By The Viking
Rotator cuff injuries are very common among athletes and non-athletes. The rotator cuff is a series of four muscles designed to hold the head of the humerus securely in the socket joint of the shoulder blade. Those four muscles are commonly referred to by the acronym SITS (Supraspinatus, Infraspfinatus, Teres Minor, Subscapularis). Most people only consider the rotator cuff after they’ve injured it. The truth is, the rotator cuff should be trained regularly as you would any other muscle group, with strength exercises and recovery. What better way to illustrate the importance of proper rotator cuff strengthening and rehabilitation than with a personal example.
Every year on Christmas Eve, I play a game of football with friends, some of whom I’ve known since grade school. This annual game has been going on for 20 years and has taken place on the same day, at the same time, on the same field in the city ofMissoula,Montanawhere I grew up. We play tackle football, usually in the snow. Sometimes, though, the snow doesn’t fall. Snow or no snow, we play anyway and, as you can imagine, the less snow on the ground, the more likely injuries are to occur. Every year, it seems, one person in particular gets hurt. The injuries are relatively minor, but occasionally we need to take a trip to the emergency room. Personally, I’ve been fortunate enough to avoid injury all the years I’ve played, until Christmas of 2006, a year of no snow. Indulge me for a moment as I go back in time a few months.
We had been playing for close to two hours and had just come back to the field from a short half-time break. My team had possession and our quarterback had called a pass play. My job was to make a quick 10 yard run, stop and, if I was open, look for the pass. I was able to gain a few yards on my defender and sure enough, the ball hit me right in the numbers, so to speak. Unfortunately for me, I didn’t have quite enough distance from my defender and as soon as I caught the pass and turned to run up field, I was hit from behind. Not wanting to fumble the ball, I kept it locked tightly to my side with my left arm. On my way towards the frozen ground, I had no option but to guard with the same arm that was holding the ball. I hit the ground hard with my left arm in a slightly extended position, still grasping the ball. I saved the fumble, but felt a numbness in my arm immediately on impact. Not wanting to show any sign of weakness, I jumped up with a smile and went on playing the game. In any other situation, I would have stopped playing immediately and tended to my shoulder. In this case, I played for another half hour or so and tried my best to forget about what happened. By the end of the game, I had almost no use of my left arm. I couldn’t even close the door on my truck for the ride home and after the game I had to wash my hair with one arm. We met up with most of they guys for a burger a couple of hours later and it was so painful, I couldn’t even hold a drink up to my mouth. Obviously something was wrong, but without tests, I couldn’t be sure what. I spent the next few weeks just resting.
Flash forward a month. For the past 30 days, I’ve had to completely alter my training schedule. Any movement that involved a pressing motion was completely off limits. My shoulder was getting better on its own, but much slower than I expected. I had a good friend and PT run some quick strength and ROM tests on it. I passed, for the most part, but there was still considerable pain on the top of my shoulder and deep in the joint. Clearly there was damage, but I couldn’t be sure to what extent without a more thorough checkup.
Welcome to the burdened world of the HMO. You see, I needed an MRI. But I couldn’t get an MRI without a referral from an orthopedist and I couldn’t get an appointment with an orthopedist without first seeing my primary care physician. So the calls began. I scheduled an appointment with my primary care physician, then a follow-up appointment with an orthopedist. I had X-rays taken and scheduled an MRI for the following Monday.
Fast forward another week. I’ve had my MRI and I’m scheduled to meet with my orthopedist to interpret the results. He calls me over to the light box where the images are posted and points out two “areas of interest.” One was my AC joint. The pain I was experiencing on the top of my shoulder was not from an AC separation, but instead from a deep bone contusion. Instead of pulling the joint apart, I slammed the two bones together when I hit the ground, effectively bruising them both. The other issue was the internal joint pain. Turns out the pain was caused by tendinosis in my subscapularis muscle.
To clarify, I had no joint separation of any kind and no tears in any of my rotator cuff muscles. In my mind, it was the best possible outcome, given the circumstances. I attribute this outcome to the fact that I included rotator exercises as part of my fitness regimen. Without the strengthening exercises I did on a regular basis, I’m quite sure the injury would have been much more severe, probably requiring surgery. But I digress…
Now that I know what’s wrong with my shoulder, I need to go about fixing the problem. Let the rehab begin.
Let’s start with the bone contusion, since that’s the easiest to deal with. Rest, rest and more rest was the ticket. Bone contusions simply take time to heal. Yes, I worked on ROM exercises and took an occasional anti-inflammatory, but as far as speeding up the recovery, its virtually impossible to do. Patience, in this case, is most certainly a virtue.
As for my subscapularis, since there was no tear anywhere in the rotator cuff, the necessary care consisted of rest (which I had been giving it plenty of), non-steroidal anti-inflammatory drugs such as Advil® (which I had also been doing plenty of) and progressive physical therapy, which I had been avoiding in lieu of the MRI results. PT consisted of internal and external rotation exercises, shoulder rotations, horizontal flexion and extension and presses and pulls in a pain free range. I’ll detail these exercises and their progression in detail in the second part of this article.
Almost immediately after I began the rehab exercises, I noticed an improvement in my shoulder. My pain-free range of motion increased and within a week, I was able to press substantially more weight in every range, especially overhead. Shoulder rehab, like any other type of “training” also needs to include rest. My rehab included rest days where I would do absolutely no work at all, simply letting the joint heal.
Now, about 5 weeks after my official rehab began, I’m completely pain free in my ADL (activities of daily life) and my strength is about 90% of where it was pre-injury.
If there is one thing you should take from this, it’s that diagnosis of any injury is extremely important. I’ve spoken with a number of other people who have injured their shoulder in a variety of ways. Only about half of them have actually had their injury diagnosed, assuming that whatever is wrong will just heal on its own. Instead of healing, though, they’ve been left with a joint that’s only partially effective and fractionally as strong as it was, leaving it much more prone to future injury. Some of the individuals I’m referring to are now 10 years or more post-injury. The chances of them ever getting back to a pre-injury level are extremely low, but there is always room for improvement. The only way to find out how much you can recover from an injury to learn what you have to do, what equipment you’ll need, then DO IT!