Massage Therapy for Rotator Cuff pain!


As I’ve had a few clients recently presenting with rotator cuff issues, I thought I’d dedicate this weeks post to just that, and more specifically how massage therapy can help 🙂

So to start off I should probably explain what the rotator cuff actually is and how it works.
The shoulder is constituted of three bones, the humerus, the scapula, and the clavicle. The shoulder joint is a ball-and-socket joint in which the head of the humerus (ball) fits into a shallow socket of the clavicle.
The rotator cuff is made up of a group of muscles, joined together by tendons, that surround the shoulder joint and keep the head of the upper arm bone firmly in place.

There are four muscles that make up the rotator cuff, which are often referred to as S.I.T.S:
Supraspinatus, the smallest of the four muscles, runs from the supraspinatus fossa superior portion of the scapula (shoulder blade) to the greater tubercle of the humerus. Contraction of the supraspinatus muscle leads to abduction of the arm at the shoulder joint and is the main agonist muscle for this movement during the first 15 degrees of its arc, thereafter assisting the deltoid to produce abduction beyond this range up to 90 degrees.
Infraspinatus, is a thick triangular muscle which occupies the chief portion of the infraspinatus fossa, to the posterior aspect of the greater tuberosity of the humerus and the capsule of the shoulder joint. Infraspinatus is the main external rotator of the shoulder joint and assists in producing shoulder extension.
Teres Minor, is a narrow, elongated muscle which lies below infraspinatus, above teres major and triceps brachii, and deep to the deltoid muscle. It runs from the upper two-thirds of the lateral border of the scapula, with the upper fibres ending in a tendon which inserts into the inferior facet of the greater tubercle of the humerus, and the lower fibres inserting into the humerus directly below this.
Subscapularis, the largest and strongest of the four rotator cuff muscles, fills the subscapular fossa and originates beneath the scapula, inserting into the lesser tuberosity of the humerus and the front of the shoulder joint. Contraction of the subscapularis muscle causes medial rotation and depression of the humerus at the glenuhumeral joint. In certain positions it also helps produce extension and adduction of the shoulder joint.

There is also a fluid-filled sac (bursa) between the rotator cuff muscles and the bone called the acromion which allows free movement of the arm. The bursa prevents friction between tendon and solid bone, as friction could cause a tear or laceration of the tendon or cuff.

Rotator cuff injuries occur most often in people who repeatedly perform overhead motions in their jobs and/or sports. Examples include painters, carpenters and people who play cricket or tennis.
The risk of a rotator cuff injury also increases with age.

Rotator Cuff Tear
A rotator cuff tear is quite simply a tear of the shoulder’s rotator cuff tendons. They can occur in two ways:
– Trauma
– Repeated micro-trauma

Traumatic rotator cuff tears occur quickly or under heavy load, e.g. a fall or lifting a heavy weight.
However the most common cause of a rotator cuff tear is repeated micro-trauma, which can occur over several weeks, months or years.

Shoulder Tendonitis
This rotator cuff injury occurs when the tendons and muscles that help move the shoulder joint are inflamed or irritated.
The most common cause is generally repeated micro-trauma to the rotator cuff tendons rather than a specific one-off trauma.

Shoulder Impingement Syndrome
When the arm is frequently moved into the impingement zone overhead, the rotator cuff comes into contact with the outer end of the shoulder (acromion).
If this repeatedly occurs, the tendons become inflamed and swollen (tendonitis) and then subsequently trapped and pinched under the acromion (impingement).

The pain associated with a rotator cuff injury may:
– be described as a dull ache deep in the shoulder
– disturb sleep, particularly if you lie on the affected shoulder
– make it difficult to perform over-head actions
– be accompanied by arm weakness/loss of mobility

Rotator cuff afflictions may be the result of either a substantial injury to the shoulder or to progressive degeneration or wear and tear of the tendon tissue. Repetitive overhead activity, heavy lifting over a prolonged period of time, and the development of bone spurs in the bones around the shoulder may also irritate or damage the tendon.

Risk Factors
The following factors may increase your risk of developing a rotator cuff injury:
Age – As you get older, the risk of a rotator cuff injury increases. Rotator cuff tears are most common in people older than 40.
Certain sports – Athletes who regularly use repetitive arm motions, such as cricketers, basketballers and tennis players, have a greater risk of developing a rotator cuff injuries.
Certain jobs – Occupations such as carpentry or house painting require repetitive arm motions, often overhead, that can damage the rotator cuff over time.
Family history – There may be a genetic component involved with rotator cuff injuries as they appear to occur more commonly in certain families.

Without treatment, rotator cuff injuries may lead to permanent stiffness or weakness and may therefore result in progressive degeneration of the shoulder joint.
Although resting your shoulder is necessary for recovery, keeping your shoulder immobilised for a prolonged time can cause the connective tissue enclosing the joint to become thickened and tight (frozen shoulder).

How Massage Can Help
Maintaining shoulder muscle flexibility can help to significantly reduce pain and stiffness in the rotator cuff. By elongating the muscles, which is accomplished by gentle stretching, massage can assist in stimulating blood flow to any affected area, increasing oxygenation and speeding up the healing process.
This not only improves range of motion, but also keeps the muscles looser — making them less prone to strain and thus there is less risk of developing a rotator cuff injury.
Deep Tissue Massage does wonders in cases of soft tissue injury. Other than providing stimulation locally, massage therapy also encourages the production of anti-stress hormones (which we looked at last time), easing pain and discomfort.
During the initial stage of a rotator cuff injury, light and superficial massage should be done and deep tissue massage can be started after the pain and swelling have calmed down. Superficial massage helps in increasing blood flow, along with preventing scar tissue formation. This in turn promotes healing and re-establishes the normal function of the rotator cuff.

If you suspect a rotator cuff injury — don’t hesitate to seek treatment as soon as you can!


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