The shoulder is the most mobile joint in the body, able to move through each plane of motion. This makes it more susceptible to injury. There are different injuries to the shoulder and muscles that hold it together. Here we will cover the injuries to this joint, as well as exercises you can do for preventing and treating rotator cuff injuries.
What is the rotator cuff
Your rotator cuff is made up of four small muscles which hold the shoulder together. The shoulder is a ball and socket joint and can move in multiple planes. This includes the sagital plane which is up and down, as well as the medial plane which would be left to right, as well as the transverse plane. There are four muscles that make up the rotator cuff. These include the suprispinatus, infraspinatus, sub scapularis, and teres minor. The main function of these muscles is to hold the head of the humerus joint in place. There are four tendons to these muscles which come together. Abduction, adduction, as well as internal and external rotation of the arm are functions of these muscles.
What causes rotator cuff injuries
Most of the time when a rotator cuff injuries occur it has to do with overuse. These injuries are common in baseball basketball, tennis, and even swimming. All of these activities have continuous movements. One specific movement where overuse has been linked to rotator cuff injury is overhead movements For example, a swimmer is continually doing a down stroke against the resistance of the water along with internal rotation of the shoulder when doing freestyle swimming. For baseball, any throwing motion will stress the joint due to the movements of adduction and internal rotation.
The most important part of any injury is injury prevention. One study looked at four steps to prevent overhead rotater cuff injuries from happening. The first is to identify risk factors involved, followed by establishing how these factors can be used to fit the return to play criteria. Using measurable tools, as well as using a good training program play a part as well (9). When put together, these factors will decrease the chances of the injury happening again. It has also been established that those that were not required to have operations were able to return to their activity at a much faster rate than those who had surgeries. (6). Although there are not many direct exercises that can be done to strengthen the rotator cuff, they work in assisting muscles in different exercises. This includes exercises like the bench press, front raise or side raise with dumbbells, or the shoulder press.
One other exercise or treatment is called PNF stretching. This stands for proprioceptive neuromuscular facilitation. This type of stretching involves a partner to assist you. Begin by applying force to your partner which is pushing against the muscle being stretched. After 5-10 seconds relax the muscle group to do a static stretch. In a study, one group used a diagonal movement with dumbbells while the other group used PNF stretching. The results showed a greater increase in muscular recruitment using PNF than using dumbbells for training.(5) This supports the use of PNF stretching as a preventive measure for preventing and treating rotator cuff injuries.
Specific movement patterns and injuries
There have also been studies and reviews on different athletic activities and the risks of developing rotator cuff injuries. Studies have also revealed that the using specific exercises can assist in preventing the injury (8). Any activities requiring continuous movement of the shoulder overhead stabilization puts one at a higher risk for injury. One example of this is a goal keeper in soccer. Out of all sports, soccer has the highest number of injuries. In one review, a group of orthopedic surgeons, physiotherapist, and trainers developed a prevention program specifically for goal keepers to assist in decreasing the chances of a rotator cuff injury. This included a general warm up, as well as specific exercises for their position (7)
Swimming can also increase ones’ chances of injury to the rotator cuff. This comes from continuous motion of the rotation of the shoulder. In one study, some preventive strategies used included stretching, strengthening, and specific bio mechanical motion instructions were used. Also, monitoring the volume, intensity, and duration of a practice session will decrease the chances of an overuse injury occurring (10)
After surgery, it is best to begin therapy right away. At one point, it was thought that immobilization was an important aspect of recovery, but this is not the case. (3). Numerous treatments have been shown to assist in healing from rotator cuff injuries (1). One treatment is shock wave therapy. This is said to decrease the need to have surgery. Evidence has shown high intensity long term use of shock wave therapy to be effective at this treatment and in speeding the recovery process. (2) Another possible form of treatment is that of lazer therapy, although its effects are unclear and manual therapy may be the preferable treatment (4).
There are numerous forms of treatment along with preventive measures to assist in a rotator cuff injury. The type of treatment used may depend on the individual or specific activity that they are taking part in. Using preventive measures with specific exercises should become a part of ones’ daily workout, especially if you are in the athletic population. There are many tools to use when preventing and treating rotator cuff injuries. The treatments and preventive measures mentioned should assist you regardless of your injury or level of activity.