Rotator cuff pathology


As a physical therapist I see a lot of shoulder pathology. This can be pain anywhere in the general shoulder area, lateral arm, or deep inside the joint. Generically, patients think they have a rotator cuff problem when they have shoulder pain, which it can be, but often times it is much more complicated than that. Let’s say someone has a non-traumatic shoulder pain. Meaning pain is occurring in the shoulder without having any kind of accident or trauma. The question has to be asked, “Why is the pain occurring and what can be causing it?” The shoulder joint needs to be looked at for range of motion (rom) and how it moves. Is it restricted or can it move through a full range? Usually the rom is restricted due to capsular tightness and this needs to be addressed. The rotator cuff muscles tend to be weak. The scapula is usually not moving in a normal upward rotation, and this can be due to inhibited low trap muscle and serratus anterior muscle. Posture is often times poor with a tight pec minor muscle and levator scapulae on the same side that has an increase in tone. All of these issues cause a poor functioning shoulder from abnormal movement mechanics, and leads to pain over time without an accident or trauma.

As a manual physical therapist what would I do that you would not get from going to typical physical therapy? First I would perform osteopathic manipulation of the thoracic spine that is causing the inhibition of the low trap and serratus anterior. Then the increased tone of the pec minor and levator scapulae would be addressed with manipulation and myofascial work. Followed by joint mobilization to specifically stretch the shoulder joint capsule to start to normalize rom. I would then finish off the treatment by giving rotator cuff strengthening, postural strengthening, and at home stretching. Usually 2-4 visits of this will completely resolve the issue over the period of a 4-6 weeks. If you have shoulder pain and would like to be treated quickly and efficiently, please give me a call or email me at my website