Physiotherapy for Rotator Cuff Injuries
The spectrum of injury for rotator cuff pathology ranges from tendinosis (i.e. intrinsic wear and degeneration) to partial tears, and ultimately to a complete tear. Patients with tendinosis and partial tears may experience shoulder pain while patients with complete tearing of the rotator cuff may also endorse shoulder weakness. Night pain is also a common symptom in patients with rotator cuff pathology.
It is important to note that the incidence of rotator cuff pathology increases with age yet despite this, the majority of people are likely asymptomatic. It is when patients experience symptoms that intervention is required. Physiotherapy is the mainstay of initial treatment and can be accompanied by additional interventions such as anti-inflammatory medications, subacromial corticosteroid injections and/or surgical intervention.
Principles of Physiotherapy for Rotator Cuff Injury
After a confirmed diagnosis of rotator cuff pathology and the exclusion of diagnoses related to the neck and remainder of the arm, physiotherapists and patients will work together to focus on four major goals. These include:
- Decreasing Inflammation by avoiding positions and activities that cause shoulder pain.
- Restoring proprioception and muscular control by focusing on intact rotator cuff muscles, as well as, the smaller muscles that stabilize the shoulder blade
- Improving active and passive range of motion
- Achieving incremental improvements in rotator cuff strength, thereby allowing for enhanced participation in advanced daily activities and leisure activities.
According to the MOON shoulder group (an multi-centre evidence base research group), the majority of patients who have rotator cuff pathology can be treated without surgery. With the use of an appropriate structured rehabilitation program, physiotherapists and patients can work together to achieve the aforementioned goals and improve quality of life.