Anatomy 101: The Rotator Cuff

You’ve probably heard of the term “rotator cuff” before, but do you know what the rotator cuff is? More often than not, a thorough explanation is required when introducing the rotator cuff to individuals in physical therapy for shoulder pain. So what is it? The rotator cuff is simply a group of four muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) that work collectively to stabilize the ball-and-socket structure that makes up the shoulder joint. By itself, the bones of the shoulder joint are not very stable, as the ball-and-socket structure is similar in composition to a golf ball sitting on a golf tee, with the golf ball being the humeral head and the golf tee being the glenoid. Inherently, a golf ball resting on a golf tee is not very stable, i.e. it is easy to knock the ball off of the tee. Physiologically, this would be rather problematic if this were the entire design of the human shoulder joint complex. Enter the rotator cuff, which helps hold the golf ball securely in the center of the golf tee. As you raise your arm overhead, the rotator cuff activates, pulling the humeral head down while it rolls upward in the glenoid. Without a healthy and efficient rotator cuff to provide the necessary counterforce, the golf ball would get dangerously close to rolling off the tee. This would not be an issue on a golf course, but could result in injury in the human body. In fact, many common aches and pains in the shoulder are the result of an injured or inefficient rotator cuff, which can result in an unstable shoulder joint, particularly with overhead activities such as swimming, rock climbing, and tennis. Shoulder impingement syndrome is a common diagnosis that involves a pinching of the supraspinatus tendon. Rotator cuff tears can involve any of the four rotator cuff muscles, but most often impact the suparspinatus. The good news is physical therapy can help strengthen the rotator cuff, in hopes of improving the stability and subsequent function of the shoulder joint. Here are a few therapeutic exercises used to strengthen the rotator cuff:

Band-Resisted Wall Crawl

Band-Resisted Shoulder External Rotation At Sides

Resisted Scaption

Quadruped Scaption

So, if you are experiencing nagging shoulder pain, you may benefit from having a physical therapist or other sports medicine specialist evaluate the health of your rotator cuff. Treatment can be rather effective and typically only takes between 6-8 weeks, the average time required to strengthen weak or dysfunctional muscles. Get started now!

-Grant Hennington, DPT

Promoting Improved Shoulder Health In Rock Climbers

Climbing season here in the Pacific Northwest is upon us and with that, more often than not, comes nagging climbing injuries. While traumatic injuries can occur from unexpected falls or hazardous rockfall, the majority of climbing injuries are related to overuse, with the shoulder joint being a common culprit. Common climbing injuries involving the shoulder include shoulder impingement syndrome, rotator cuff tendinopathy, rotator cuff tears, and labral tears. But can anything be done to prevent climbing injuries resulting from overuse? The short answer is yes, with a combination of strength, stability, and mobility exercises being ideal for reducing your risk of injury. Here are 5 therapeutic exercises to try:

1. The band-resisted wall crawl exercise helps to strengthen the rotator cuff, a group of muscles that help to stabilize the shoulder joint during overhead activity. Perform 3 sets of 5-10 repetitions every other day of the week.

2. The bird dog exercise helps to build stability of the shoulder joint complex, while also isometrically strengthening the rotator cuff, helping you better perform moves involving mantling. Perform 3 sets of 10 repetitions every other day of the week.

3. The open book exercise helps to increase the mobility of the thoracic spine while also improving the flexibility of the pectoral muscles, helping to create a more efficient overhead reach. Perform 1 set of 10 repetitions each direction, up to 7 days per week.

4. The chest opener stretch, performed on a foam roll, helps improve posture by stretching out the pectoral muscles, which are chronically tight in rock climbers. Perform 1 set of a 3 minute hold, up to 7 days per week.

5. Thoracic spine mobilization over a foam roll is a great way to improve thoracic extension, helping with more efficient overhead reach in climbers. Perform 1 set of 60 seconds, up to 7 days per week.

With any and all of these exercises, the motion should be gentle and pain-free. Fight the temptation to do more than recommended, as you will not get better twice as fast if you do twice as many repetitions, sets, and/or days per week. It should be noted that not only will these exercises help reduce your risk of injury, but they will also give you a bump in performance, allowing you to climb more challenging routes for longer periods of time. The exercises should be performed for a minimum of 8 weeks in order to experience significant changes in strength, stability, and mobility. Climb on!

-Grant Hennington, DPT