This is a back view of the shoulder

The rotator cuff is actually a group of 4 small muscles.  The function of the rotator cuff is to stabilize the arm into the shoulder socket.  Stabilization of the arm into the shoulder socket is required for all movements of the arm and shoulder and the rotator cuff is subject to muscle strains and tendinitis. The most commonly injured rotator cuff muscles are the supraspinatus, infraspinatus, and teres minor.  The subscapularis is the least injured.  The supraspinatus attaches on the top of the scapula and passes through the acromial arch to attach on the top of the arm.  The fact that the supraspinatus passes through this arch is one of the reasons it is the most injured and talked about rotator cuff muscle.  When the supraspinatus tendon is injured from the subacromial arch it may also be diagnosed as impingement syndrome. Other muscles and soft tissue that can be affected through impingement syndrome is the long head of the bi-ceps tendon and the sub- acromial bursae.

This is the subacromial arch. This space is occupied by the supraspinatus tendon. Movements that require the arm to move out to the side and in front of the body narrow this space. These movements coupled with the arm rotating inward also further close up the space.

Impingement Syndrome

When the arm is raised into abduction (out to the side), or into flexion (in the front of the body), or internally rotated the space between the acromial arch and the arm is narrowed.  This space is occupied by the supraspinatus, the long head of the biceps tendon, and the sub-acromial bursae.  This is one reason why sports with an overhead movement can injure these structures.  Sports like baseball, tennis (overhand serve), or swimming (the crawl) use movements overhead.  Also professions where you have to work overhead such as painters, sheetrockers, carpenters, or plumbers are suscpetible to this type of injury.  Computer and office workers can also be prone to shoulder impingement injuries because postures that encourage a rounding of the shoulders (protaction of the scapula) and rounding of the shoulders creates an inward rotation of the shoulder joint.  When the shoulder joint rotates medially the large head of the arm closes up the space.  So now that you tend to have shoulders that rotate inwardly, anytime you raise your arm above your head the head of the humurus bangs into the supraspinatus tendon.  This is one reason why physical therapists and personal trainers will tell you that if you perform lateral raises, to make sure your thumb is pointed up (this encourages lateral rotation which increases the space.)

Rotator Cuff Tears

The other 2 rotator cuff muscles that are commonly injured are the infraspinatus and teres minor.  These muscles are susceptible to tensile overload, fatigue, and trigger points. These muscles help stabilize the arm into the socket and any movement that requires movement of the arm will use these muscles.  Push-ups, lifting weights, and  activities that require eccentric muscle contraction, such as throwing, will place stress on these muscles.

Common Reasons Surgery is Used

When stress is placed upon the joint for a period of time or there is a traumatic injury, artritis can set in.  When there is arthritis or bone spurs in the acromial space this will impinge the supraspinatus and when joint movements are made that close up the space,  this will rub on the tendon and tear it.  In this situation massage will not do much because now this is a structural problem.  These are the situations where surgery is probably needed.  Surgery is also needed when the tendon is completely torn.

How Massage Therapy Can Help Shoulder Impingement

Depending on how bad the shoulder joint has bone spurs and arthritis and to what degree the tendon is torn massage can be very helpful for shoulder impingement syndrome.  Massage can help reduce inflammation, help reduce scar tissue build up and help realign torn fibers, and decrease pain.  Also, massage directed at postural muscles that rotate the arm medially and protract the scapula can help with the postural issues that predispose the supraspinatus to shearing stresses.  Types of massage strokes that can be used are effleurage, friction, static pressure, and static or PNF stretching.   Many of these conditions develop over time and surgery is needed because the tendons are degenerated and arthritis develops in the joint.  When shoulder pain is first noticed is essential to seek treatment from a doctor because if it is treated early enough the degeneration process can be slowed or stopped.  When deciding to seek a massage therapist for these types of shoulder problems ask your doctor about the appropriateness of massage and seek out a massage therapist who has a good understanding of the biomechanics of the shoulder and tissue healing and repair.

How Massage Therapy Can Help Rotator Cuff Muscle Strains and Tendinitis

The infraspinatus and teres minor are not susceptible to an impingement stress but rather tensile stress.  In low grade strains where the tendon is still intact, massage for strain or tendinitis to these muscles can also be very helpful.  Massage to the belly of the muscle and at the muscle/tendon site can be helpful as well as effleurage, friction, static pressure, and stretching.  Also addressing postural muscles that create a rounded shoulder posture will be helpful as well as this will also place stress on these muscles. I hope this article was helpful and if  you know anyone who suffers from shoulder issues please send this along to them.

If you would like to make an appointment or would like more information on how massage can help you call (203) 660-0584 or email at hello@h2tmuscleclinic.com.