist, I hear it often. My first question is, " which one?" I usually get an inquisitive look and the response is; " I don't know, just my rotator cuff." That unfortunately leaves me with very little information. So, I do a little assessment (which is helpful, but doesn't always pin point the real problem.) The truth is, the rotator cuff isn't just one muscle. It's a combination of four muscles, all used to stabilize your shoulder joint. 

Photo source NRS website

A nice little mnemonic to help you remember this group is:

Supraspinator
Infraspinator
Teres minor
Subscapularis

Unfortunately, some of us may already have damaged rotator cuffs and may not even know it. Common causes are things like normal wear and tear, poor posture, falling, and repetitive stress.  The latter is usually found in people who are athletes. ( tennis players, swimmers, baseball players, etc) Sometimes, normal wear and tear can be found in people with physically demanding jobs, like construction workers. Age is no friend to us either. As we age, the collagen in our tendons breaks down, we may develop calcium deposits and bone spurs. All set us up for weaken and strained muscles and tendons.


When the rotator cuff muscles become too weak and the shoulder joint capsule is too tight, the result is shoulder impingement. Impingement is caused by decreased space in the subacromial space (poor posture is a behavior indicative of this, as medial rotation of the shoulders creates this small space.) This space is located in the coracoacromial arch; between the acromion process posterior and coracoid process anterior. This impingement inhibits our range of motion, causing shorten muscles and pain. 

If you have injured this area, the common theme is pain. You may find reaching over your head or behind your back particularly challenging, in turn you protect it, by limiting the use of your arm.

As a massage therapist I cannot diagnose someone as having a  shoulder dysfunction; only a doctor can diagnose weather or not you have an injury. They will conduct tests like: X-Rays, MRIs (Magnetic Resonance Imaging) and ultrasound imaging to detect if there is any damage. They may provide treatment options like: 

• Steroids: sometimes doctors will use corticosteroids to reduced pain and inflammation.
• Surgery/Arthroplasty: doctors will sometimes recommend surgery for a damaged tendon or muscle. If arthritis has set in and is very severe they may replace the shoulder altogether.

If you're like me and prefer a more natural take on your road to recovery,  here are some simple things to consider:

• Rest: Take it easy for a few days. Continuing to over work the area may only exacerbate it causing irritation, inflammation, and pain.
• Ice/Heat rotation: If there is inflammation, it is recommended to use ice for the first couple of days before incorporating heat. This will help in reducing inflammation while assisting the muscle to relax. I'm a fan of frozen veggie like peas or a simple ice pack for icing and heated water for relaxing the muscle. (Heated water allows you to control the temperature better than using electrical pads.) The rotation should be about 20 minutes for each.
• Massage: a massage therapist can use neuromuscular and myofascial release techniques to eliminate adhesions and trigger points. A deep massage can help reduce pain as well as discomfort and improve range of motion. 
• Reconditioning: by keeping muscles limber through flexibility exercises and strengthening the lower and mid trapezius muscles, along with the rhomboids and serratus anterior. This will aid in the prevention of secondary impingement by elevating the scapular ( shoulder blade) control. As the muscles in the front and back of the body work together.

A combination of these things will likely be what helps you recover. Always use proper lifting and stretching techniques, and work within your comfort zone. 




Here is a link that will take you step by step through some rotator cuff exercises:
http://d13094505.z155.divergencehosting.com/rotator-cuff-injury.html




Natasha Triplett, CMA, LMT
Owner of Artistry in Motion Massage Therapy
http://www.ammt.massagetherapy.com/services