Saturday, 28 January 2012

The Therapist Is In...Q&A -- Spotlight on the rotator cuff

The Therapist Is In...Q&A -- Spotlight on the rotator cuff

The Therapist Is In...
Q&A -- Spotlight on the rotator cuff
by Shannon Murphy, MPT

Q: What is the rotator cuff, exactly? And why do so many people have trouble with it?
A: The rotator (ro-ta-tor... not "rotor") cuff is a complex of small muscles that help to keep the shoulder in joint and control its movement. The "cuff" refers to the fact that the muscles create a nearly continuous sleeve around the shoulder.
A number of factors make the rotator cuff easy to injure. For one, the shoulder is a ball and socket joint, which makes it very mobile. However, unlike the hip (the other main ball & socket joint in the body), the muscles and ligaments surrounding the joint are fairly small. And unlike the hip, humans tend to heavily use one arm more than another because of hand dominance. When poor posture, overuse, and age build up, our tissues tend to break down.
Q: Is "rotator cuff tendonitis" the same thing as "shoulder bursitis"?
A: Not precisely, but they are related. "Bursitis" specifically refers to inflammation of the bursa, a small cushion found around different bony parts in the body (like the "acromion", where the shoulder blade meets your collarbone). "Tendonitis" refers to inflammation of the tendons, which are the portion of muscles that attach to bone. The supraspinatus (soup-rah-spin-A-tus) tendon is the usual culprit in rotator-cuff tendonitis, because it gets pinched under the bony arch of the acromion when the muscles are not coordinating properly. It attaches to the side of your shoulder, high up, and can be very tender when pressed.
Q: I am trying to go to the gym more regularly -- what type of exercises should I do to help my rotator cuff?
A: Specific exercise recommendations should always come from a medical professional (e.g. physical therapist) who knows your specific body and circumstances. However in general, most people need to work muscles in the shoulder blade region -- circuit weights like a seated row, seated posterior delt, or various types of rope and weighted tricep extensions are usually good bets. Similarly, most people need to be cautious with lifting overhead -- avoid military presses or bicep curls that position your elbow at/above your shoulder. Specific rotator-cuff exercises can be done with a cable column or elastic band: simply bend your elbow into an "L" shape at your side and rotate your arm toward your stomach and then away -- depending upon the orientation of the cable/band, you will work different parts of the cuff.
Remember, however, that exercise technique is as important as exercise selection. There is no substitute for a trained and watchful eye when performing new activities. Most people with shoulder problems do not coordinate their muscles properly on their own. If you are struggling with an injury or pain, you need to seek the guidance of a medical professional.
Q: What can I do to prevent rotator cuff problems in the first place?
A: All the usual health advice definitely applies! Maintain a healthy weight, drink plenty of water, focus on good posture, and don't smoke. A healthy lifestyle keeps all of your tissues stronger and limits the number of additional stresses placed upon them. Other specific "do's and don'ts" include:
Women--buy good bras! The larger your chest, the wider/more padded your straps need to be. Racerback or T-style bras are also a good choice for the well-endowed. Otherwise, a significant amount of pressure gets transferred to the thin straps and makes it very difficult to maintain normal use of the shoulder. Breast reduction is a relevant consideration for some women.
Office workers -- watch the mouse! Do not over-reach, even though it may not "seem" to hurt. Your arms should be positioned with elbows near your sides, not forward. Forearms should ideally be supported with well-fitted chair arms or some portion of the desk. Take frequent stretch breaks and pinch your shoulder blades from time to time.
Physical workers -- many trades (electrical, plumbing, hair styling, etc) demand a lot of your shoulders. It is very important that you learn industry-specific tricks to make your life easier, and be smart about career planning (e.g. moving into supervision roles as you age) There is no gain with pain on the job, and many workers become permanently sidelined from their line of work when they don't take care of themselves early on.

This series of columns are by Shannon Murphy, MPT, Owner/Director of BodySense PT. 9 Saint Paul St, 3rd Floor, Boonsboro, MD 21713. 301-432-8585 phone, 301-432-1987 fax,

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