The shoulder is a ball and socket joint that allows for a wide variety of motion in many different planes. Therefore, it requires stabilization to avoid injuries from occurring. A large percentage of sports-related shoulder injuries involve the rotator cuff. What is the rotator cuff? It consists of four muscles whose job is to stabilize the shoulder, suspending the head of the humerus in its proper position within the socket. The four muscles are the supraspinatus, infraspinatus, subscapularis, and teres minor. Like four tires on a car, the four muscles of the rotator cuff need to be balanced in order to provide efficiency in performance. If one tire loses air or becomes off alignment, the car can still drive forward, but at some point down the road, that one tire will start wearing more than the others, causing further imbalance. Ultimately, that tire if not replaced, balanced, or inflated it will break down. Most people with rotator cuff injuries do not realize they have a problem until suddenly they notice disabling pain. At this point, at least one of the four muscles, if not more, have worn down, torn, or weakened from imbalance.
The precursor to rotator cuff imbalance is poor posture, especially poor sitting or working posture. Like the ball of the humerus, the shoulder blade (scapula) also needs to be in a balanced position for for efficient shoulder movement. The rotator cuff muscles attach from the shoulder blade to the head of the humerus to stabilize it within the socket. Those with slouched or rounded shoulder posture have atrophy of the shoulder blade and upper back muscles thus placing the scapula in an inefficient forward position. When people move their arm repeatedly in poor posture, the rotator cuff tendons can get repeatedly pinched and worn down under the forward scapula, commonly known as rotator cuff impingement. Continued impingement over time can cause eventual damage to the rotator cuff tendons, which may require surgical repair depending on the extent of injury. With the help of a physical therapist, patients with rotator cuff impingement can work to restore balance in the shoulder complex through stretching, manual therapy, and pain-reducing modalities. While working to increase range of motion and improving pain management, physical therapists provide home program instruction to address progressive strengthening and stabilization of the shoulder. For patients who undergo surgical repair, physical therapists promote postoperative healing and provide rehabilitation to restore normal shoulder functioning and return to work or sport activities. Other shoulder injuries that occur commonly in athletes are dislocations of the shoulder with or without capsular tearing (also known as a labral tear). Dislocations are typically rehabilitated under the guidance of a physical therapist in efforts to stabilize the muscles surrounding the shoulder, re-establishing muscle balance and strength, reducing pain, and restoring range of motion. Fractures of the humerus and/or collar bone (clavicle) are also treated in a similar manner, after a period of immobilization, to ensure healing. The physical therapist will always tailor your treatment program to your athletic needs and goals in effort to maximize performance and return to sport.