Preventing rotator cuff injuries

The old belief that only baseball pitchers suffer from tears of the rotator cuff in the shoulder is simply not true, says Garrigues. “Rotator cuff tears are pretty common, actually. About 50 percent of people over the age of 60 will have one.”

The shoulder has more range of motion than any other joint. Most of its stability and movement relies on the small rotator cuff muscles and the larger muscles that surround the shoulder joint.

In fact, an untold secret of rotator cuff injuries is that couch potatoes and gym rats are equally susceptible. While traditional weightlifting and cardiovascular training provide many benefits, they often do little to strengthen the complicated assembly of muscles that keep the shoulder joint stable and healthy.

It is true that baseball pitchers suffer rotator cuff tears -- or rather, fraying on the edges of some tendons -- because of the tremendous forces they exert on their shoulder every time they throw the ball.

But overhead activity of all kinds is what tends to injure people: reaching high to paint a wall, change a light bulb, or serve a tennis ball. “Anything where your arms are raised up over your head is asking the most out of the shoulder,” says Garrigues. “It’s a common story: ‘I was painting my ceiling, and now my shoulder hurts.’ That’s classic.”

Often people will discover shoulder pain through everyday activities such as reaching out to put on a coat sleeve, reaching for something on the back seat of their car, or simply shaking hands with someone. Any motion that extends the elbow away from your side puts strain on the rotator cuff.

Injured shoulders can also be troublesome at night, when lying down allows for swelling in an inflamed joint. Occasionally, nighttime pain can get so bad that sleep is possible only in a reclining chair -- and some patients can’t sleep at all.

So how do we avoid such an injury? Keep the shoulder strong and flexible with exercises targeting the small muscles that make up the rotator cuff. The key is to complement a program strengthening the larger muscles of the shoulder with a few key exercises just for the rotator cuff.

And here’s another untold secret: Whether you are active or inactive, young or old, the exercises for strengthening your rotator cuff -- and most physical therapy for shoulder pain -- are identical.

“Good posture in the shoulder blades, stretching, and some very simple strengthening exercises will help prevent 99 percent of all shoulder problems you could have,” Garrigues says.

“It’s the same thing whether you’re a baseball pitcher at an elite level, a middle-aged weekend warrior, or an elderly person with a degenerative shoulder. The first-line treatment for any of those patients with shoulder pain is basically going to be the same thing.” 

If you do injure your rotator cuff, there are several treatment options. The type of treatment depends not only on the extent of the injury, but the age of the patient and their functional demands.

All patients receive physical therapy, which they are encouraged to continue at home. Sometimes, even with a torn rotator cuff, strengthening is all that is needed. 

“Four separate tendons surround the shoulder,” Garrigues says. “If you have torn half of one tendon, you still have three and a half tendons left. If those are strong, it can often fully compensate for the torn part. 

“Many people with a small tear can have a pain-free, strong, healthy shoulder with full ability to do overhead activity. That’s why keeping those muscles strong is so important.”