Probably the most common shoulder injury /pathology seen in our clinics is that of the rotator cuff - a hugely important unit of muscles and tendons involved in the movement, stability and co-ordination of the shoulder, but a group of muscles that many people are not even aware of until they experience problems with them.
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The cuff is a unit of 4 muscles originating from both sides of the shoulder blade, which attach to various aspects around the head of the shoulder bone (humerus) and are vital in supporting and stabilising the shoulder joint.
The cuff has a specific 'timing' pattern of its muscle firing which means that if the cuff is functioning normally, this precise timing allows a co-ordinated, fluid and controlled movement of the head of the shoulder in the socket as the arm is moved away from the body. It also enables the shoulder to remain in a stable and uncompromised position in the socket when the arm is loaded.
The rotator cuff can be damaged through direct trauma to that area such as a fall onto the shoulder or arm, which may produce an immediate partial cuff tear or in worse cases a rupture. Lifting heavy loads can damage the cuff, if the load is too great or moves awkwardly. Beyond 40 years of age, the cuff begins to degenerate which means that it can take relatively little force or strain through the shoulder to cause a tear in the cuff.
Poor posture and incorrect muscle use around the shoulder girdle can lead to an imbalance of muscle activity and strength in this area, leading to untimely movement and abnormal positioning of the head of the humerus in the shoulder socket, ultimately causing irritation to soft tissue structures around the shoulder joint and often inflammation to the rotator cuff tendons. Individuals with problems associated with the rotator cuff may notice a gradually increasing shoulder discomfort, an 'arc' of pain on moving the arm away from their body, an ache in the front or side of their shoulder or an inability to lift or carry loads without pain. Some rotator cuff injuries can become so painful that lying on the affected shoulder is impossible and raising the arm can be significantly restricted.
Tennis players, rowers, canoers and swimmers can experience shoulder injuries if their rotator cuff is not performing correctly. The type of repetitive movement of the shoulder in such sports places significant strains on the tissues around the shoulder and on the shoulder joint itself.
Good posture and a balanced upper limb training programme where the rotator cuff features as importantly as the other muscle groups is the best way to make sure that you don't develop a shoulder problem because of a weak cuff and muscle imbalance. An efficient cuff can help to stabilise the shoulder girdle, protecting it from repetitive activities and also prevent injuries from happening further down the upper limb.
Rotator cuff exercises are usually fairly simple and involve lighter weights / resistance than the other shoulder muscles tend to be trained with, but need to be accurately performed in order for you to benefit from them. You always need to make sure that you are executing these exercises with the correct posture, and at a steady, controlled pace. If in doubt, ask one of the Personal Trainers in your gym to watch you whilst you perform them, or arrange for a Physiotherapist to look at your specific muscle balance and stability / co-ordination of your shoulder and advise you which exercises would be most beneficial to you. If you are a climber, a tennis player or swimmer, the rotator cuff strength and precision is paramount to you being able to carry out your sport - but your cuff exercises will need to be specific to your individual sport and compliment your training.
Rotator cuff injuries can respond extremely well to physiotherapy treatment involving both manual therapy techniques and a specific rehabilitation programme. Those more severe tears may require surgical repair, following which regular physiotherapy is vital if a good outcome is to be achieved.
They may be smaller, less well-known muscles than their neighbours around the shoulder girdle, but the rotator cuff are the most important upper limb muscles you will ever train. King of the shoulder muscles, when this little unit works well, you can enjoy a stronger, more efficient shoulder without the risk of developing pain and dysfunction.