Caring for Your Shoulders in Your 50s: the Rotator Cuff
Shoulder problems are common among adults, especially as they enter their 50s and beyond. Many people experience issues related to the rotator cuff, a group of muscles and tendons that stabilize the shoulder joint. Over the past year, I had the opportunity to work with several women who presented with shoulder pain, primarily stemming from rotator cuff problems like tears and tendinopathy. My patients opted to try conservative treatment first, and I witnessed significant improvements in their symptoms.
Understanding Rotator Cuff Issues
For those over 50, rotator cuff abnormalities can be quite common but it is important to note that for some people these changes can be symptomatic while for others they do not cause any pain. The prevalence of rotator cuff abnormalities in asymptomatic people is high enough for degeneration of the rotator cuff to be considered a common aspect of normal human aging, making it difficult to determine when an abnormality is new and could be the cause of symptoms.
While many surgeons favor a ‘‘wear and tear’’ theory, there’s a growing belief that the rotator cuff undergoes a natural degenerative process, much like the thinning and graying of hair.
When pain is present, rotator cuff-related pain often manifests as difficulties with overhead movements or rotations, making daily tasks challenging. Activities such as reaching for something on a high shelf, putting on or taking off a bra, or even reaching behind your back can become painful or nearly impossible.
The Role of Physical Therapy
If you’re wondering how physical therapy can help with a rotator cuff problem, the answer lies in a well-structured exercise program combined with the use of manual therapy, especially in the beginning of the rehabilitation process.
Exercises can effectively manage both partial and full-thickness tears by addressing weakness and functional deficits of the affected muscles and tendons. Manual therapy helps with pain management.
Here are some strengthening exercises I recommend for those dealing with rotator cuff issues - please note that appropriate modifications are often necessary to avoid exacerbating symptoms.
External Rotation (ER) strengthening
Internal Rotation (IR) strengthening
Single arm bent over row
Lateral Raises on scapular plane
During a rehabilitation cycle, we aim to perform these exercises for about 12 weeks, gradually increasing the load over time. Ultimately we want to get to a place where we can focus on slow, controlled movements, targeting 6-8 repetitions with a heavy load, leaving 2 reps in reserve (RIR).
Moving Forward
If you’re experiencing rotator cuff-related pain, keep in mind that many individuals find relief through tailored exercises. The key is to gradually increase the challenge of these exercises, ensuring continued improvement. If the exercises aren’t challenging enough, your muscles and tendons won’t see the changes you’re aiming for.
References:
Teunis T, Lubberts B, Reilly BT, Ring D. A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age. J Shoulder Elbow Surg. 2014 Dec;23(12):1913-1921. doi: 10.1016/j.jse.2014.08.001. PMID: 25441568.
Edwards P, Ebert J, Joss B, Bhabra G, Ackland T, Wang A. EXERCISE REHABILITATION IN THE NON-OPERATIVE MANAGEMENT OF ROTATOR CUFF TEARS: A REVIEW OF THE LITERATURE. Int J Sports Phys Ther. 2016 Apr;11(2):279-301. PMID: 27104061; PMCID: PMC4827371.
Itoi E. Rotator cuff tear: physical examination and conservative treatment. J Orthop Sci. 2013 Mar;18(2):197-204. doi: 10.1007/s00776-012-0345-2. Epub 2013 Jan 12. PMID: 23306597; PMCID: PMC3607722.
