Rotator Cuff Injury Without Accident or Trauma

It certainly seems a bit strange, how so many people get rotator cuff injuries with no real trauma or accident. Its not like they are challenging their shoulders by throwing fastballs or javelins. Most people do remember "tweaking" their shoulder during something like painting, or perhaps some other overhead work. Often times the pain can appear for no apparent reason at all. Doing an internet search on rotator cuff injury will often get you nowhere. "Tear" or "degeneration" is what you are told. So without any real trauma one is left to believe the degeneration theory, aka "wear and tear". But you CAN'T UNDO degeneration! So what CAN you do? Prepare for surgery? Not so fast.

Once again I will try to limit the use of medical jargon, as I feel it often used to confuse the patient instead of communicate the real problem. The rotator "cuff" is the band of four muscles around the top of the arm bone, which is the humerus. All 4 rotator cuff muscles are there to keep the arm from sliding out of the "socket". Three of the four muscles are also for moving the arm by turning it outwards, away from your belly button (external rotation). The remaining one muscle helps turn the humerus inwards, towards the belly button (internal rotation). This one muscle works in conjunction with some quite large muscles by comparison, the pectoralis major and the latissmus dorsi.

When we are in the upright position, we mostly use our deltoid and trapezius muscles to do the heavy lifting. These muscles are also a bit bigger than the rotator cuff set.

The problem occurs if we are not fully upright. Then the movement starts to resemble external rotation (arm twisting away from belly button). Even a slight bend forward can make your body shift to using the smaller, weaker rotator cuff muscles to a greater degree instead of the larger and bigger deltoid and trapezius. Gravity does not change just because out body position does.

The slight bend forward in the above picture is NOT UNLIKE a slouch. You may be thinking that perhaps this exercise is not a good idea. I would generally agree. If you have worked your rotator cuff muscles to the point of chronic pain, and occasional strain, I don't see the sense in working those muscles further. Yet this and other external rotation exercises is what most doctors and therapists would give you (including many chiropractors). It can sometimes help short term, but it is a poor choice for a long term solution.

What DOES make sense is correcting posture so this strain on the rotator cuff muscles LESSENS. But posture is more than "standing up straight". Because we cannot see ourselves, it very difficult for us to monitor our own body positions. Most people have a poor body awareness to begin with. A good postural analysis is therefor essential. This includes the whole body, not just the area of pain. What I mean is that if your knees are so stiff or damaged to the point that they don't fully straighten, this could be creating a forward bent posture. If you are doing this, you are likely straining your rotator cuff muscles. This is only one example, but there are many possible postural alterations that can contribute to rotator cuff stress. Any surgical solution is temporary at best unless you correct what has created the stress to begin with. And for the record, surgical repair is not as successful as you might think. A 2010 study in the Annals of Internal Medicine concuded:
"Evidence on the comparative effectiveness and harms of various operative and nonoperative treatments for rotator cuff tears is limited and inconclusive."

Of course most people with postural faults don't realize they are doing it. This is why an integrated approach is often the best solution. If you have not had a head to toe evaluation in regards to your chronic rotator cuff pain, give us a call. We can also work on that knee problem.