Are you feeling pain in your shoulder when reaching overhead? Or taking out light objects like a fruit plate from the fridge? Or reaching behind you into the back seat of your car? Do you experience achiness down the side of your upper arm? Does any of this feel like it’s limiting your daily activities? If so, then you might be suffering from a rotator cuff injury.
Hearing the word rotator cuff injury might sound frightening. However, don't consider yourself alone, as it affects millions of individuals each year, and plenty of treatment options exist. According to studies, 30% of people under age 70 and 70% over age 80 have suffered from torn rotator cuffs.[1]
The crucial question is, what can you do about the pain and weakness if you have a rotator cuff injury? For instance, is surgery necessary? Or can non-surgical treatments like physical therapy help you recover?
Before we get into the self care treatment, let's explore the full range of options together so you can make an informed decision.
Disclaimer: This article is for information only. It’s always a good idea to consult with a medical professional for specific treatments for injury and pain.
Can a Rotator Cuff Heal on its own?
Rotator cuff injuries can NOT heal on their own. Either surgery or nonsurgical treatments are required for them to go back to normal. However, surgery isn't always the only solution. Many patients can improve function and reduce discomfort with nonsurgical therapy that strengthens their shoulder muscles.
It depends on the intensity of the tear. Sometimes, the injury is so severe that surgery is the best solution, but sometimes, people have rotator cuff injuries without ever realizing it, so in those cases, surgery isn't required because the injury is very minor.
Nonsurgical therapies are usually a great option because they improve the condition of around 8 out of every 10 people with partial tears. However, it may take time (up to a year) for the situation to improve.
Before going into more detail about surgical and nonsurgical approaches, let’s first understand what the rotator cuff is, its role in arm movements, how it gets injured, and, lastly, how your doctor will help you if you have a rotator cuff injury.
Rotator Cuff Anatomy
Before digging more into rotator cuff injuries and how nonsurgical treatments can help let's discuss its anatomy.
The ball and socket joint in the shoulder is made up of three bones:
- The humerus (upper arm bone)
- The scapula (shoulder blade)
- The clavicle (collarbone)
The upper arm bone's ball, or head, is inserted into a shallow socket on the shoulder blade. Think of it as a golf ball on a tee.
To keep this shoulder joint in its place, the rotator cuff comes into the picture. It comprises four muscles
- Subscapularis
- Supraspinatus
- Infraspinatus
- Teres minor
These muscles keep your arm in the shoulder socket and have tendons (thread-like structures) that cover the head of the humerus. The rotator cuff connects the humerus to the shoulder blade, allowing you to lift and rotate your arm.
Rotator Cuff Muscles Function
The rotator cuff muscles have multiple functions during various arm motions: they engage to keep the head of the humerus from slipping, enabling a complete range of motion and stability.
The rotator cuff muscles contribute to shoulder joint mobility by allowing for abduction, medial (internal) rotation, and lateral (external) rotation. Let's discuss their functions one by one:
- Subscapularis: this muscle helps the arm in medial (internal) rotation.
- Supraspinatus: this muscle helps with arm abduction.
- Infraspinatus: this muscle helps in the shoulder's lateral (external) rotation.
- Teres Minor: this muscle aids in shoulder lateral (external) rotation
Something to keep in mind is that during a physical examination, the rotator cuff can NOT be selectively tested from other shoulder muscles. Different shoulder movements (not individual muscles) can be assessed for pain and discomfort.
Signs of a Rotator Cuff Tear
As we already mentioned, rotator cuff injuries are widespread. Patients with rotator cuff injuries mostly visit physical therapy clinics to help reduce pain (like Jamie, who we've been treating for the past 6 months at the time this article was published), but when a patient complains of rotator cuff injury, here's what we typically look for:
- Difficulty, discomfort, and weakness in raising, lowering, or rotating the arm.
- Moving your arm in certain postures, you may experience popping, clicking, or crackling noises or sensations.
- Shoulder ache that intensifies at night or while resting the arm.
What Does a Torn Rotator Cuff Feel Like?
It depends. You may have dull discomfort or deep and/or sharp pain in your shoulder. Sudden tears caused by accidents or trauma may result in severe shoulder discomfort and arm weakness.
Degenerative tears may cause minor discomfort that can be relieved with over-the-counter pain medications.
However, over time, discomfort may worsen, and pain medications may become increasingly ineffective.
Not everyone with rotator cuff injuries will experience discomfort, but the majority experience some degree of arm and shoulder weakness.
Can you See a Torn Rotator Cuff on an X-ray?
Patients frequently ask whether an X-ray can detect rotator cuff injuries. The answer needs to be clarified. An X-ray produces a two-dimensional view of the shoulder's skeletal architecture, including the humerus ball (arm bone head), the glenoid socket (shoulder blade part), and the acromion (collarbone part).
While some indications, such as a spur on the acromion, humeral structural changes, or significant arthritic changes, might indicate a probable rotator cuff rupture, X-rays only provide limited information. Most rotator cuff injuries need MRI imaging for a reliable diagnosis.
Average Cost of Shoulder Surgery Without Insurance
If you are planning surgery, you will definitely ask this question. The answer is that the typical cost of shoulder surgery is between $6,000 and $22,000. However, it can sometimes cost up to $50,000, although this is exceptional[2].
Recovery from Rotator Cuff Surgery
Recovery from rotator cuff surgery can take up to 6 months, and physical therapy is required to help regain shoulder strength and range of motion.
Shoulder Pain after Surgery
Most people who have undergone rotator cuff surgery report that it takes around nine months for the shoulder to feel entirely normal.[3]
This finding is backed by research stating that shoulder muscular strength does not fully recover until nine months after rotator cuff surgery in individuals who have undergone the procedure.
Rotator Cuff Tear Recovery Time
The repaired rotator cuff tendons take around six weeks to mend initially to the bone, three months to develop a pretty firm attachment to the bone, and six to nine months before the tendon is healed to the bone.
What to watch out for after Shoulder Surgery
- You should avoid reaching, lifting, pushing, or tugging with your shoulder for the first six weeks after surgery.
- You should not use the recovering arm to reach behind your back.
- You can take your arm out of the sling several times a day to move your fingers and bend and straighten your elbow.
How to Heal a Rotator Cuff Naturally (Without Surgery)
Now that we have gone over the time-consuming and costly surgical approach, let's discuss the nonsurgical approach. The most important thing is that surgery is only sometimes required for your rotator cuff injury. Nonsurgical treatments can also significantly reduce pain and increase mobility. This non-surgical approach can vary based on your injury, however, it usually comprises any of the following:
- Resting the shoulder can help reduce symptoms. You may need to change your activities and discontinue some sports for some time.
- Nonsteroidal anti-inflammatory medications (NSAIDs) are used to relieve pain and swelling at the site of the injury.
- Steroid injections to alleviate pain and edema. Injections include corticosteroids for inflammation and ortho-biologic injections such as PRP for pain relief and healing.
- Physical therapy: this can help you learn activities that will strengthen your muscles, improve mobility, reduce pain, and help you get back to normal functionality.
However, you should consult a trusted medical professional before pursuing any treatment options
1. Rotator Cuff Non-Surgical Protocol
For your rotator cuff-related pain to improve in a nonsurgical way, it takes around 12 or more weeks to fully recover. Following is the protocol to follow:
- Protect and manage pain for the first four weeks.
- Avoid lifting heavy objects and overhead activities.
- Rest the arm for 3-6 days following injury.
- Light exercises in passive range of motion, icing, and some nonsteroidal anti-inflammatory painkillers.
- In the next 4-8 weeks: manage pain, improve shoulder mobility, and add strengthening exercises.
- In the third phase, add functional activities and some advanced strengthening exercises.
- In phase four, try to actively perform full range of motion activities. Perform as many strengthening and stretching exercises as possible to gain complete strength and endurance.
2. Nutritional Supplements for Rotator Cuff Recovery
Tendons are mainly composed of collagen, a protein essential for tissue strength. While there's no scientific evidence to support taking certain supplements will improve rotator cuff recovery, you can eat a balanced diet full of nutrients to improve tendon health:
- Vitamin C: Found in tomatoes, citrus fruits, and broccoli, vitamin C supports collagen synthesis and reduces oxidative stress. It's also available in supplement form.
- Protein: Essential for tendon growth, include sources like beans, lean meats, poultry, fish, or whey protein supplements to aid repair.
- Minerals: magnesium, zinc, and copper found in nuts, seeds, legumes, and shellfish promote collagen synthesis. Consider multivitamins to meet daily requirements.
- Omega-3 Fatty Acids and Turmeric: Found in fish oil and turmeric, these supplements may reduce inflammation. Foods like red cabbage, red grapes, cherries, apples, and blueberries containing cyanidin may also help in inflammation reduction.
3. Rotator Cuff Exercises without Surgery
Endorphins are the body's natural hormones that relieve pain. They are released when you exercise and stretch, which also helps relieve tension in your muscles.
Exercises to Strengthen the Rotator Cuff
Activities you can start doing on your own are stretching, strengthening, and functional exercises to help recover your range of motion and reduce pain. These include:
Stretching exercises:
- Shoulder External Rotation Stretch with Wall Support
- Position one hand on the wall with your elbow close to your body. Twist your torso away from this arm, stepping away if necessary to enhance the shoulder movement. Rotate back and forth, gradually and safely deepening the stretch with each repetition.
- This should make you feel a stretch in the front of your shoulder.
- Be careful not to straighten your elbow while rotating away from your arm.
- Shoulder Butterfly Stretch
- Start by sitting down with your hands clasped behind your head. Draw your elbows toward your knees, rounding your back and shoulders forward. Once you have rounded forward as far as possible, gradually reverse the motion by opening up your chest and shoulders while squeezing your shoulder blades together. Maintain this open stretch position for 15-30 seconds.
- You should experience a stretch in your chest and shoulder muscles, as well as in your mid-back.
- Ensure that the tops of your shoulders and arms remain relaxed as you move back and forth.
- Seated Thoracic Mobilization using a Towel
- Use a rolled-up towel, shirt, or similar fabric to create a 'fulcrum' for mobilizing your mid-back, akin to a foam roller. Place the object under your mid-back and gently arch the upper half of your back over it while exhaling. Shift the object to various spots on your mid-back to target multiple segments.
- You should experience moderate pressure in your mid-back. Feeling a "pop" is normal and nothing to worry about.
- Avoid placing the object on your lower back; keep it on your upper back. Engage your core and avoid excessive arching in your lower back.
- Quadruped Pec Stretch with a Swiss Ball
- Kneel on the ground beside a Swiss ball and get into a quadruped position with your knees under your hips and your hands under your shoulders. Place one arm diagonally on top of the Swiss ball. Roll forward slightly to feel a comfortable stretch in the front of your shoulder and pectoral muscles. Hold this position for 15-30 seconds.
- Avoid shrugging your shoulders. Find the optimal position to stretch the front of your shoulder and maintain it.
- Seated Thoracic Windmill
- While seated, lean your chest towards your knees and reach down along the inside of one knee. As you reach down, rotate the opposite arm upward toward the ceiling. Your chest should face the side you opened to for the best stretch. Alternate between reaching down and twisting up with each arm.
- You should feel a stretch in your mid-back, chest, and shoulder.
- Avoid leaning back as you rotate up. Stay upright once your arm reaches the optimal stretch position.
Strengthening exercises:
- Shoulder blade retraction (squeezing the shoulder blade)
- Start by lying face down and forming a Y shape with your arms. It's crucial to keep your elbows bent at a 90-degree angle and positioned above your shoulders. Rotate your hands so your thumbs point upward, bringing your hands close together above your head to form a diamond shape. Squeeze your shoulder blade muscles to lift your elbows off the ground, then lower them back down slowly and controlled.
- You should feel the muscles in your shoulder blades engaging when you squeeze them together.
- Keep your elbows above your shoulders and bent at 90 degrees at all times. Focus on engaging your shoulder blade muscles to raise your elbows.
- Prone T with Elbows Bent
- Face down, position your arms so your elbows are directly out from your shoulders, bent at 90 degrees. Rotate your hands so your thumbs point upward. Squeeze your shoulder blade muscles to lift your elbows off the ground, then lower them back down slowly and controlled.
- You should feel the muscles in your shoulder blades activate as you squeeze them together.
- Always keep your elbows straight out from your shoulders and bent at 90 degrees. To lift your elbows, engage your shoulder blade muscles.
- Plank Push-Up Plus
- Start in a plank position with your elbows on the ground directly under your shoulders and your legs extended from your hips, with your toes pressing into the ground. Allow your shoulder blade muscles to relax, then push into the floor, raising your body back up primarily using your shoulder blade muscles.
- You should feel your shoulder muscles engaging.
- Maintain a straight line from your shoulders to your hips to your ankles.
- Side Lying External Rotation with a Dumbbell
- Lay on your side with your knees bent. Bend the elbow of your top arm to form a 90-degree angle or an "L" shape. Place your head on your other arm or a pillow for support. Rotate your arm up and out while maintaining your elbow's "L" shape. Your thumb should point up as your arm lifts off your stomach. Imagine a rod running from your shoulder to your elbow that must stay still. Keep your elbow at your side as you rotate your arm up and back down to the starting position.
- You should feel the muscles in the back of your shoulder and shoulder blade working.
- Avoid letting your elbow lift or move back as you rotate the dumbbell up. Stay on your side without leaning back.
- Prone Shoulder Extension on a Bench
- Lay on your stomach on a bench or table, allowing one arm to hang down at your side. Keep your elbow straight and engage your shoulder blade muscles to lift your arm up and back, keeping it close to your side with your palm facing inward. Once your arm is lifted to your side, lower it back to the starting position and repeat for the prescribed number of repetitions.
- You should feel your shoulder muscles working.
- Keep your upper trapezius relaxed and focus solely on using your shoulder blade muscles.
4. Ways to Relieve Rotator Cuff Pain
The biggest hurdle for any patient with rotator cuff injury is managing pain. The RICE technique is very useful in relieving pain however, certain other things need to be considered:
Temporarily avoid doing any movements that worsen your pain, and try to avoid movements that feel too uncomfortable. Maintain a regular sleep schedule to help with pain relief and recovery.
How To Relieve Rotator Cuff Pain at Night
If your rotator cuff discomfort intensifies at night or disrupts your sleep, follow these steps:
- Change your sleeping position to relieve strain on your aching shoulder.
- Use a medium-firm mattress that fits your body curves while providing enough support, as well as an ergonomic pillow.
- Do not sleep on the affected side or with your arms overhead.
The idea is to sleep in a posture that will not twist or squeeze the painful rotator cuff.
Best Sleeping Positions for Shoulder Pain
According to research on sleep disturbance, those with rotator cuff injuries had more difficulty sleeping than those with other shoulder issues.[4]
Here are some tips for sleeping with rotator cuff discomfort.
The ideal sleeping position for rotator cuff discomfort is on your back with your arms at your sides. This helps prevent straining your shoulder during sleep. If you are a side sleeper, then sleep with the injured side facing up. Create a "pillow wall" in front of you and place your arm on it. Ensure that the pillow wall is as tall as your torso. These cushion methods make your injured shoulder feel better by positioning it in a more natural posture and reducing tension on the joint.
Note: we recommend not sleeping on your stomach (at least temporarily). This could worsen your arm and shoulder pain.
CONCLUSION
We know how painful and frustrating a shoulder injury can be. However, this article has provided you with enough base to decide whether you want a surgical or a nonsurgical approach for your rotator cuff injury. Even so, if you are unsure whether your pain is related to a rotator cuff injury or something else, you can always book your appointment with Plyogenix’s Doctors of Physical Therapy. They will perform a Detailed Evaluation and help you understand why you’re hurting. Rotator cuff injuries can be challenging to recover from, but with Plyogenix, it’s easier than you think. Book your appointment today and start your journey towards healing.
Happy healing!
Reference:
https://journals.sagepub.com/doi/10.1177/2151458515583895
https://coloradosportsdoctor.com/how-much-does-shoulder-surgery-cost/
https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/failed-rotator-cuff-repairs
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6723368/
