Updated: Mar 5
Have you got a diagnosis of a rotator cuff tear, bursitis or calcification or in other words a sore shoulder?
If you’ve ever had shoulder pain you know it’s no laughing matter and as poor old Atlas will testify it will easily bring tears to your eyes if it gets painful enough.
Often we see people at the clinic with shoulder pain who have been given one (if not more) of the following diagnoses regarding their grumpy painful shoulder;
Rotator cuff tear.
Rotator cuff disease, (I hate that one; it is NOT a disease, it IS a painful tendon).
Calcification. These are small focal areas in the tendon that are probably the tendon just trying to repair itself… badly!
Bursitis. The bursa is a fluid filled sac in the shoulder that helps your joint move freely. When the bursa gets inflamed it’s called bursitis and creates pain, some would argue considerable pain.
The list goes on and on and is usually accompanied by a less than helpful dose of doom and gloom regarding the future. My personal bugbear is “I have a tear and there’s nothing you can do about it”.
There is in fact plenty we can do about it and preferably there’s a long-lasting solution that doesn’t require surgery or injections as well.
Not sure if surgery, injection or physiotherapy is the answer?
It appears to be true that a tear in the rotator cuff will not repair itself like a ligament or muscle tear. Fun fact – you can have a tear but not have pain.
Around 25% of 50-year olds have a tear in the rotator cuff but have NO pain and for every decade older we get the incidence of tears get higher in people with NO shoulder pain. That’s awesome news as it shows we can have a healthy fully functioning shoulder that may not be in pristine condition under the surface, (a bit like a car I used to own!).
Let’s simplify the shoulder and look at what your diagnosis is telling you to do.
To continue with this good news about your shoulder let’s look at the best way to get it back to its happy place.
To take a simple approach most shoulders fall into 3 categories;
· Painful and weak
· Painful and stiff
· Painful and unstable
The rotator cuff tears, bursitis and calcifications of this world generally fall into the WEAK and PAINFUL category. This results in the shoulder having the following issues;
· Poor or altered movements that irritate the structures around the cuff including the bursa or tendon.
· Lack of strength endurance in the cuff that affects the ability to perform repetitive movements or tolerate repetitive work.
So the best approach to take and the one that has shown results equal or better than surgery in some cases is a progressive exercise program that;
1. Improves the quality of movement, make it a smooth operator so to speak.
2. Increase the strength of not only the rotator cuff but also the muscles at the shoulder blade, elbow and grip.
3. Strengthen up the specific movement patterns that you struggle with.
It sounds like surgery and injection isn’t the only option so what should I do?
Well in the acutely painful shoulder the aim is to get it back to its HAPPY place ASAP.
Top tips for this are;
· Place a rolled-up towel under the arm pit, it’s an attempt to offload and reduce compressive forces at the shoulder allowing it to settle.
· Exercise: try bending over a letting the arm hang then gently swing it in circles. This helps to stimulate your natural painkilling mechanisms, massage the bursa, maybe! Creates a bit of space in the shoulder.
· Ice: 10 mins every hour to 2 hours.
· See your GP regarding appropriate analgesia.
Now that the shoulder is feeling good it’s time to get it stronger and healthier.
Once it’s settled down it’s time to get down to the business that gets this weak painful shoulder into a strong resilient bullet proof shoulder. To achieve this it’s necessary to do the following two things:
1) Strengthen the weak areas
That’s where a progressive exercise program that gets it moving smoothly and then builds up its strength and endurance comes into play.
This is the long-haul part and in reality your exercises in the first 12 weeks will need to be progressed in three weekly intervals as you improve.
After that you should be progressively strengthening it for 4-8 months from onset to get a long lasting successful shoulder. This can take the form of bodyweight exercises or use of TheraBand or weights that NEED to be progressed in difficulty and weight in order for you to get the best result.
2) Stretch the tight areas
Occasionally there is a need for stretching to help improvement around the back of the shoulder, or the front at the chest muscles.
Here is a look at some of our favourite shoulder rehab exercises from the early stage rehab right up to some late stage loading;
Is surgery or injection ever an option?
To suggest that surgery or injection is not warranted in some shoulder conditions is not realistic.
There are certainly shoulders that require surgical intervention as they will have a far better outcome than with rehab alone.
When it comes to rotator cuff issues the following are influential in who requires surgical intervention;
site and size of the tear.
age of the individual.
failure or poor response to rehabilitation or other interventions.
This is not an exhaustive list but the are certainly indications of the need for surgical intervention as opposed to conservative rehab-based treatment alone. These shoulders fare much better with surgery before they start rehabilitation and they do need rehabilitation after surgery to make them ore robust and maximise the surgeons efforts.
So in summary i can do a lot to get my shoulder better without worrying about the state of the tendons or joint, how awesome is that?
The solution to your shoulder may not be as drastic as needing surgery or injections and may be as simple as this 4 part process;
1. Settle the pain down.
2. Stretch the tight structures.
3. Strengthen the weak muscles and tendons.
4. Stay consistent and be persistent with your rehab.
Next in this series we will have a look at the shoulder blade what it s role is in shoulder movement and clear up some of the mythology surrounding it.
Any further questions feel free to contact us at the clinic.