A Modern Take on Rotator Cuff Injuries

A Modern Take on Rotator Cuff Injuries

by Cindy Dehan, MS PT 

The shoulder is considered to be one of the most intricate joint systems in the entire human body, with interactions between the upper arm (the humerus), the scapula, and the thoracic spine, in addition to the complex neurovascular system. The rotator cuff plays a vital role in proper shoulder function. Specifically, the rotation cuff system consists of the interaction of four major muscles: the supraspinatus, the subscapularis, the teres minor and the infraspinatus. The primary roll of the rotator cuff is to center the shoulder joint and allow for proper joint motion.

Identifying the reasons for shoulder pain can be just as complex as the shoulder system itself. Similar to the spine, it is difficult to determine a true pathoanatomical “culprit” for shoulder pain, and it may be more beneficial to conceptualize issues found in the shoulder with regards to functional limitations. The American Physical Therapy Association recently published a clinical guideline article regarding the shoulder and outlined three separate types of classifications that shoulder issues may fall into. Shoulder pain and mobility deficits/adhesive capsulitis (frozen shoulder), shoulder stability and movement coordination impairments/dislocation of the shoulder joint, and shoulder pain and muscle power deficits/rotator cuff syndrome. Any of these conditions can impact the rotator cuff, but for the purposes of this article, we will focus on the muscle power deficits/rotator cuff syndrome (RCS) classification.

Traditionally, pathology of the rotator cuff was thought to be almost always be related to issues with impingement, where compression and high levels of friction were associated with the pain and dysfunction often reported by patients. More recent evidence suggests that mechanical loading of the tissue may cause changes to the tendon quality and contribute to the sensitivity of the tissue. Overhead movements such as throwing, can increase tensile load. Reaching overhead can increase the compressive forces in part of the shoulder complex. It is not uncommon to find pain while catching at midrange when lifting the arm. In fact, pain and weakness are common when performing movements that place any stress onto the rotatory cuff system.

Very few things in life have a specific protocol that you can follow from start to finish without having to adjust a little. Managing rotator cuff issues is no different. Given the fact that underlying cause of shoulder pain and dysfunction can be multifactorial the interventions should be selected to treat the impairments, not necessarily the diagnosis. Specific exercises which address the scapula and rotator cuff, in conjunction with manual therapy, has been shown to be beneficial for patients with RCS. It is also of benefit to look at the mechanics and relationship of the thoracic spine to the shoulder, as treatment to the thoracic spine may improve certain shoulder impairments. Core/midline stabilization can also contribute to issues seen in the shoulder based upon the specific activities someone participates in.

In an ideal world, we could develop a series of movements, exercises or hands on treatment that could fix everyone just the same. But the challenge is that we all are very unique and while we might share a common complaint of shoulder pain, the underlying cause is very different from person to person. That is why it is important to have a thorough, comprehensive exam so that the individual characteristics associated with your shoulder can be addressed and a detailed, personalized approach can be implemented.

Anti-Inflammatory Foods

by Dylan Bartley, MSPT, CMP

In treating any injury in physical therapy, one must take inventory of how one’s body is prepared to fight it. We all need a good immune system and a quick response to an injury. Inflammation is a necessary part of that response, helping to temporarily immobilize the area and bring valuable inflammatory cells to begin the repair process. But our inflammatory system has a tendency to get out of hand with all the stress we place on our bodies and toxins in the environment.

Tuning up your diet a little to quiet the inflammatory system is often a great way to stay in balance. Often times an improper diet is actually the cause of excess inflammation. If one has an allergy to dairy or gluten, that person’s immune system will be working on overload to fight the food that the body has decided is toxic, and inflammation will run rampant through the body. So in building a diet to fight inflammation, one must first make sure that the diet is not the cause of inflammation. Once you’ve done that, now it’s time to add in some foods shown to control an overproductive inflammatory system. Here’s a list compiled from Jennifer Cole, Editor of FrozenShoulder.com. If your shoulder injury or knee pain has been lingering for more than a few weeks, check in with a physical therapist and go grocery shopping for some good food.



    • Certain types of fruit are well regarded for their anti-inflammatory properties, specifically red, purple and blue fruits. Red grapes, for example, contain quercetin an antioxidant which may be effective in reducing inflammation. Blueberries, contain high levels of anthocyanin, an antioxidant that is known to be effective in minimizing swelling. Try to eat organic fruit wherever possible as pesticides are often hard to wash away, especially on small berries.
    • Pineapple is known to contain an enzyme which has been found to have anti-inflammatory properties. This enzyme is called bromelain. Wherever possible try to eat fresh pineapple as far less bromelain is usually present in canned products.
    • Many vegetables contain properties that may help act as anti-inflammatory agents. Try to eat plenty of fresh – ideally organic – cruciferous Vegetables. These include cauliflower, broccoli, brussel sprouts, cabbage, cress and bok choy. These vegetables are all loaded with antioxidants that can help rid the body of harmful compounds.
    • Salmon is one of the healthiest fish you can eat and is known to contain anti-inflammatory omega-3’s. It’s always better to eat fresh fish wherever possible and wild salmon is one of the highest regarded anti-inflammatory foods. Try to include oily fish in your diet your diet at least twice a week.
    • Ginger is known to have a host of health benefits. A 2010 study showed that daily consumption of ginger helped to reduce muscle pain associated with exercise by a staggering 25%. Ginger is simply a great addition to any diet as well as being effective in reducing inflammation.
    • Extra Virgin Olive Oil provides a large amount of those special fats that are effective at fighting inflammation – in addition to providing various other health benefits. It should be relatively easy to find a way to incorporate extra virgin olive oil into your daily diet. This pure oil is considered by many in Mediterranean culture to be the secret to longevity!
    • Garlic has been linked to positive health claims for just about everything from the common cold to heart disease. There are numerous claims and counter-claims about the effects of garlic as an anti-inflammatory food. , We decided that garlic should make this list purely based on the overwhelming amount of anecdotal evidence – but remember, the myth maybe larger than reality!
    • Turmeric is an Asian spice that is known to contain curcumin – a natural anti-inflammatory compound. Curcumin is also often found in various curry blends and is believed by many to be a powerful natural pain reliever.
    • Sweet Potatoes are well known to have a positive anti-inflammatory effect are a valuable source of complex carbohydrates, beta-carotene, fiber,manganese and vitamins B6 and C.
    • Despite numerous studies, there is little evidence to support the claims made for the anti-inflammatory properties of Green Tea. Nonetheless, the health benefits of green tea have been lauded in asia for centuries and just about every nutritionist continues to promote it’s wonders!