The shoulder – it’s complicated. This is not a delineation of its relationship status on Facebook, but rather a reference to the many complex moving parts. The shoulder joint is capable of a huge range of movement, in many different directions. This is made possible through an intricate system of ligaments, tendons, muscles, nerves and joints. If just one link in the movement chain is incorrect, the ripple is felt throughout the associated structures. Over time, this ‘faulty link’ causes damage and pain. The victimized structure is often among the rotator cuff tendons – a group of tendons in charge of shoulder stability and control.
Once a rotator cuff tendon is damaged and painful, a reflex ‘spiral of doom’ develops: the shoulder is painful, so the muscles work differently. This changes the biomechanics, and puts more load on the shoulder, making the shoulder painful, so the muscles work differently…and so it goes on…
Rotator cuff tendon issues are notoriously difficult to treat, and slow to settle. The principles that prevent injury, on the other hand, are simple to understand and follow.
Anatomy Made Easy
The main shoulder joint is a ball and socket – the ball is provided by the humerus (upper arm bone), the socket by the scapula (shoulder blade). To allow us to have such a huge range of movement in our shoulder, the socket is actually very shallow. It doesn’t hold on to the ball very well. Thankfully, we have a group of tendons helping to hold the ball in its socket. These are the rotator cuff tendons. They are so called, because these tendons also assist with creating rotation movements at the shoulder.
Shoulder joint mechanics are further complicated by the fact that the scapula, which provides the socket (and ultimately the arm’s connection to the torso), is a moving plate of bone floating over the ribcage, with no stable attachment other than a collection of muscles and tendons. There must be adequate control in the muscles that stabilize the shoulder blade, to ensure the socket is a stable base for the arm to work from. There are many links in the chain!
Yet the plot thickens further. As well as providing the socket, the scapula also provides a strut of bone that creates a roof over the top of the ball and socket. This ‘spine’ of the scapula protects the joint and its tendons. This ‘protection’ is a double edged sword, however, because the presence of this bony roof over the joint also means that the tendons have limited room to move.
When we are young and injury free, the rotator cuff tendons and the scapula function seamlessly together to move our arm around, providing range and power to perform our everyday and sports related tasks.
Rotator Cuff – What Goes Wrong
Poor posture, poor upper body strength, and ageing are all factors that can compromise the rotator cuff tendons.
Poor posture causes the scapula to sag. This means the space beneath the ‘roof’ gets smaller, and this ‘low clearance’ means the tendons can get squashed.
Poor upper body strength reduces our ability to hold the scapula in a steady position. Extra movement in the scapula leads to increased load on the rotator cuff tendons, which leads to wear and tear.
As we get older (eg 30 plus), our tendons become less elastic, and therefore less able to recover quickly from the jolts, twists and pulls that we subject our shoulders to every day.
Any one of these factors can cause injury, let alone the unfortunate but common combination of all three!
One day, you go to reach into the back seat of the car, and twang – something suddenly hurts in your shoulder. Sometimes pain may start gradually and build up for seemingly no reason. In both instances, it is likely that a rotator cuff tendon (usually the Supraspinatus) has become damaged.
In some cases, this damage is an actual rip or tear in the tendon. Tears can be partial, which are normally managed with Physiotherapy, or full thickness, which often need surgical repair (not fun – six weeks in a sling and a long rehabilitation phase). Ultrasound imaging is the only way to properly diagnose a tear.
In other cases, a painful tendon is not torn, but rather, ‘frayed’, or worn. This is known as ‘tendinopathy’, and requires extensive rehabilitation and time to recover.
In any situation involving rotator cuff tendon pain, there is a high risk of developing ‘impingement’. If a tendon becomes injured and inflamed, it swells, and takes up more space. In addition, muscle weakness and poor posture can cause the ‘roof’ over the shoulder joint to be lowered. Then, each time you reach up, the tendon becomes pinched between the humerus and the ‘roof’ of the shoulder blade. ‘Low clearance’, and a swollen tendon simply do not mix.
Rotator Cuff – Injury Proof Toolkit
There are a number of things you can do to keep your shoulder tendons healthy, and decrease the likelihood of a rotator cuff injury:
• Keep fit – good general fitness makes the tendon tissues more healthy and resilient
• Keep good shoulder range – make sure you take your shoulders through their full range of movement everyday. Lift them right up over your head, behind your back, out to the sides
• Keep good movement in your thoracic spine/mid back, especially if you sit a lot. Think spinal twists, arching, lying over a rolled up towel. This will help to maintain good posture.
Injury Proof Toolkit
1) Change Your Environment
Anything that encourages poor posture should be improved. This could include:
- Low computer monitor – lift to eye level
- Unsupportive chair – use a rolled up towel in your lower back, sit tall
- Reclined car seat – straighten it up and pull your shoulders back
- Low workbench – lift to elbow height
2) Change Your Habits
Activity that encourages upper body mobility and strength (in a good postural position) should be added. This could include:
3) Add This Exercise
This exercise should be done daily to prompt good muscle activation around the scapulae, and good posture. This muscle activation should be performed before any load is placed on the shoulders, eg lifting weights, pushups etc.
- Sit or stand tall
- Gently squeeze shoulder blades back and down
- Do not arch your back
- Release. Perform 10 repetitions