Your shoulder is one of those parts of your body that you won’t realize you use as much as you do, until there is something like a rotator cuff injury. Simple activities like combing your hair, brushing your teeth, tying your shoes, and even sleeping can become painful reminders of this. If you are a recreational or professional athlete, this painful reminder can be even more frustrating because it will affect your ability to exercise or perform at your highest level. The pain can move around making a diagnosis feel difficult and the pain referral patterns for the rotator cuff is often not in the area that is injured. That is where Urban Wellness Clinic doctors come in, because we thrive at getting to the root cause of pain, which is often not where the pain is located.

What is a Rotator Cuff?

Your Rotator Cuff is a group of muscles and tendons that are located in and around the shoulder. They connect the upper arm to the shoulder blade. The tendons of the rotator cuff provide stability to the shoulder girdle area, with the muscles allowing the shoulders to rotate. 

There are 3 bones in your shoulder: Your scapula (shoulder blade), your humerus (bone in your upper arm), and your clavicle (your collarbone). Your shoulder is a ball and socket type of joint where your upper arm bone fits nicely into a socket that is in the shoulder blade.

The rotator cuff muscles and tendons play an important role in the functioning of this mechanism, as it keeps the arm in the shoulder socket. The network of muscles that come together as tendons that cover the head of the humerus is called the rotator cuff. This is where the mobility of your shoulder stems from, so you can imagine how debilitating it could be when it causes pain. 

These muscles in the rotator cuff include the infraspinatus, supraspinatus, teres minor, and the subscapularis. There is also a bursa (lubricating sac) which is located between the rotator cuff and the bone at the top of your shoulder called the acromion. The bursa can become inflamed and painful when there is an injury to the rotator cuff tendons. The main job of this bursa is to prevent the muscles from rubbing down on the bone.

What Are The Symptoms of a Rotator Cuff Injury?

Some symptoms include pain at night, particularly if you are trying to sleep on the affected shoulder. Pain when lowering or raising your arm to perform a movement. Weakness and pain when lifting your arm, and crepitus which is a grating sound or sensation made when there is friction between the bones and cartilage. 

5 Common Causes of a Rotator Cuff Tear

There are many causes of rotator cuff pain and tears but we share the mains causes we see at Urban Wellness Clinic everyday. Often times the patients coming to us have seen other chiropractors, physical therapists, or orthopedists with no relief. Our goal is to see past and discover the underlying cause of pain that may be outside the injury moment. A better way to describe it is the injury maybe be the straw that broke the camel’s back but there was probably some movement or pattern causing wear and tear before the actual injury.

1. Poor posture and rolling forward of the shoulders will pull on the entire rotator cuff. The rotator cuff was meant to rotate the arm not elevate the shoulders to the ears.
2. Overuse, especially when playing overhead sports like tennis or volleyball.
3. Improper form when weightlifting, or lifting weights overhead. Particularly if there is poor core stability. 
4. Hypermobile shoulders or loose connective tissue that will lead to tight rotator cuffs due to the attempt to stabilize the shoulders.
5. A traumatic injury like falling with an arm extended out, or being pushed from behind.

Other root causes we see are abdominal scars including gall bladder removal, appendectomy, c-section scar, or hysterectomy. Every day contributing habits include, shallow stressed breathing habits, overarching of the low back, wearing high heels, and breath holding or not exhaling long enough throughout the day.

Treatment Options

ART (Active Release Therapy) is commonly used to treat an injured rotator cuff injury. It is a hands on soft tissue technique that is used to alter the tissue structure by breaking up any scar tissue adhesions, which will in turn restore normal function to the affected areas. 

NKT (Neurokinetic Therapy) is used to find compensations. The rotator cuff, along with the pec and the upper  and middle trap will be overactive as a result of this injury. The major and minor pec in someone with a weak shoulder will act as stabilizers, as well as the serratus anterior, lats, lower traps, and middle traps. Once the compensations are discovered, our chiropractors will adjust and create an exercise model specific to your injury and needs. 

Cupping is often included in therapies, particularly if the muscle doesn’t release after Active Release Therapy. Cupping will remove stagnation from the area, and get fresh blood and oxygen moving to the area. 

DNS (Dynamic Neuromuscular Stabilization) is used to rehabilitate and activate the serratus anterior, creating good shoulder stability in rolling patterns. This is similar to the movements we made as babies. Movements include hands and knee beast plank, then beast to bear, and DNS twist with a reach. 

Strength is a very important component to rehab and long term care. Ensuring there is optimal core stability, strengthening the serratus with arm bars, push ups, pallof press, along with a solid overhead pressing program with kettlebells. These will program the motor control and the muscle memory of the scapulohumeral rhythm – which is how the scapula and the arm bone move together in unison over all of the planes of motion.  

Why Visiting With Us Is Important To Your Recovery

Our experience and dedication to quality care allow us to take our time to find the root of the cause. The evaluation starts from head to toe, we’ve seen old hip injuries affect the opposite rotator cuff, we know the relation between old injuries that have been left untreated and seemingly newer injuries that pop up in other locations in your body. 

Rotator cuff tears can happen from shoulder instability, and we also know that shoulder instability and weakness go hand in hand with core weakness. 

We do not use therabands for this type of injury. We know the significance of training normal human motion, functional movement, and we have seen that when people use therabands – there is too much shoulder retraction or pulling the shoulder blades together.

The Biggest Key

Our ultimate goal is to help you avoid surgery. Not only does surgery come with it’s own set of risks, it will require you to take time away from your work, your life, and your family. In addition, the pain medications prescribed post surgery run the risk of side effects and addiction.

If you have any questions or want to talk about your injury, feel free to give us a call at 212-355-0445 or shoot us an email at hello@urbanwellnessclinic.com

In Good Health,

Dr Emily Kiberd