Vail Daily health column: Re-thinking rotator cuff injuries
September 8, 2014
When a sliding door is off track, is the track to blame? At first we may focus on the noise and rubbing in the groove, but we know that concentrating our attention here is not the solution. The door being "off" is the problem. Fix the source and the symptoms resolve.
This is a great analogy for the shoulder. We have symptoms in our shoulder, so we focus on the damaged tissue and the local pain. The problem isn't that you have a torn rotator cuff, it is why.
It begins when you start to have discomfort at the top of your shoulder.
Certain movements hurt, sleeping becomes uncomfortable and you may even start to lose mobility. After searching the Internet and talking to friends you determine you have a rotator cuff injury. You are right. Research shows that 50 percent of people without any shoulder pain have rotator cuff tears. Tears are a normal part of aging.
TRYING TO REDUCE PAIN
With the diagnosis of rotator cuff injury, you are encouraged to perform band exercises to strengthen the cuff. The next step is a cortisone injection to relieve the swelling. This provides a temporary fix. You may try other modalities (massage, dry needling, electric-stim, etc.) to reduce the pain. After much frustration, an MRI is conducted to confirm the suspected tear.
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Experts warn the tear will worsen without surgery, so a repair is performed. Depending on where you fall with statistics, you have a 20 to 90 percent chance of failure.
FOCUS ON THE POWER MUSCLES
The problem is that we focus too much on the rotator cuff. These are not power muscles. The rotator cuff consists of four muscles that provide rotational stability for the shoulder joint; they keep the ball in the socket.
It is when the larger muscles surrounding the shoulder get off balance that the cuff starts to take a beating. Most people with rotator cuff tears actually have good strength in their cuff.
THE BIG PICTURE
For true resolution, we need to look at the big picture. What are the true imbalances? What is working too much and which muscles aren't working enough? Is your neck involved? How do you move and what are your compensations?
Rather than treating the symptoms, treat the source. Don't replace the track when the sliding door is to blame.
Julie Peterson, owner of Concierge Physical Therapy, is the only physical therapist in the Vail Valley certified to perform neurokinetic therapy. Peterson has a strong background in manual therapy and functional movement. She can be contacted by email at info@conciergePTcolorado.com or by phone at 970-306-3006.