The Rotator Cuff
Rotator cuff issues are common and well-known to most who have developed some sort of shoulder pain. These four muscles have a large influence on how the shoulder moves and given enough time they tend to develop problems. Those problems can reveal themselves in ways like difficulty reaching over head or behind your back, they can restrict how much weight you can lift or the types of movements you can perform in the gym. All of that being said, outside of large tears, typically we can alter our mechanics enough to off-load the cuff and regain our movement options.
The rotator cuff has been defined as a group of four muscles that surround the shoulder and provide stability for that ball and socket joint. They arise from the shoulder blade and attach to different aspects of the upper arm, typically blending into the connective tissue that envelops the bones. Between those bones resides a small amount of fluid, called synovial fluid, that is said to lubricate the bones and provide nourishment for the cartilage on the ends of them. If there is enough space around the shoulder, the cuff provides a force that manipulates that fluid within the joint and compresses the connective tissue surrounding it. That fluid is incompressible, but it will move away from high pressure and as a by-product provide a hydraulic effect that moves your arm.
Should the rotator cuff sustain some form of injury, whether it be a chronic tear or an acute injury, the ability to compress the connective tissue and make use of the hydraulic system available becomes compromised. This may be when movement of the arm becomes challenging. Compensations can develop and we start using other structures to lift our arm for desired activities. There are a number of exercises that can be found online which are thought to develop the rotator cuff musculature in such a way that it can overcome the injury and return to its former capacity. These exercises have some merit, however barring a significant injury, learning how to change the mechanics of nearby areas like the trunk, neck or elbow and beyond may restore space within the shoulder and provide the cuff with sufficient leverage to do what it does best.
The rotator cuff is an area of intense interest for those with shoulder problems, and those four muscles do play a large role in mobility of the arm. The mechanics may go deeper than any of us actually realize, but with some degree of certainty, it goes well beyond simply making those muscles larger via isolated exercises. The body is a vastly interconnected network, if we can alter some pathways it may allow for more desirable capabilities.
Austin Ulrich, Physical Therapist
