Rotator Cuff Tears
I work with several seniors, and a common problem among them is a torn rotator cuff. Torn rotator cuffs can cause pain, limit mobility, and decrease a person’s quality of life. Some important questions for fitness professionals to ask themselves are what makes seniors susceptible to a rotator cuff tear, how to prevent the pathology from happening , and how to rehabilitate a surgically repaired rotator cuff.
The rotator cuff is complex of the supraspinatus, infraspinatus , subscapularis, and teres minor which function as an active stabilizer to keep the humeral head in the glenoid cavity of the scapula during joint motion (Moore, Dalley, & Agur, 2014). Because the shoulder joint sacrifices stability for mobility injury is quite common. Rotator cuff tears are multifactorial and have many causes. Seniors are at risk due to increased thinning and disorientation of collagen fibers, myxoid degeneration and hyaline degeneration of their tendons, particularly the supraspinatus (Wani, Abdulla, Habeebullah, & Kalogriantis, 2016). The elderly are also prone to a lifetime of microtrauma to the area, their muscles and tendons are not as strong, and the blood flow to the rotator cuff decreases with age (Wani et al., 2015). Because the structural integrity of the rotator cuff tendons weaken with age, in addition to repetitive use , hypoperfusion, and age related atrophy, seniors are commonly victims of rotator cuff
To help prevent rotator cuff tears a progressive strength training program is recommended. Many people with rotator cuff injuries there is a strength imbalance the external rotators, the infraspinatus and teres minor, and the internal rotator, subscabularis, which may be a factor in injury (Cools, Johansson, Borms, & Maenhout, 2015). To address this imbalance Cools et al. (2015) suggest eccentric exercises because these muscles work as decelerators during motion and matches their function more, slow exercise to maximize absolute strength, fast exercises to maximize endurance, and plyometrics to activate the stretch shortening cycle. This way the rotator cuff is not muscularly imbalanced and is strong and durable. This should help prevent rotator cuff tears.
Even with a preventive program injuries still occur. After the rotator cuff is torn sometimes needs surgery to fix the problem. Exercise rehabilitation is generally helpful in most cases. van der Meijden et al. (2012) lay out a protocol for moderate rehabilitation focusing on four phases. The first phase focuses on building passive range of motion in the arm while relearning neuromuscular control. In phase two active assisted range of motion exercises are intiated to orient the fibers in the collagen matrix and increase tensile strength (van der Meijden et al., 2012). In phase three the rotator cuff is put strengthened lightly and in the last phase as healing progresses more advanced strengthening exercises are used. The van der Meijden et al. (2012) protocol is based on a thorough review of the literature and would be recommended to help a client overcome a torn rotator cuff.
Cools, A. M., Johansson, F. R., Borms, D., & Maenhout, A. (2015). Prevention of shoulder injuries in overhead athletes: A science-based approach. Brazilian Journal of Physical Therapy, 19(5), 331-339.
Moore, K. L., Dalley, A. F., & Agur, A. M. (2014). Clinically oriented anatomy (7th ed.). Baltimore, MD: Lippincott Williams & Wilkins.
van der Meijden, O. A., Westgard, P., Chandler, Z., Gaskill, T. R.,
Kokmeyer, D., & Millet, P. J. (2012). Rehabilitation after arthroscopic rotator cuff repair: Current concepts, review and evidence-based guidelines. International Journal of Sports Physical Therapy, 7(2), 197-218.
Wani, Z., Abdulla, M., Habeebullah, A., & Kalogriantis, S. (2016). Rotator cuff tears: Review of epidemiology, clinical assessment and operative treatment. Trauma,18(3), 190-204.