Athletes Have Unique Rotator Cuff Treatment Needs

Rotator cuff treatment varies significantly depending on the individual’s needs. When we’re treating a rotator cuff, one of the first things we look at is an individual’s activity level. This is because athletes who participate in sports that include overhead lifting and throwing have unique rotator cuff treatment needs compared to the general population.

Unfortunately, athletes’ needs often aren’t addressed in traditional physical therapy clinics. Since we specialize in working with active adults and athletes, they often end up in our clinic after they are frustrated they didn’t get results the first time around. Here’s some of the common rotator cuff treatment aspects that get missed when it comes to athletes.

• Ratios and Balance of Strength, not Weakness
• High Dynamic Stability Needs
• Calming Down Angry Muscles

Rotator Cuff Treatment for Athletes Looks at the Balance of Strength, not Weakness

In a typical individual with a rotator cuff injury, weakness of the rotator cuff, specifically the muscles that rotate the arm away from the body (external rotators) tends to be one of the main causes. However, most athletes have a good amount of external rotation strength. The problem for athletes lies in the ratio of external rotation strength to internal rotation strength.

While internal rotation strength is usually greater than external rotation strength, when it becomes significantly greater, problems result. This is because the internal rotators and the external rotators work together to keep the glenohumeral (shoulder) joint in the correct position. When the internal rotators are proportionally too strong, the shoulder joint is pulled off-center and is put in a poor position for optimal function.

When Shoulder Pain Happens

Overtime, repeatedly moving the shoulder joint in a less-than-ideal position leads to pain. This pain normally presents in the front of the shoulder, but can also be felt on the side, deep within – or less commonly – on the back of the shoulder. Pain typically presents itself with overhead or horizontal (bench press, push ups) pressing as well as more dynamic activities, such as snatching or kipping pull-ups.

To help resolve this discomfort, we focus on beefing up the strength of the external rotators. This closes the gap between the strength of the internal rotators and external rotators. A few of our favorite exercises to do this are –

Rotator Cuff Treatment for Athletes Addresses Dynamic Stability to a High Degree

Most think the shoulder joint operates like a ball and socket joint. And, technically, it is classified as such. However, a better description of the joint is a golf ball on a tee. There’s a lot of golf ball and not a lot of tee. (Yes, that’s poor grammar, but it helps illustrate the point.) This means that a large majority of stability at the shoulder comes from muscles (the rotator cuff to be specific) contracting around the joint.

When the overall strength or endurance of the rotator cuff isn’t sufficient for the stability demands of an athlete’s sport, excess movement occurs. This excess movement also leads to shoulder pain.

To address stability weaknesses, we train the shoulder in unstable positions. This is done via graded exposure. The strengthening should be challenging enough that it is difficult and fatiguing but not so challenging that it is sloppy. Pushing strength too quickly here worsens the original injury instead of helping it. Two of our favorite exercises to use for stability training are below.

Rotator Cuff Treatment for Athletes Includes Calming Down Angry Muscles

Here’s the thing, regardless of who is coming in the clinic door, they want to feel better. That’s one of our first priorities. When you have less pain, you’re better able to tolerate strength and stability work. Because of that, rotator cuff treatment for athletes often starts with dry needling or cupping, as shown below.

Athletes Have Unique Needs

If you’re an athlete who is seeing a physical therapist and using a lightweight (yellow, red, green or even black) resistance band for rotator cuff treatment, you’re in the wrong office. Simply moving the rotator cuff (you’re not truly strengthening with those bands unless you’re early post-surgical or have an incredibly weak rotator cuff), isn’t sufficient enough to get you back to snatching, doing kipping pull-ups, or pitching a full game. You need a physical therapist who is comfortable and familiar with working with athletes like yourself.