4 Step Guide for Improving Rotator Cuff Pain
Shoulder pain is the third most common musculoskeletal complain reported by general practitioners in primary care settings. Rotator cuff syndrome can effect a person’s quality of life. Due to its complexity it is difficult to diagnose and often times even more difficult to treat. As a result many people resort to advanced imaging and even surgeries that do not lead to favourable outcomes. There is a shift to a belief that conservative therapies provided by a health care professional such as a chiropractor and physiotherapist should be first line of treatment.
The rotator cuff is comprised of four muscles deep in the shoulder joint and is serves as a dynamic stabilizer for the shoulder. Many conditions such as impingement syndromes, bursitis, rotator cuff tendinitis, and tears arise from damage to the rotator cuff. This can be due to acute trauma such as a fall or develop gradually. This is what makes diagnosing and treatment very confusing.
When it comes to treatment as I mentioned earlier, conservative therapies should be the first applied. This is good news for both patients and health care practitioners because many of these therapies can be performed by the patients with the guidance of a health care practitioner and are affordable. Additionally, it is much less of a financial burden for the health care system as money and time is not wasted performing advanced imaging and surgeries.
As much as it is a complicated subject, a good practitioner can create a progressive plan for the patient to follow. I will attempt to summarize and simplify the best options for patients with shoulder pain below. In general, when someone experiences a rotator cuff injury we firstly want to control the pain and inflammation then progress to a return to function and work.
Evidence Based Treatment for Rotator Cuff Syndrome
1. Heat/Cold: it is believed that to control pain and inflammation that within 48 hours after an injury ice is recommended. Once outside that 48 hours heat and/or cold can be applied intermittently for short periods for pain relief.
2. Exercises: Prescribed exercise, with or without analgesic medication, is consistently recommended as the preferred initial treatment for rotator cuff syndrome. There are a couple points that I want to stress with exercise prescription. One point is that a treatment program should always be progressing to a more active form of treatment. This is especially true when dealing with patients that need to return to work or performance. Pain control modalities such as TENS, ultrasound, and acupuncture can be used in conjunction but never alone in a treatment session. In order to fully get an individual back to pain free function exercise is required!
Another point I want to make is that exercise needs to be progressed and built upon. It is not enough for a patient to do the same exercises daily. In the videos below I will demonstrate how I progress my patients through a graduated progressive rehabilitation program starting with simple shoulder isometrics contractions against a wall. Once done pain free weights should be incorporated. Stay tuned for the next blog post on what a full shoulder program looks like.
3. Manual therapy: includes hands on techniques such as mobilization, manipulation and soft tissue techniques used by a suitably qualified health care practitioner such as a chiropractor and physiotherapist. Research has demonstrated that these mobilization techniques have improved function and decreased pain in patients with shoulder pain. Manipulation, mobilization, and soft tissue therapies have improved success when combined with exercise.
4. Acupuncture has also been shown to be effective in treating rotator cuff syndrome. Much like other pain control modalities though acupuncture as a standalone treatment has not necessarily been shown to be effective. However, combining acupuncture with the above treatments has demonstrated to improve pain and function.
These are the most researched therapies for rotator cuff injuries. Individuals should
always consult a health care professional to assist them with their exercise program and to discuss their options. At the end of the day a combination of the above treatments have been most successful. It’s worth mentioning that depending on the chronicity a shoulder injury may take up to 12 weeks to fully recover. Remember, do not get frustrated and choose a health care professional that is going to guide you through this process and get you back to work, sport, or your everyday life pain free.
Clinical Practice Guidelines for the Management of Rotator Cuff Syndrome in the Workplace. University of New South Wales. 2013