Shoulder Pain and the Rotator Cuff

As a physiotherapist working with Powerhouse Rugby Union FC, one of the most commonly injured areas of the body I see is the shoulder. However, research and clinical experience tells us that it is not just athletes that suffer from shoulder pain, with up to two thirds of the general population experiencing shoulder pain in their lifetime (Luime et al 2004).

Exercise 1: External Rotation - Tension band by rotating arm outward from midline, keeping elbow tucked in.

Exercise 1: External Rotation – Tension band by rotating arm outward from midline, keeping elbow tucked in.

On the rugby field, a common mechanism of injury will be when the arm is forced out to the side and overhead, such as when reaching out for a tackle. This causes the humeral head to shift forward in the socket and either sublux (go out and back in) or dislocate. This results in stretching of the ligaments of the shoulder joint and usually leads to anterior instability. Initial management of any acute injury should always consist of RICER (Rest, Ice, Compression, Elevation, Referral – in this case for X-ray or MRI). Once the initial pain has settled and range of movement has been restored, the rehabilitation process can begin.

When rehabilitating players from these traumatic injuries, there are many principles that can be applied to other types of shoulder pain, such as that from heavy lifting, overhead activities or poor posture at work.

The shoulder joint is often likened to a golf-ball on a tee, with a large range of movement, but relatively little bony stability. This makes it the most commonly dislocated joint in the body, accounting for 45% of all dislocations (Smith, 2013). The ‘rotator cuff’ are a group of four muscles that surround the shoulder to provide dynamic stability, without compromising range of motion. Whether you are an athlete or office worker, strengthening this group of muscles can often provide stability, reduce pain and improve performance. Below are examples of two exercises (Exercise 1 and Exercise 2) that can be used to strengthen the rotator cuff muscles using a ‘thera-band’.

Exercise 2: Sword-Pulls - From opposite waist, tension band by pulling arm and shoulder blade upward and back like drawing a sword. "Hoorah!"

Exercise 2: Sword-Pulls – From opposite waist, tension band by pulling arm and shoulder blade upward and back like drawing a sword. “Hoorah!”

The other important goal of rehabilitation is to increase joint position sense and control (proprioception). This allows the shoulder to adjust appropriately to different movements and positions, ie. throwing, lifting, etc. A great exercise for this is shown below (Exercise 3). Starting against a wall, this exercise can be progressed by stepping feet further back, or by performing a push-up (one hand or two) on the ball.

Exercise 3: Fit-ball circles - Leaning on Fit-ball, make small circles whilst maintaining a steady shoulder-blade.

Exercise 3: Fit-ball circles – Leaning on Fit-ball, make small circles whilst maintaining a steady shoulder-blade.

The final stage of the rehabilitation program is to then make it specific to the client’s needs, whether this be return to sport, work or leisure. This usually involves taking the strength and control worked on so far and applying it to relevant positions and environments. This is arguably one of the most important phases of rehabilitation, and one that is often neglected as pain subsides. The goal of this final stage of rehabilitation is to prevent re-injury and return the client to their full potential.

If you, or someone you know, has shoulder pain, feel free to contact on of our physiotherapists for a consultation to learn how we can help.

Brodie Doyle Jones
Physiotherapist
South Melbourne Physio

REFERENCES

Smith G, Chesser T, Packham I and Crowther M. (2013) First time traumatic anterior shoulder dislocation: A review of current management. Injury, Int. J. Care Injured 44: 406–408
Luime J, Koes B, Hendriksen I, Burdorf A, Verhagen A, Miedema H and Verhaar J. (2004) Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol 33(2):73-81.
Helgeson K and Stoneman P. (2014) Shoulder injuries in rugby players: Mechanisms, examination, and rehabilitation. Physical Therapy in Sport 15: 218-227
Wilk, K and Macrina L. (2013) Nonoperative and Postoperative Rehabilitation for Glenohumeral Instability. Clin Sports Med 32: 865–914

DISCLAIMER: The exercises in this article are for reference purposes only, and should not replace a thorough assessment and tailored program from your physiotherapist.