How to Prevent Rotator Cuff Problems


Many will come into our office hoping they have not torn their rotator cuff. Nobody wants to have the dreaded rotator cuff surgical repair and work hard in physical therapy after surgery. Before we talk about how to prevent rotator cuff problems, let’s discuss what the rotator cuff is.

The rotator cuff is a group of four muscles that are responsible for keeping the shoulder joint stable. The shoulder joint is formed by the humerus, the upper arm bone and the scapula, known as the shoulder blade. At the end of the humerus, there is a ball and part of the scapula has a “C” shaped depression that the ball slides, glides and spins in, allowing shoulder motion. The rotator cuff muscles originate on the scapula and travel under the acromion and attach to the humerus by way of their respective tendons.

Damage to the rotator cuff is very common and varies as we age. Pain over the top of the shoulder or down the outside of the arm, shoulder weakness or loss of shoulder motion, can occur due to injury or repetitive trauma. From athletes and heavy laborers performing repetitive activity above the level of the shoulder, to falling onto the shoulder, from a quick sudden pull as when a dog pulls on the leash, from throwing, a faulty golf or tennis swing and as a result of heavy lifting, we can cause tissue damage or disruption to the tendons and/or the muscles of the rotator cuff.

When there is tendon irritation or inflammation that causes shoulder pain with movement, it is called shoulder impingement syndrome. The inflamed tendons butt against the acromion, part of the scapula, with motion causing pain and subsequently limitation in motion. Tears occur as a result of a traumatic event or long term overuse of the shoulder. Rotator cuff tears can be full thickness or partial thickness depending on if the tear goes all the way through the muscle/tendon.

It is important to avoid developing or progressing to a rotator cuff tear from an existing shoulder impingement. Here are some general tips to prevent damage to your rotator cuff:

  • Avoid repeated overhead arm positions. If your job requires such movements, come see us to learn arm positions that may be used with less risk.
  • Fall prevention is crucial. Our program to minimize fear of falling and prevent falls is invaluable.
  • Perform rotator cuff muscle and scapular stabilization and strengthening exercises in your workout routine.
  • Maintain good posture. A forward position of the head and shoulders alters the scapular position and creates shoulder impingement syndrome.
  • Avoid sleeping on your side with your arm stretched overhead or lying on your shoulder. These positions begin the processes that cause rotator cuff damage.
  • Avoid carrying heavy objects at your side so to avoid straining the rotator cuff.
  • Avoid smoking as it decreases blood flow.
  • Consult us at the first sign of symptoms. When left untreated, severe pain and significant inability to use the arm occurs. Early intervention speeds recovery and saves time and money.

During your first session, a review of your medical history, surgeries, medications and a thorough physical examination will be performed of the neck, upper back, jaw and shoulders. A series of specialized movement tests will be provided to help pinpoint the precise cause of your shoulder pain. We can identify if there is tendonitis, bursitis, impingement, a tear or muscle imbalance. At times rotator cuff injury can accompany labral tears (the ring of cartilage at the shoulder joint) or the long head of the bicep tendon may be inflamed or dislocated. In some cases the results of the tests might indicate the need for a referral to an orthopedist or for imaging tests to further identify the problem and appropriate course of treatment.

The physical examination helps us develop a personalized treatment plan for the physical therapy office setting and for at home. Your treatment plan will include pain reflex release techniques and other manual therapies to reduce your pain 50 percent at the end of the first session. Modalities such as biofeedback, ice, heat, iontophoresis, ultrasound and electrical stimulation may be used to help manage pain while pain free movement is restored with therapeutic exercise and postural correction. As always, our focus is on getting your pain and difficult function under control as you learn self-care and home exercise techniques to reach your goals.

Wishing you Good Health!


Zoe Fackelman, PT