Injury Spotlight - Rotator Cuff Tears

The Rotator Cuff The rotator cuff is a small group of muscles that sit at the back of the shoulder and is an incredibly important group of muscles for pole dancers. They are considered our primary stabilisers and ensure our shoulder doesn’t dislocate when loaded! There are 4 rotator cuff muscles: supraspinatus, infraspinatus, teres minor and subscapularis, but I commonly group teres major in as the forgotten 5th rotator cuff because of its location.

When loaded, any of these muscles can tear acutely, leading to sudden onset of pain. This is a common injury in pole dancers, considering the load placed on our body, and is often associated with poor technique. But what a lot of people don’t know about rotator cuff tears is that they can happen through a variety of ways including:

• Usual degenerative changes over time

• Repetitive micro trauma

• Traumatic injuries like dislocations

• Non-traumatic injuries

• Or secondary to other dysfunctions

Pole dancers usually experience repetitive micro trauma over time secondary to poor shoulder engagement and technique, but acute tears do still occur. We have covered correct shoulder engagement and technique in great detail in our twisted grip blog.

Common symptoms of an acute rotator cuff tear include:

• severe pain at time of injury

• pain at night/unable to lie on the shoulder

• pain with overhead activities

• positive painful arc sign

• weakness of involved muscle

• shoulder stiffness

Shoulder pain? Don’t be too quick to jump to conclusions Whilst rotator cuff tears are common on imaging, don’t be so sure that it’s the cause of your pain. Imaging will frequently show up rotator cuff in symptomatic patients. In fact, a study in 2011 showed partial rotator cuff tears in 22% of asymptomatic patients, bursal thickening in 78% and weird and wonderful abnormalities in 96% of patients (Girish et al., 2011, Am J. Roent). If you’re getting a scan it’s always worthwhile comparing to the other side to figure out what are ‘normal’ findings for you. Shoulder pain can certainly be present with an old or asymptomatic rotator cuff tear, so it’s important to be clinically assessed and diagnosed by a good physiotherapist, not just via imaging.

There are also a ton of other causes for shoulder pain including but not limited to:

• Acromioclavicular injury

• Adhesive Capsulitis

• Bicep tendinopathy

• Labrum tear: Slap lesion, Bankart lesion

• Glenohumeral ligament tears or sprains

• Subacromial Impingement Syndrome

• Shoulder Instability/dislocation

• Calcific Tendonitis Shoulder

• Cervical pathology: Cervical nerve root injury, Cervical Radiculopathy, Cervical Spondylosis

• Arthritis – osteoarthritis, rheumatoid

• Subscapular nerve entrapment

• Scapulothoracic bursitis

• Thoracic Outlet Syndrome

Treatment All forms of steroid injectables should be avoided with muscle tears. First line management should be exercise-based rehabilitation. Whilst full thickness tears occur rarely, a conservative rehabilitation period of a minimum of 6 weeks should be attempted prior to any surgical decisions being made. There is currently poor evidence regarding the evidence of surgery in this population so it’s best not to jump the gun here but instead focus on rehab first. Most full thickness tears resolve with a 3-6 month rehabilitation program. And patients that do end up having surgery have a much better outcome if they have already strengthened up the surrounding muscles first.

Injured your shoulder and wondering what you can do to help??? Get yourself in to see a physiotherapist ASAP. Do not push through any pain or discomfort with pole tricks thinking it will go away on its own. I can guarantee it won’t. Keep your shoulder gently moving and exercise areas around the shoulder in a pain free manner if possible to maintain some strength prior to seeing your physio. However, if you’re in a considerable amount of pain, chat to your pharmacist or doctor about over the counter pain relief.

How will a Physio help?? Depending on your diagnosis, the extent of the injury and a few other factors, physios are able to:

• Educate you on the extent of your injury and how to prevent this from reoccurring in the future

• Teach you how to best fully rehab your injury

• Provide or teach you how to perform immediate pain relieving techniques such as taping, joint mobilisation and self-release

How long will this pain last for? This is always dependent on the cause and extent of the injury, but generally not long. The recovery time of a rotator cuff injuries varies between pole dancers and is completely dependent on compliance with your tailored management program. With correct treatment, majority of the pain will resolve within 2-4 weeks, however the area of injury will take between to 6-12 weeks to restore its original strength. To prevent re-injury, care must be taken when returning to pole and should be guided by a healthcare professional.

How can I prevent this from occurring again in the future?? Well the bad news unfortunately is that once you’ve sustained an injury, you do have a higher risk of re-injuring it. The good news however is that you can work on the issue that caused you to injure it in the first place! This is where it’s important to make sure you are engaging your shoulder muscles correctly. Make sure you catch up on that earlier mentioned twisted grip blog to learn how – yes now!

Have you been trying to manage a shoulder niggle? Don’t let it become a full blown injury that stops you from poling!

Online telehealth appointments can be booked with the Pole Physio via our ‘Book Online’ page that can be found here. Assessment and tailored rehabilitation are provided in accordance with best practice and evidence-based treatment to help you unleash your 'poletential'.

Until next time, train safe.

The Pole Physio

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