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Shoulder pain and rotator cuff injuries

by | Sep 2, 2021 | Rehab, Rotator Cuff, Shoulder

The important stuff you need to know about rotator cuff injuries.

The rotator cuff is a very important group of four small muscles (supraspinatus, infraspinatus, subscapularis & teres minor) that connect the upper arm to the shoulder blade (see image). Their main role is to not only move and control movements of your shoulder but to also provide dynamic stability to the shoulder joint.

Unfortunately, rotator cuff tears, which can occur to any one of these muscles, are one of the most common causes of shoulder pain and disability in both the sporting and general populations and can make everyday tasks increasingly difficult and often very painful.

Research has shown that the risk of developing a rotator cuff tear increases with age. Jobs and sports that require repetitive overhead work also increase the risk of rotator cuff injury. Jobs such as construction, carpentry, electricians and painters as well as sports that require overhead movements such as swimming, baseball, cricket and volleyball can all predispose the shoulder to injury.

How do rotator cuff tears occur?

Rotator cuff tears generally develop as a result of either:

Traumatic events – Such as a fall onto an outstretched arm or lifting a heavy object

Non- traumatic events – Such as excessive repetitive use or normal age related wear and tear

How do I know if I have a rotator cuff tear?

  • Symptoms of a rotator cuff tear can vary from person to person, however, common findings include:

  • Pain on the side or back of the shoulder

  • Pain in the upper arm.

  • Reduced shoulder movement and pain associated with overhead tasks such as changing a lightbulb or reaching for the top shelf of a kitchen cabinet or other tasks such as reaching behind your back or out to the side.

  • A feeling of weakness with shoulder movements

  • Pain sleeping on the affected side

Should I get a scan?

Imaging studies, both Ultrasound and MRI, have shown that the prevalence of rotator cuff tears in asymptomatic (symptom free) individuals is approximately 50% in those aged between 40 to 60 years of age, and as high as 80% in those older than 80 years of age. (Harris et al, 2012). This means that if a tear is present on an ultrasound or MRI it may just be due to the natural ageing process and not related to your shoulder symptoms at all.

If you have shoulder pain and are unsure whether you require imaging, your physiotherapist will be able to determine if your pain is caused by the presence of a tear or any other underlying factors.

How can physiotherapy help?

Research has shown that physiotherapy management, specifically strength training, should by the first treatment option for rotator cuff injuries (Ladermann et al, 2015; Ainsworth et al, 2007; Collin et al, 2015).

Rotator cuff tears account for over 50% of all shoulder conditions seen by physiotherapists on a regular basis (Donatelli, 2011).

The first thing that we will determine is whether your symptoms are in fact due to a tear to the rotator cuff. This is achieved by a thorough assessment of your shoulder, neck and upper back including:

  • A detailed history of your injury
  • Clinical examination of your shoulder movements and strength
  • Special orthopaedic shoulder tests
  • Examination of your neck and upper back movements
  • Palpation of your shoulder muscles and surrounding structures
  • Determine if imaging is required
  • Determine if you need to see an orthopaedic specialist
  • Set specific, individualised rehabilitation goal

What does treatment entail?

A 1 hour initial consultation is recommended for your first session. After your assessment, treatment may include:

If you think you may be suffering from a rotator cuff tear or have some shoulder pain and are unsure where to start, then get in touch!

 

Ankle dorsiflexion knee to wall measure for squat

How to Treat and Manage Stiff Ankles

If your ankle mobility isn’t up to par, the next steps depend on the source of the restriction. Generally, if the limitation is felt at the front of the ankle, it may be due to joint-related issues.

  • Banded Ankle Mobilizations: This technique involves using a resistance band tied to a stable surface while performing ankle flexing exercises on a step. Check out this quick helpful video for guidance.

Conversely, if the tightness is located in the back of your ankle around the Achilles tendon region, consider:

  • Contract/Relax Stretches: A simple exercise like the bent-knee calf raise can effectively relieve restrictions in this region.

Lastly, for an immediate solution, consider using a wedge or support under your heels during a squat. Two papers from The Journal of Strength and Conditioning Research have shown that wedges can enhance squat depth without negatively impacting biomechanics. While some may see this as a “cheat,” the science supports it. If you struggle to achieve that 12 cm in the knee-to-wall test and find it challenging to squat low, use that wedge!

Hip Range of Motion

How Much Flexibility Do I Need and How Do I Test It?

For effective squatting, studies have determined that achieving 125 degrees of hip flexion is necessary—this is 35 degrees beyond a right angle. To test your hip mobility, you can use an inclinometer available on your iPhone. Simply follow these steps:

  1. Lie down on your back with your legs extended.
  2. Place the inclinometer length-ways on your thigh,
  3. Gently lift your knee towards your chest to measure the maximum angle, without moving the opposite leg.

     

    measuring hip flexion

    How to Treat and Manage Stiff Hips

    The hip joint is mostly passive during a squat, so if you’re experiencing limitations, it’s most likely due to an issue with the hip joint itself. There is up to 20% of the population that may be limited by the shape of their hip joint and the way it developed during childhood and adolescence. If that is the case, it makes if very difficult to improve the range of motion. Things like acetabular retroversion or a lower femoral head/neck offset ratio cannot be changed.

    For the rest of the population, here are some effective strategies for improving hip mobility:

    • Banded Hip Mobilisations: These exercises can help increase the range of motion in your hips by stretching and mobilizing the joint. Look for a demonstration in this video.
    • Inner Range Hip Flexor Strengthening: Strengthening your hip flexors can counteract tightness and enhance your ability to squat lower.
    • Like with ankle mobility, adding a heel wedge can help. By elevating your heels, you may experience a reduction in trunk forward bend, minimizing the hip flexion required and facilitating a more comfortable squat position.

    Conclusion

    Mastering a deep squat requires more than just strength; it hinges on sufficient ankle and hip range of motion. The studies from 2015 and 2022 have made it clear: flexibility in these joints is paramount for optimal performance.

    By regularly assessing your mobility and implementing these targeted exercises and techniques, you can improve your squat depth, enhance your overall strength training, and reduce the risk of injury. Remember, every body is unique, so listen to yours and adjust your approach accordingly. Happy squatting!

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