After a rotator cuff injury, a decline in physiological shoulder function is often observed. If left untreated, this can lead to an inability to perform customary recreational or sports activities or even activities of daily living. If the pain continues, guarding is common, where the shoulder joint is protected and movement is minimized. There may also be a psychological component if the injury continues to interfere with the ability to participate in regular fitness pursuits. The systematic process of healing starts with maintaining or increasing shoulder range of motion, followed by improving aerobic fitness and finally building strength and power.
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A rotator cuff injury may have been caused from a one-time incident or the result of chronic overuse or misuse. As the body attempts to heal the injured shoulder, the first stage of healing is inflammation. This can last for one day to one week. According to the American Red Cross, first aid for any musculoskeletal injury is “RICE”. This acronym stands for rest, immobilization, cold and elevation. The goal of treatment is to control inflammation so the swelling does not overly restrict joint mobility. Regular application of ice can reduce swelling, control pain and promote healing. There is much debate over taking anti-inflammatory medications, as they reduce the body’s natural healing tendencies and may mask the pain, causing a premature return to activity.
As the body continues to heal itself, swelling may continue and scar tissue develops. Over the next few weeks, it is important to enhance circulation and blood flow to the injured area. Stretching the shoulder joint in a variety of angles frees the tissue and allows for increased blood flow. Stretching should not be painful but should be performed to the point of “slight discomfort“. Performing regular cardiovascular activities, with limited shoulder involvement, also improves overall circulation and promotes healing. Massage therapy may also be beneficial.
As pain subsides and joint range of motion is restored, it is appropriate to begin strengthening the shoulder joint. Depending on the severity of the injury, this process can take one to 12 months. Initial strengthening may include some light strength training using small dumbbells or exercise tubes; these activities are intended to restore balance and stability to the shoulder joint. For example, exercises that incorporate shoulder internal and external rotation will improve shoulder stability. All movements should be kept below shoulder level.
Making a Stronger, More Stable Shoulder
To restore strength and eventually power to the shoulder, it is important to have a strong core. Shoulder stability relies heavily on core strength, so a series of spinal stabilization and abdominal exercises should be incorporated into any shoulder routine, especially as overhead activities are added. For those wishing to return to sports like tennis, volleyball or swimming, it is also important to integrate overhead strengthening exercises. According to the American Council on Exercise, it is also important to incorporate strength exercises that involve multiple planes of movement. For example, start with the arm in front of the body, hand close to and facing the thigh. Lift the arm out to the side while rotating the hand so the palm faces the front. Keep the hand no higher than shoulder height. It is appropriate to continue using light weights or exercise bands, performing multiple sets of 10 to 20 repetitions. As the shoulder becomes stronger, it is appropriate to increase the weight and add a variety of exercises as tolerated.
When to See a Doctor
If after the initial injury, there is tingling, numbness or loss of sensation in the shoulder, arm or hand, it is wise to contact a doctor. Also consult a doctor if the pain does not improve within a few days. If during the rehabilitation process, progress is halted or re-injury occurs, it may also warrant a trip to the doctor.