Rotator Cuff Related Shoulder Pain - Fighting Fit Physiotherapy Nerang Gold Coast

What is rotator cuff related shoulder pain, and how do we fix it?

The shoulder is the 2nd most common area we treat here at Fighting Fit. The first being back pain!

In this blog will discuss one of the most common shoulder presentations. (Rotator cuff related shoulder pain or RCRSP for short!)

When consulting someone with shoulder pain for the first time, I usually hear complaints of:

“I’ve just moved house and cleaned out the garage and now have an irritating ache in my shoulder”
“I fell onto my shoulder after riding my dirt bike on trails and now it still aches”
“I can’t wash my hair and put my bra on because I get a sharp pain when I move my arm”
“I’m sore after heavy bench press at the gym last week, now my shoulder aches at night”
“My shoulder has been sore for a long time, it gets better while I’m gardening then is really sore after, I can’t remember hurting it, it just started one day”

These types of reports and complaints of shoulder pain are very common and it’s something we see every day at Fighting Fit.

So, what is Rotator Cuff Related Shoulder Pain (RCRSP)

Rotator cuff related shoulder pain is a new, broad term to describe a cluster of common shoulder complaints & pathologies.

Most people will attribute pain to pathology, so common tissues and injuries your will think of are:

Rotator cuff tendinopathy or tendinitis
Partial / Full thickness tears of the rotator cuff muscles
Subacromial bursitis
Subacromial or rotator cuff impingement syndrome

Here’s what the rotator cuff muscles look like:

Let’s Break down a few different pathologies under the umbrella of RCRSP

👉 Partial / Full thickness tears of the rotator cuff muscles

One thing we see often is a scan result reporting rotator cuff tear. Whether on a MRI or Ultrasound.

We know that many people go through life with a rotator cuff tear and have absolutely no pain (just like disk bulges in the lower back).

Heres some stats for you:

A recent study (Barreto et. al 2019) of 123 people 18-77 years of age, showed that when you hurt one shoulder and scan the unaffected shoulder, there is only a 6% difference in findings of partial tears and 5% in full thickness on MRI.
26% of sore shoulders had a partial rotator cuff tear, compared with a 20% prevalence of partial rotator cuff tears in non-painful shoulders.
6% of sore shoulders had a full cuff tear, compared with a 1% prevalence of full cuff tears in non-painful shoulders.

Rather then relying purely on a scan by itself, looking at the size, location, age of the person, how the tear occurred, lifestyle, it’s clinical presentation and level of function are far more important to help you make an informed decision on how to proceed if it becomes an ongoing issue

👉 Rotator Cuff Tendinopathy or Tendinitis

Tendinopathy is another very common complaint of shoulder pain, you know the scan that say your supraspinatus has tendinitis, tendinosis, a calcific tendinopathy, or thickening of the rotator cuff tendons.

In the same study mention above 92% of sore shoulders shoulder displayed tendinopathic changes, but 88% also displayed tendinopathic changes in the non-painful side.

In many cases, tendinopathic change, i.e. thickening, fraying, calcification is just normal age related change and probably just your bodies way of adaptation to load over time!

4% just get pissed off at any one time!

👉 Subacromial bursitis

“I have a bursae in my shoulder!”

The amount of times I have heard this doozy is incredible. Everyone has a bursae in their shoulder, its normal. Sometimes they just get annoyed and sore.

But here is an interesting finding from the same study. 54% had sub acromial bursitis in the painful side. 56% had sub acromial bursitis in the pain-free shoulder!

Subacromial bursitis is very common, all you need is thickening with impingement on abduction (elevation of the shoulder out to the side) to be termed bursitis on an ultrasound.

Many sore shoulders with subacromial bursitis are weak shoulders that couldn’t handle the load thrown at it and the tissues simply got pissed off!

👉 Subacromial or Rotator Cuff Impingement Syndrome

Another super common one.

“I don’t have enough space in my shoulder for the tendons and bursae to move without pain!”

This also leads to many unwarranted and failed shoulder surgeries such as a subacromial debridement, where they shave the bone to create more space.

Recent research and thinking now suggests that the lack of sub acromial space is actually a result of physical deconditioning, reduced strength and resilience of the rotator cuff causing the humeral head to migrate north and reduce the space for everything to move.

By creating more space with surgery but not addressing the underlying strength impairment and reduced function of the cuff, surgery is unlikely to be useful and result in failed outcomes.

The take home message is that reported pathology doesn’t always indicate the causation of pain!

Here is some Other Vital factors for RCRSP that don’t come up on a scan!

Lifestyle;

it is very important to identify and address other factors that may be contributing to your shoulder pain.

Smoking status;

those that smoke, have impaired tissue healing capacity!

Sleep heath;

poor sleep = poor recovery, poor recovery results in poor adaptation. If your life is busy and stressful, your tissues don’t have time to repair.

General exercise;

in-activity is the best predictor of injury when someone decides or needs to become physically active. If you regularly do nothing, then all of a sudden life requires a lot of physical work. Expect to be sore and increase your risk of tissue damage and/or over load due to your lack of strength and endurance.

Diet;

Poor nutrition results in poor tissue health and a delayed tissue healing response. If you eat well, you will optimise your bodies ability to heal but also adapt to tissue stress.

General Health;

as we age, and if we age poorly due to long standing poor lifestyle choices, then we are at risk of other co-morbid health concerns.

Diabetes = poor tissue recovery,

Heart disease = poor oxygenation and circulation to peripheral tissues, impairing tissue recovery and adaptation.

That just to name two… imagine if we went into the three or more co-morbid conditions that most people have over the age of 65 these days!

What do you need to over-come shoulder pain?

⚠️ You need an initial assessment at Fighting Fit where we can perform a thorough examination of your shoulder pain.

We will to get to know you, your body and lifestyle! We will ask lots of questions life when your pain started, was it an injury or did just started hurting

How does this shoulder pain affect your day-to-day life?
What activities do you now, what can’t you do now and what do you want to get back to doing?

Its important to find out the person your treating, not just their injury, I need to know how it affects them personally and in their day-to-day life

Then, we will get you up and take a look at your shoulder and how it is moving. We will go hands-on as we need to know what the musculature feels like and if it’s really sore to touch or pressure.

We will test the range of motion of your shoulder with your arms by your side, above your head and lying on the plinth.

We will then test the length and strength of the muscles around your shoulder including the rotator cuff muscles (see above) including the muscles of your chest and your neck.
We will look above and below the problem area and perform some special tests of the neck, shoulder and upper back to rule in or out other pathologies in disguise as shoulder pain.

There are also special tests of the shoulder itself to make sure we have the correct diagnosis for the start of treatment in order to hit the ground running

Treatment for Rotator Cuff Related Shoulder Pain

Treating Rotator cuff related shoulder pain varies from person to person. There is no one size fits all approach to fixing shoulder pain.

Given the highly variable nature of presentations, pain, movement and function. It’s so important to get a complete picture of the person in front of you and develop a individualised approach to treatment.

Treatment in the early stages will usually consist of hands on therapy or manual therapy to ease acute symptoms and improve range of motion, Taping may even be used to assist in offloading painful movements or positions. Education will always be important, you need to know how to manage your activity and function, when to work and when to rest, plus other tricks and tips for symptom relief.

Fighting Fit will always progress quickly to an exercise component. Why? Because behind every painful shoulder is some form of weakness that needs to be address or pain just comes back!

Exercise is the best long term solution for Rotator cuff related shoulder pain and can be tailored to suit the patent in front of us at any stage of rehabilitation or presentation.

Exercise will be performed in a graded fashion meaning that it will start at your current level and progress as we improve with range of motion, strength or symptoms.

Our graded exercise will generally consist and progress through:

Low load and isometric exercises
Stabilisation and higher load through range of movement exercises
Beginner strength through to gym-based and proprioception exercises
Return to sport or work specific exercise load

Exercise is important as it increases the capacity of the shoulder to handle exactly what you need it to do whether it’s hanging out the washing or digging holes.

Other factors we will need to address for you and your RCRSP!

Lifestyle: Its very important to identify and address other factors that may be contributing to your shoulder pain. Smoking status, sleep heath and other exercise factors are vitally important in affecting the pain that you may experience

A fear of tears: One thing we see often is a scan result reporting rotator cuff tear. We know that many people go through life with a rotator cuff tear and have absolutely no pain (Just like disk bulges in the lower back).

It’s the size, location, age of the person and how the tear occurred is far more important and we will help you make an informed decision on how to proceed if it becomes an ongoing issue!

Don’t stress, a tear is like eating a donut. If you only see the hole, you miss the most important part!

There is no one size fits all for rotator cuff related shoulder pain, it’s our job here at Fighting Fit to ensure that you have adequate movement, strength, endurance, and power throughout the shoulder and rest of your body to succeed in your day to day life.

Book a consult today!

Kyle Wells is a Physiotherapist at Fighting Fit Physio.

He has a special interest in arthritis, neck pain and tendinopathy. Just to name a few.

Kyle loves cross fit and has an exceptional eye for technique and performing exercise correctly.

He use exercise to improve patient results and get them moving better for the long term.

Brenda Samosa

05:52 07 Nov 24

I had a really bad shoulder and had been seeing a different physio for 3 months (from a different place) I got told Tyson was good. After just a few sessions the movement was coming back. I’m 66 and was worried I would have to stop surfing. But with a lot of help from Tyson I’m back in the waves ( thank you so so much)

Cyana Ferguson

08:16 30 Oct 24

Steve Harris

22:33 15 Oct 24

Great team, all friendly, super helpful and first class clinical advice and a big shout out to my Physio Noah with my shoulder issue

Andrea Bell

05:33 19 Sep 24

These guys are the best in the biz 🎉

Ryan Brockett

04:20 18 Sep 24

Shout out to Max from fighting fit physio. He helped me out massively straight after shoulder surgery and back into work and sports in no time. Couldn’t recommend anyone better!

Scotty

08:31 31 Jul 24

Five star service from Max & the team!
Professional & very thorough, you know that patient outcomes are of the highest priority.
I highly recommend this business.

Riley Wilson

08:27 14 Jul 24

Be AWARE they’ll immediately try to commit you to multiple follow up sessions after your initial consultation. This happened to me and then I later found out that as it just so happens, they have a cancellation policy that says you have to pay 100% of the consultation fee for cancelling. They failed to tell me this when they were pushy in committing me to 6 sessions after my consult, so that was a really nice little surprise.

I was already uncomfortable with how pushy they were in having me commit to so many sessions, so when I heard about the policy I just cancelled all together. So, I can’t speak further to the quality of their service throughout therapy phase. FYI this was also a few months ago now, it’s possible (though unlikely) they may have changed the policy. Just ask the question.

Megan Shelley

06:51 03 May 24

Fighting Fit Physiotherapy is hands down the best physio I've encountered. Having tried multiple physios for various injuries, I always find myself coming back to them. Their expertise consistently exceeds expectations, helping me get back to my sport faster than I thought possible. Their personalized approach and attention to detail make all the difference. I could not recommend a better or more exceptional physio team!

Gina Matthews

08:41 24 Mar 23

Can't recommend this place high enough. I was in so much pain with my knee an had been for months through advise an exercises I'm now looking forward to returning to gym an back riding my horses in endurance thank you so much

Courtney Halse

01:36 29 Nov 22

Kyle was knowledgeable, personable and professional. He saw me through my second pregnancy and continued to work with me until 6 months post partum on issues with my back. Would recommend anyone to go and see him.

Also shout out to Georgia on the front desk. She makes you feel welcome and brings a sense of warmth to the place!

Alli Davenport

08:07 04 Nov 22

After hip replacement surgery in February I wanted toget back into weight training legs, I started with Mitch 18 weeks ago and after a lot of hard work and sweat I am able to safely train again, I cannot thank Mitch enough for his support,encouragement and knowledge. The staff are friendly and helpful and I always looked forward to my session's

Robert Parkinson

10:50 15 Aug 22

This is the second time I have been treated by the team at FFP.
As a health professional myself I have been impressed with the level of care I have received from all members of the team.
The personalised treatment and rehabilitation programs have produced excellent results and I have completed both programs pain free and feeling stronger than before my injuries.
During the program there was constant communication and follow up and they were very accommodating with my work schedule.
All in all it was a very holistic experience and I would highly recommend the service.

Kiri Canavan

07:30 08 Jun 22

Tyson was amazing! We came up with an 8 week plan at my first consultation with weekly check ins and updates to exercises. 8 weeks later, I am pain free and able to train harder than ever. Highly recommend and the staff are all fantastic and super accomodating!

What is rotator cuff related shoulder pain, and how do we fix it?

The shoulder is the 2nd most common area we treat here at Fighting Fit. The first being back pain!

So, what is Rotator Cuff Related Shoulder Pain (RCRSP)

Let’s Break down a few different pathologies under the umbrella of RCRSP

👉 Partial / Full thickness tears of the rotator cuff muscles

👉 Rotator Cuff Tendinopathy or Tendinitis

👉 Subacromial bursitis

👉 Subacromial or Rotator Cuff Impingement Syndrome

The take home message is that reported pathology doesn’t always indicate the causation of pain!

What do you need to over-come shoulder pain?

Then, we will get you up and take a look at your shoulder and how it is moving. We will go hands-on as we need to know what the musculature feels like and if it’s really sore to touch or pressure.

Treatment for Rotator Cuff Related Shoulder Pain

Other factors we will need to address for you and your RCRSP!

There is no one size fits all for rotator cuff related shoulder pain, it’s our job here at Fighting Fit to ensure that you have adequate movement, strength, endurance, and power throughout the shoulder and rest of your body to succeed in your day to day life.

Book a consult today!

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