Tips for Avoiding a Rotator Cuff Injury

February 25, 2021

Shoulder injuries are a complete pain in the a_ _. I’ll let you fill in the last two letters. I was thinking “arm” but the other word that comes to mind is also an accurate statement. Shoulder injuries can be very painful and can severely limit our normal activities (even something as simple as putting on a shirt). Unfortunately, as we age, the likelihood of sustaining a shoulder injury increases because the tendons and muscles become weaker and more brittle. The most common shoulder injury is a rotator cuff tear. Sometimes a tear can be treated conservatively with physical therapy but, in some cases, a tear requires surgery to restore function. The recovery from surgery can be difficult. There are several things that you can do in daily life to avoid this. Here are tips for avoiding a rotator cuff injury.

First things first…what on earth is the rotator cuff?

As a physical therapist, I’ve heard patients use many different expressions to describe this anatomical feature; from “rotator cup” to “the rotisserie cup” (the latter is my all-time favorite). The rotator cuff is not some magical, misunderstood cup.

It’s really a group of 4 muscles that help to hold the head of the humerus (that’s the ball at the end of the arm bone) in place so that the shoulder can move without dislocating. The problem is that the design of the shoulder is pretty precarious. The muscle most commonly injured, the supraspinatus, runs a treacherous course from the top of the shoulder blade under one bone (the acromion process) to attach to another bone (the humerus).

So basically, the tendon (the end of the muscle that attaches to a bone) sits in between two bones. Due to its location, the tendon is vulnerable and becomes even more so depending on the position of the shoulder and arm.

Any time you rotate your thumb toward your body and lift your arm above shoulder level, the tendon is in a risky position. Add weight to that (like groceries) and it’s even more risky.

Posture (Check Yourself, Before You Wreck Yourself)

Here’s the biggie: if you have poor posture to begin with, you are begging for a rotator cuff injury because it automatically puts that tendon in a susceptible position. So, one of the most important things you can do to help avoid a rotator cuff injury, is to focus on BETTER POSTURE.

There are several ways to accomplish this. First, look at yourself in a mirror in profile view. Where is your shoulder in relation to your ear or your hip joint? Does it sit forward compared to either? Perfect alignment would be ear in line with shoulder, shoulder in line with hip joint.

Most of us don’t have perfect alignment. But we can work on it. Be mindful of your posture throughout the day. Do your neck or mid back hurt when you are sitting or standing? That’s your body’s way of telling you that your posture stinks. Listen to your body.

Stretch (It’s All About the Pecs and Scaps)

You can help to improve your posture by stretching your pec muscles. This will decrease the tension in those muscles and allow the shoulders to line up with your ears. There are many ways to accomplish this, but the “doorway” stretch is a nice, easy one to try. Start by lifting your arms up to a door frame. Let your hands rest on either side of a door frame with elbows at approximately a 90-degree angle. Step through the doorway with one foot until you feel a gentle stretch in your chest and shoulder muscles. Hold for 30 seconds, repeat 2-3 times.

While stretching your pec muscles is important, it won’t completely fix the posture situation. You also need to work on strengthening the muscles that sit in between your shoulder blades and underneath your shoulder blades. These muscles get stretched out when the chest muscles (pecs) are tight, so we need to do some gentle strengthening to get them to do what they were intended to do: stabilize or help keep the scapulae (that’s plural for shoulder blades) in place.

A great way to begin some easy strengthening is to perform “scap pinches” throughout your day. Focus on keeping your shoulders down and gently squeeze your shoulder blades together.

Thumbs Up, Buttercup (Trust Me, This Will Make Sense)

The last bit of advice for avoiding a rotator cuff injury is to keep your thumbs facing the ceiling when you are reaching for something overhead. This is particularly important if you are picking up something heavy, but even applies if you are picking up a coffee cup. It’s just a good habit to get into. Conversely, try to avoid pointing your thumbs toward the floor if you are lifting your arm above shoulder level.

In a nutshell, if you work on improving your posture, stretching your pec muscles, strengthening the muscles of your mid back, and reaching and lifting with your thumbs facing the ceiling–you will be doing the best that you can to avoid a rotator cuff tear.

Read other helpful blog posts about a variety of subjects here on our website.

Leanne Johnston is a Doctor of Physical Therapy and has been treating orthopedic conditions for over 18 years. She is passionate about patient education and empowering her patients by giving them tools to take charge of their own well-being.