As a coach I get a lot of questions about injuries. I’m no physical therapist, but when you work with both athletes and non-athletes on a daily basis the questions of what to do about injuries and how to train with an existing injury are impossible to avoid. Any information about dealing with injuries is invaluable to trainers and trainees alike.
Probably the most common questions are about rotator cuff injuries. Injuries to the rotator cuff are fairly common and the shoulder is a complex series of joints that can be difficult to understand. As a result, many rotator cuff injuries are self-diagnosed and are likely to be something else entirely. In the event a legitimate rotator cuff injury rears its ugly head, staying informed on how to deal with it is paramount. A recent review in Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology aimed to do just that. In the review, researchers looked at numerous studies to piece together a comprehensive understanding of rotator cuff tears and suggested treatments.
First, let’s describe what the rotator cuff is, which may be confusing all by itself. The rotator cuff is what we call four of the muscles in the shoulder that are responsible for some of the shoulder’s motion. A lot of that motion involves the rotation of the humerus, the long bone in the arm, which is why the group of muscles is referred to as rotators. Another major role these muscles play is the stabilization of the shoulder, which is a series of joints that requires muscular stabilization to allow for greater range of motion.
When one of the muscles, or the tendons that connect the muscles to the bones, becomes torn, either partially or completely, you have a rotator cuff injury. In the review, they found that in the general population most rotator cuff injuries actually occur in older people, typically as a result of disuse and poor range of motion. However, amongst athletes, we can see this phenomenon occur as a result of trauma.
More critical to that finding for athletic readers, is that the research indicated that only 10% of partial tears heal completely, and another 10% heal partially. 53% of tears will actually worsen and 28% will progress into full tears, which do not heal on their own. In some cases these tears can cause long term changes to the joint itself.
The first recommendation on dealing with a tear is immediate treatment, but the suggested treatment is something in need of further study. Unless the tear is full, mild therapy and rest is suggested over surgery for at least 6 weeks and as long as 3 months. A longer period of conservative treatment will actually increase the risk of the tear worsening, perhaps in part due to atrophy and worsening blood flow. If possible, the athlete should resume activity after that time and work up to previous strength levels over time.
If avoiding surgery is not possible, the good news is that the surgical success rate is good. The research tends to indicate what is called a “double row” repair of the muscle as being stronger and less likely to tear again.
1. Nicholas Clement, et. al., “Management of degenerative rotator cuff tears: a review and treatment strategy,” Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 2012, 4:48
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