Physical Therapy for Rotator Cuff Injuries

By: Dr. Erin Weber, PT, DPT

Rotator cuff injuries can create shoulder pain, weakness and difficulty with daily tasks and return to exercise. Injuries to the rotator cuff can span the wide spectrum from normal age-related wear and tear, to large full thickness tears. Research consistently supports physical therapy as a primary intervention, with surgical intervention reserved for larger tears.

The rotator cuff is made up of four specific muscles: supraspinatus, teres minor, infraspinatus and subscapularis. The muscle bellies sit posteriorly around the scapula, with the tendons inserting into varying points in the shoulder. Together, these muscles work to generate stability for the shoulder joint. The glenohumeral joint is classified as a ball and socket joint, but think of it as a golf ball sitting on a tee. The job of the rotator cuff is to stabilize the head of the humerus (the golf ball) as the arm moves through space, and especially with resistance. When one of these muscles is injured, weak, or being compressed via impingement, the arthrokinematics of the shoulder are disturbed. This is where physical therapy can be a major problem-solver!

Doing physical therapy for rotator cuffs can assess and correct weaknesses and faulty movement patterns that contribute to increased wear and tear, as well as inefficient ability to generate power during tasks (ie: throwing a ball, chaturanga, swinging a racket). Even with rotator cuff tears, strengthening can correct for some of the imbalances and reduce pain by improving joint mechanics. We often are able to abolish pain and restore function by improving the coordination of the stabilizing muscles (keeping that golf ball resting in the tee).

One of the major trends seen across patients with shoulder pain is the difficulty with coordinating scapular stabilization with shoulder movement and loads (ie: reaching overhead and planks). Improving strength as wells as establishing better coordination of muscle groups working synergistically is our strategy. We may need to mobilize the shoulder joint if the humeral head isn’t gliding correctly (golf ball), as well as perform manual therapy techniques on shorter tissues, which can better facilitate inactive muscles.

Posture is another major component to addressing rotator cuff injuries and insufficiency. Sitting with your shoulders rounded forward jams the humeral head forward (golf ball), impinging on tendons that insert along the joint. Tight pectoral muscles can inhibit your middle trapezius, leaving you predisposed to faulty mechanics. Research supports the use of thoracic spine mobilization to improve shoulder joint mechanics, which is why we often co-treat with our chiropractors to address imbalances completely, ensuring that the gains made are long lasting.

Physical therapy is quintessential tool for addressing rotator cuff injuries. If you don’t have pain but suspect that your shoulders are not functioning at their ideal, physical therapy is also the best prevention. NY State is a direct assess state, meaning that you can come in without a doctor’s prescription to be evaluated by a physical therapist.

If you’d like to explore physical therapy for rotator cuff injuries or anything else, reach out to our Physical Therapy Department. Start by filling out the form below.

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