I'm not an athlete, why do I have a rotator cuff tear?

It turns out that rotator cuff tears are a common cause of pain and disability among all age groups. Here is what you need to know!

Recently a dear friend and former neighbor reached out to me right before rotator cuff surgery. She was in excruciating pain and worried about the recovery process. I was so sorry to hear that she was in such pain, but I wondered how a mostly sedentary woman around my age managed to tear her rotator cuff. 

She had no idea!

It turns out that rotator cuff tears are a common cause of pain and disability among all age groups. More surprisingly to me, they are the most common non-traumatic upper limb cause of disability in people over 50 years of age. 

Women suffer this injury at a higher rate than men. 


Would you believe a major cause could be how you move and your overall posture?

How can this be? 

I identified 5 common movements that when repeated over the course of years, can pull you out of proper alignment. Repeating these movements over time can cause rotator cuff injuries. 

So, if you can avoid these movements, you should be fine:

KIDDING! We all know it is virtually impossible to avoid movements like this! Well, except for the baseball player. He’s kind of stuck.

So let’s dive in and figure how these activities of everyday life might predispose us to problems later on. 

The Rotator CuffThe rotator cuff is a group of four muscles and tendons that surround, move and control the shoulder joint, one of the most mobile joints in the human body. This ball and socket joint is relatively unstable, and hence more prone to injury. It primarily keeps the arm bone in place and allows it to move upward and outward in all directions. The muscles of the neck, chest, upper back and shoulder blade are closely interrelated with the rotator cuff complex.

Misalignment anywhere in this system can have ripple effects. How can you tell if there are misalignments? One way is to look at your posture. So let's compare the 2 postures below, can you even believe this is the same person? 

​Going from top to bottom let's examine the posture of Slouching Girl and Straight Girl with respect to the lines I've dropped from the tops of their heads down their spine: 

1) The ears. Straight Girl's ear lines right up. This means the muscles in the front of the head and neck are balanced and can share the job of keeping her head up (among other things) as they have roughly equal strength. But Slouching Girl's ear (and head) is far forward of the line. This overly stretches and weakens the muscles of the back of the head and neck and tightens those in front. This affects things further down the chain (and can create a whole host of problems beyond the scope of this blog post), as we will see below.

2) The armpit - wait, where is Slouching Girl's armpit? Ok, we know it's there, but it is hidden by that sunken chest. Not so with Straight Girl! We can see her armpit AND a nice big space in between it and her chest. Slouching Girl’s forward head and sunken chest cause her shoulders to round and her shoulder blades to protrude out her back. Similar to 1), above, Slouching Girl has an imbalance between the muscles in the front and those of the back.

 3) The Ribs - Again, we know Slouching Girl has ribs, but the only ones we can (kind of) see are her back ribs. Straight Girl’s ribs are nice and prominent. There’s not a lot of space for Slouching Girl's front ribs to expand on an inhale. This usually means the shoulders will have to go up instead. This is called paradoxical breathing which, like forward head syndrome, can lead to a variety of other problems. 

Incidentally, even though we know these 2 pictures are of the same young woman, one looks like she has a beer gut!  What a shame, for someone so slender. 

What does this all mean for the rotator cuff? Besides the muscle imbalances set up by the position and alignment of Slouching Girl’s shoulder complex (and related areas), the actual space for the shoulder joint and arm bone have been made smaller, thereby limiting arm movement. All this puts increased tension on the rotator cuff muscles and tendons. Over time this will wear them down which can lead to impingement, fraying, weakness and tearing.

Besides misaligned posture, other causes of rotator cuff tears are:

  • genetic predisposition,
  • poor exercise execution (ie, women trying to get in shape or back in shape, who take classes, use weight machines, or follow workout routines without investigating the risks or their correct execution), and
  • Comorbidity such as diabetes, hypertension, high cholesterol, thyroid disease or smoking.​

What can we do to prevent this? Let’s revisit My 5 shoulder killing movements and add possible modifications/alternatives based on what we’ve learned about posture:

  • If you’ve got to spend a lot of time on a hand-held device, try to hold it up closer to eye level while not tilting your head down. ​
  • Avoid rounding your shoulders and reaching your head forward when lifting up your baby from or putting her back down on a low surface. Bend at the hips instead of the upper back. Organize things so the baby will be as close to you as possible. This could mean raising up the height of the crib or lowering the side when it is time to lift or lower the baby. Or it could mean changing the baby on the floor, like the woman in this picture. Look how straight her back is because all the bending takes place at the hip rather than the upper back and shoulders.
  • We can even help our friend the pitcher by encouraging him to do opposing movements from the forceful overhead throwing motion. Here he has arms back rather than forward. In order to reach that far back he must stretch out his chest in the front. He’s also strengthening his upper back muscles at the same time.
  • When lifting luggage into the overhead bin, be sure to get as close as possible. When you’re close to the bin your arms can be wider apart, more relaxed, not so stretched out and over your head. You can also call upon more muscle groups to join in the effort!​
  • Long hours sitting at a desk can take a huge toll. Be sure to:
  • Sit with your low back up against the chair
  • Move the chair close enough so you’re not reaching for the keyboard
  • Set the computer screen high enough so your head isn’t pointed down
  • Take frequent breaks! Get up and walk around.

Want to do even more to reduce your risk of rotator cuff tears, and improve your posture at the same time? Reach out to me today for a free consultation and posture analysis. Let's design an exercise program to keep you in the game for as long as possible! 
Sources: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4241421/http://healthlibrary.brighamandwomens.org/85,P01381http://www.ncbi.nlm.nih.gov/pubmed/26429723

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