Active Seniors

Getting to Know Your Rotator Cuff

Injuries to the rotator cuff muscles are extremely common. In fact approximately 30% of adults over 60 have a tear and 62% of adults over 80 have tears in their rotator cuff muscles. Let’s explore more about the anatomy and function of the rotator cuff to better understand how we can keep them healthy.

What are the rotator cuff muscles?

The rotator cuff consists of 4 muscles that connect the shoulder blade to the upper arm. As the name implies, they all have a role in rotation however more than this they help to keep the shoulder joint stable as it explores its large range of movement possibilities. Three of the four muscles (supraspinatus, infraspinatus and teres minor) are located in the upper back area, attaching to the back of the shoulder blade. These 3 muscles rotate the arm outward. The final rotator cuff muscle, called the subscapularis muscle, is located on the front of the shoulder blade and rotates the arm inwards with the chest and latissimus dorsi muscles.

Muscles and their Movements 

Movements involving bringing the arm in front of the body, particularly when holding a weight, load the 3 muscles in the back of the shoulder blade more specifically. In contrast, movements where the shoulder extends behind the body produce more load on the subscapularis muscle. Movements where the arm is raised to the side place equal load through all 4 rotator cuff muscles.

No one’s rotator cuff is perfect!

Shoulder pain that develops in the absence of trauma has a large probability (75+%) of involving the rotator cuff. The most common cause of rotator cuff tears is degeneration. Over time, repetitive stress and inadequate recovery time can result in small tears and thickening of the rotator cuff. The most commonly affected rotator cuff muscle is the supraspinatus muscle.

It is important to understand that throughout life, the rotator cuff muscles are likely to sustain some age-related changes that don’t necessarily result in pain. Approximately 2 in every 3 people over the age of 70 have abnormal rotator cuff imaging findings. It is therefore more accurate to think about rotator cuff related pain being an issue of sensitivity rather than of damage as pain is a poor guide to what is wrong and the extent of the damage.

The power of exercise 

Current research indicates that exercise is vital in the management of rotator cuff injuries. Careful consideration needs to be given to ensure that the appropriate load is given to promote recovery, without creating further stress. Exercises should target all areas of the shoulder, and should also include core and hip strengthening exercises paying particular attention to their link to shoulder function. It is also important to identify and rectify any imbalances in the body that may have led to the problem itself. For example, a golfer with stiff hips may overload the shoulders by trying to move more through the shoulders and upper back to compensate and maintain the distance of their drive.

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