What is a Rotator cuff?
The rotator cuff is a group of 4 muscles (supraspinatus, infraspinatus, teres minor and subscapularis) tendons around the shoulder joint that keep your humerus (upper arm bone) firmly within the shallow socket of the shoulder.
Injuries to the rotator cuff muscles/tendons can cause a dull ache in the shoulder, especially when you sleep on the involved side. Ageing causes tendons to wear down, which can lead to a tears and injuries. Other signs and symptoms include:
- Limited range of motion of the shoulder due to pain
- Certain positions of the shoulder giving a sharp discomfort
- Inflammation of the tendon/muscles disallowing full range of movement
- Chronic degeneration and calcium deposits that form over time contributing to limited range of motion.
How does it happen?
Rotator cuff injuries often occur from repetitive overhead motions i.e. shoulder presses, overhead snatches, tennis, baseball, swimming, badminton.
When there are muscular or structural imbalances around the shoulder joint combined with muscle fatigue, the likelihood of rotator cuff injuries increase. The rotator cuff is a stabilization muscle and its primary job is to maintain stability or aid the primary muscles (deltoids, trapezius, latissimus) for movements. When our primary muscles start to fatigue, the stress is transferred to the rotator cuff muscles eventually forcing them to “take over” thus giving rise to injury
Common issues that contribute to rotator cuff injuries are:
- Tightened pectorals/anterior deltoids pulling the shoulder joint forward instead of neutral
- Increased thoracic kyphosis (hunchbacked) that also contribute to forward rolled shoulders
- Weak posterior shoulder muscles (rhomboids, posterior delts)
- Poor technique or form with movement
- Lack of flexibility
Can it be treated and where does chiropractic fit in?
Yes! These are issues Alpha Chiropractic doctors regularly come across. Below is a flowchart of the steps to address your rotator cuff injury
- Stop the aggravating factor! We all know that when it comes to competition or training for an event, we tend to increase the training regime and place more stress on our bodies. The shoulder isn’t going to heal properly if you keep injuring it despite taking medicine to numb the pain, injections or massages. You will have a lot more time in the future once you allow it to heal. Your body’s health and wellbeing come first!
- Address the imbalances in the shoulder joint! I find that a lot of people with rotator cuff injuries tend to have a lot of frontal shoulder restrictions or overdevelopment of front deltoids compared to rear shoulder musculature. They also have weak scapula (shoulder blades) that most people neglect. Scapula stabilization is important and acts as an assistance to the rotator cuff so these needs to be addressed as well! By releasing and doing soft tissue work to free up the frontal restrictions combined with stretches and working to strengthen the weaknesses in the rear shoulder and scapula help for an overall optimal balance of the shoulder joint complex.
- Address postural issues. As a chiropractor and an avid crossfitter, I regularly get adjusted once a week to release the restrictions in my mid back and improve range of motion as I’m constantly bending over to lift weights and treat people. I always spend a good 3 minutes slowly rolling with the foam roller up and down my spine. Too often because of our poor hunched posture, we have poor mobility in the mid-upper back. Chiropractors help to improve one’s posture with specific adjustments and exercises for better spinal health and posture. Good structure > Great posture > Better function > Personal Records
- Re-learn proper technique. At times, you will have to think about why some people continue to get injured whereas others don’t. It also comes down to technique when doing a certain movement. Often beginners are prone to injury as they haven’t developed proper technique or continue to practice poor technique leading to injuries. Under the watchful eye of a coach it is important to listen to their expertise and not let ego take over. The purpose of a coach is to also prevent injuries as well so next time you hear your trainer or coach correcting your form, it’s because they can see what you can’t see. It would be easier to learn correct form at the start rather than much later or when you’re injured thinking “I should’ve listened”
In my experience, the presentation of an injury is usually the least useful factor in determining a long-term course of rehabilitation. Often the presentation is a result of many years or months of improper care, technique, spinal/muscular imbalances etc. Addressing the above issues first can prevent a lot of injuries happening later. Pro-Active care or Preventative care is much better than reactive care when a lot of the damage has occurred.
Rotator cuff issues are potentially preventable through improved scapular mobility and stabilization. Accidents happen and some injuries aren’t avoidable. That said, do yourself a favor. Get yourself checked out by a health professional i.e. Chiropractor, trainer/coach and listen to your body. They have the ability to let you know that something is wrong through signs, symptoms and observation of posture.
-Dr. Mark Enriquez, Chiropractor and CrossFitter
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