Rotator cuff related shoulder pain can be frustrating. The good news is, we can do something about it and so can you! If you haven’t already, read our previous blog on rotator cuff injuries here, which covers the anatomy of the rotator cuff, as well as common injuries such as tears, tendinopathy, bursitis and “impingement”. Like most injuries, the treatment for rotator cuff related shoulder pain depends on each individual. One person might have trouble lifting their arm above their head whereas somebody else might have trouble dressing themselves. However the treatment, broadly speaking, will be quite similar while focusing on your specific deficits or activities you want to perform but are having trouble with.
Education and Advice
Avoid aggravating movements
This will be different for each person but is a very important part of the recovery process. Avoiding aggravating activities will allow the rotator cuff to heal faster and prevent flare ups. This may include things like reducing the time spent laying on the affected shoulder, reducing repetitive overhead lifting at work or avoiding hand behind back movements. It can be tricky to navigate this step, but put simply, if a particular movement hurts, try to avoid it.
Medications
The use of anti-inflammatories and painkillers may be helpful in the acute phase to reduce pain and inflammation. This can be quite powerful in allowing you to get more movement and tolerate more exercise in the early stages. It is best to talk to your pharmacist or GP about medicine and what can help you. Keep in mind, this should be a short term help and reliance on medication can be harmful in the long term.
Manual Therapy
Manual therapy such as massage, mobilisations and passive stretching can be effective in achieving pain reduction early on in the rehabilitation process. Research shows that when manual therapy is combined with exercise therapy, better results are achieved than just exercise alone. But manual therapy alone is not effective in treating rotator cuff injuries.
Exercise Therapy
Exercise therapy should be the first line of treatment for rotator cuff related shoulder pain to improve range of motion, pain and function in both the short and long term. The best exercise program for one person will be completely different to the best program for another. This is where your physiotherapist comes in…they will tailor your program to your specific needs and deficits. The level of difficulty of exercises, aim and intensity will all depend on how painful your shoulder is, what contributing factors may be present and what your goals are. Initially, your program might focus on general strengthening or range of motion exercises using light weights or resistance bands and below shoulder height. This will then progress to heavier exercises above shoulder height and then overhead as you get stronger and pain reduces. The ultimate aim of this program is to improve the load tolerance and capacity of your rotator cuff muscles, which will reduce pain and improve function to get you back to doing what you love. Research suggests at least 12 weeks of structured rehabilitation because good improvements in strength and capacity take around 8-12 weeks. Rome wasn’t built in a day!
Ultrasound
There is poor evidence for the use of ultrasound when treating rotator cuff injuries. Time would be better spent focusing on the treatments above!
Injections
Corticosteroid injections can offer short term pain relief and improvement in function. BUT, this effect is lost and the injury can get worse in the long term. Some studies have even shown that these injections increase the risk of rotator cuff tendon tears. So why even consider it? It should be used as a second line treatment for those in severe pain and with a significant loss of function or those that don’t respond well to exercise therapy. If after 12 weeks of rehab, there is no change, a steroid injection should be considered. This can help by providing a window of time where pain is reduced, and can therefore allow a period of strengthening which may otherwise be limited due to excessive pain levels.
Surgery
Over the last 10 years, surgeries to repair rotator cuff tears combined with removal of bursa and/or shaving of bone (subacromial decompression) have been quite common. Surgery should not be considered as a first line treatment (for the most part), it should be the last resort. To read our blog about surgery for rotator cuff injuries, click here.
Key Messages
- Education and advice combined with a structured 12 week exercise program and manual therapy is the best practice for the treatment of rotator cuff injuries
- Each person and injury is different, a tailored treatment from a physiotherapist will give you the best results
If you’re struggling with rotator cuff related shoulder pain, give us a call today on (03) 9391-2600!
