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Preventing shoulder injuries

Eric Pitcher, P.T., C.S.C.S.

One of the most common complaints seen by physical therapists and orthopedic physicians is aching and the occasional sharp pains in the shoulder and upper arm. These complaints may start suddenly or develop over time, but either way, these symptoms are among the telltale signs of an injury to the rotator cuff. The rotator cuff is perhaps the most vulnerable component of the shoulder complex and is all too familiar to many of us. 

The shoulder is a complex structure and is probably the most mobile joint in the human body. There are few sports or daily activities that are not affected by the mechanics of this architectural body wonder. The shoulder actually consists of two joints – the ball and socket joint at the top of the arm and the association between the shoulder blade and the trunk. The rotator cuff is the term for the group of muscles that surround the ball and socket joint of the shoulder. The flattened muscle tendons of the rotator cuff surround the upper arm bone like a cuff on a shirt sleeve. These often-flimsy muscular attachments give the shoulder exceptional mobility, but they also make it vulnerable to injury for the same reasons. 

Injuries to the rotator cuff occur in two major ways: either as one traumatic event causing an injury; or, more commonly, from overuse of the shoulder during activities that require the arm to move over the head. These overuse injuries often are related to poor body mechanics or an imbalance in muscle strength, both of which increase the chance of injury. For an athlete or those who like to play certain sports, rotator cuff injuries can mean disaster. Perhaps the most vulnerable group of athletes prone or susceptible to shoulder injuries is throwing athletes such baseball and softball players, football quarterbacks and tennis players.

Fortunately, with proper training and maintenance the rotator cuff can be part of a finely tuned machine. Exercises and training for the rotator cuff should focus on flexibility, strength and endurance in the cuff muscles themselves, as well as all the core muscles of the trunk and shoulder girdle. Specific muscle training for the rotator cuff should focus on internal and external rotation with relatively light weights including raising the arms from waist to shoulder height. These exercises are probably most easily accomplished with elastic bands which can be found in gyms and physical therapy clinics or can be purchased at sports stores.

Equally important are shoulder and core stability exercises. By increasing the strength and control in the muscles that support the scapula, the humerus (bone of the upper arm) and shoulder blade, we are able to provide a firm, stable foundation for the rotator cuff to work its magic.  Popular ways to train the core and shoulder girdle musculature, as well as increase the stability of the rotator cuff include the use of medicine balls or over-sized stability/exercise balls. And of course, a well-balanced stretching program is very important to keep everything limber and moving.

For most of us, athletes or not, the rotator cuff is an afterthought that only comes to the forefront after it has been injured. However, since we all have shoulders, maybe we should learn to use them properly, keep them strong and flexible, and don’t let a preventable injury slow us down.

Eric Pitcher, P.T., C.S.C.S., is a physical therapist and strength and conditioning specialist at the Sports Medicine Center of Northern Arizona at Flagstaff Medical Center. For more information about this topic or other sports-medicine topics, contact your physician or the Sports Medicine Center of Northern Arizona at 928 773-2125.