You were reaching to place the bag of flour on the top shelf, started a new workout routine, or maybe you slept on your arm a little funny. All you know is when you woke up, your shoulder is no longer the happy shoulder it was the day before. After a day of two of hoping the shoulder pain would go away, you finally google "why does my shoulder hurt" and the first reason listed is that you injured your rotator cuff.
Current literature does not support that the rotator cuff is the SOLE reason for shoulder pain. While an inflamed or partially torn tendon does contribute to a painful shoulder, simply treating the rotator cuff alone is usually not adequate to fully eliminate the entirety of shoulder pain. Movement of the shoulder joint is multi-faceted and more complex than a few muscles turning on and off and then the bones moving.
So my shoulder hurts and treating my rotator cuff alone will not fix me, what will? An individualized, specific program needs to be implemented to ensure that you return your shoulder to its prior level. To solve the true reason behind your shoulder pain, a thorough evaluation of the entire body system needs to be performed rather than focusing solely on the shoulder itself. The literature shows us that the cervical spine, thoracic spine, ribs, scapular control/positioning, and the shoulder joint itself all need to be thoroughly evaluated to determine the source behind the pain. So what are we looking for in these various areas that may clue us into why your shoulder hurts?
In regards to the cervical and thoracic spine - we are looking to see how the joints are moving. Most of the nerves that control our shoulder muscles begin in the cervical spine and any lack of motion or increased muscle tension in these areas can affect the control we have over our arm, especially overhead reaching or lifting. Think of a circuit. It doesn't matter how strong the battery is if the wiring is messed up. The nerves are our "wires" to the shoulder muscles and we need to make sure the connection is not impeded. If the cervical and thoracic spine joints are not moving well, chances are that the nerves are struggling to move a well.
Next, we need to look at your scapular (shoulder blade) control. We all know that our shoulder is a ball-and-socket joint but we don't always think about what two bones make up that joint. We all know our arm bone (Humerus) is the ball, but not all of us realize that the socket is our scapula. For shoulder movement to be smooth and pain-free, we need to control both the ball and the socket. This is where you typically hear about peri-scapular muscles like the middle trapezius, the lower trapezius, the rhomboids, the serratus anterior among others. We need to make sure that the muscles that control your scapula are firing and that the scapula itself is moving well and doesn't have a mobility restriction of arm movement pattern.
Finally, we get to the shoulder itself. The dreaded rotator cuff. During this part, we assess the range-of-motion, strength, and control of your shoulder. The rotator cuff is responsible for stabilizing and controlling the shoulder. Rather than being a muscle that is all about power and muscular force, its job is to keep the "ball" in the middle of the socket as we move our arm. We want to ensure that no muscular imbalances have developed that are causing the rotator cuff to struggle to perform this task. These exercises will focus on controlling your arm very specifically and then gradually increasing load as you demonstrate full control.
On top of all this, we have to respect the shoulder's level of irritability. When you initially come in for treatment, your shoulder will most likely be highly irritable. Usually, we are not able to directly treat the root cause of the issue until we begin to decrease the irritability of your shoulder otherwise we run the risk of flaring your symptoms up. During this process, we could utilize a plethora of different techniques: myofascial release, gentle stretching, dry needling, gentle joint mobilization, and isometric strengthening to name a few. As the irritability decreases, we can begin to more directly treat the root issue while we respect the nature of healing process. At this stage, treatments would be more directly tailored to treating the root area with techniques like isotonic strengthening, joint mobilizations, and functional strengthening/re-training.
Once again, simply treating the rotator cuff alone is not sufficient to ensure your recovery from your shoulder injury. At times, the rotator cuff isn't even the issue. To ensure that you receive treatment targeted at the TRUE reason behind your shoulder pain, a thorough evaluation of all potential contributing areas needs to be conducted.
Here at Columbia PT In Motion, we are committed to assisting all of our patients in maintaining a healthy and active lifestyle through these trying times.