By Alan Williams, PT, OTR/L, ATC, CSCS

Not to make myself sound old, but I’ve been a physical therapist for quite a while, and I’ve heard a lot of injury stories. One of my favorites comes from a lovely woman in her 80s; I’ll call her Gracie. Gracie came to Idaho Physical Therapy for rehabilitation following surgery to repair her torn rotator cuff. Rotator cuff injuries are perhaps the most common of shoulder ailments, especially in those over 40, so I was not particularly surprised by Gracie’s situation – until she told me how she was injured. “My husband and I were playing Wii bowling, and I got so mad that he was beating me, I swung the controller too hard and tore my rotator cuff!” Many people come into my clinic complaining of pain in their “rotary cup,” and as Gracie discovered, it’s possible to injure your rotator cuff even when engaging in the most innocent of activities.

The rotator cuff is comprised of four muscle tendons in the shoulder – the teres minor, the infraspinatus, the supraspinatus, and the subscapularis. These tendons control movement as well as stabilize the humerus (upper arm bone) inside the joint. Thus, the rotator cuff is vulnerable to the same injuries and conditions as other tendons. Pulls, strains, inflammation (tendonitis), and tears are all commonplace. The pain is usually located in the front and side of the shoulder, increases with movement, and may be moderate to intense depending on the severity of the injury.

Though they have many names, there are essentially two types of rotator cuff injuries – overuse and trauma. Overuse is exactly as it sounds; the tendons become weak and fatigued from extreme overuse. This is most often due to repetitive motion (especially if bad form is used while performing the motion), but poor posture can also be to blame. At risk are those over 40 (due to normal degenerative changes in the tendons) and those who perform frequent overhead actions, such as painters, carpenters, and participants in baseball, volleyball, swimming, etc. Overuse injuries to the rotator cuff can be in the form of sprains, strains, tendonitis, bursitis, or tears.

Trauma injuries are usually due to an accident (such as a fall or car accident) or performing too intense an action for the tendons’ abilities (such as pulling too heavy a box off a high shelf, or in Gracie’s case, swinging a Wii controller too hard). This results in pulls, sprains, strains, and tears. Unfortunately, we are all vulnerable to these types of accidents and lapses in judgment, but those with weakness, poor flexibility, and poor overall fitness may be especially prone to rotator cuff injuries.

The best way to protect yourself from injuring your rotator cuff is to increase its strength and flexibility. Combine gentle stretching with weight lifting exercises; for example, lie on your side with your top arm at a 90 degree angle to your body, and using a light weight (since the rotator cuff is not naturally strong in most people and must be strengthened gradually to avoid injury), lift the weight 10-12 times, then switch. Your physical therapist can give you even more ways to strengthen and protect your rotator cuff.

If you should injure your rotator cuff, treat the area with rest, ice, and gentle stretching (but only if doing so does not further aggravate the tendons). However, if the pain is intense and sudden, gets worse, or simply does not improve within a couple of days, see your physical therapist. You may have a more serious injury.

These days Gracie is back playing Wii with her husband, and she’s using a more controlled bowling approach. With proper treatment, a rotator cuff injury won’t keep you down for long, but prevention really is the best medicine. Keeping your “rotary cup” strong and flexible will help you avoid missing out on your favorite activities.

Don’t let a shoulder injury keep you down. Call 463-0022 today for your FREE Shoulder Pain Assessment!