It’s likely that most of us are unaware of just how important the shoulder is. Well, that is until you injure it. A shoulder that is in pain of any sort, including rotator cuff pain, can cause daily activities such as brushing your teeth, taking a shower, getting dressed, combing your hair and even sleeping very difficult and frustrating.
And if fitness is important to you, having a rotator cuff tear — like suffering from frozen shoulder syndrome — can make even the smallest amount of exercise more challenging and possibly painful.
The human shoulder is made up of a somewhat complicated system of bones, joints, connective tissues and muscles that provide the support needed for the arm to function properly. It’s believed that the upper extremities can acquire more than 1,600 positions within a three-dimensional space at the shoulder joint. As long as the shoulder is working properly, complicated activities like throwing a ball, shoveling snow, raking the leaves, climbing, lifting weights, and swimming not are possible but fun. A well functioning shoulder is vital to our activities!
In fact, chronic shoulder pain, which lasts more than a few weeks to a few months, is the most commonly reported upper extremity problem in athletes, both recreational and professional. (1)
What Is the Rotator Cuff Exactly?
The rotator cuff is a group of tendons and muscles that are located in the shoulder and upper back area, connecting the upper arm to the shoulder blade. The tendons of the rotator cuff provide stability to the shoulder area and the muscles allow the shoulder to rotate.
Your shoulder is made up of three bones: your upper arm bone that is called the humerus, your shoulder blade known as the scapula, and your collarbone that is named the clavicle. The shoulder is a ball-and-socket type joint where the ball, or head, of your upper arm bone fits perfectly into a shallow socket in your shoulder blade area.
The rotator cuff tendons and rotator cuff muscles play a pretty important role since they are what keeps the arm in the shoulder socket. There is a network of four muscles that come together as tendons to form a covering around the head of the humerus and that is what we call the rotator cuff. The rotation and ability to lift the arm comes from the rotator cuff, so as you can imagine, when it is causing pain, it can be rather debilitating and very frustrating.
The muscles in the rotator cuff include the teres minor, the infraspinatus, supraspinatus and the subscapularis. There is also what is known as a lubricating sac, or bursa, which is located between the rotator cuff and the bone on top of your shoulder called the acromion. The bursa is what allows the rotator cuff tendons to freely move and glide as you engage your arm in any motion or activity. When the rotator cuff tendons are injured or damaged, this bursa can also become inflamed and painful. (2) (3)
Common Rotator Cuff Injuries & Causes
There are many common causes of rotator cuff pain and/or injury, which is typically a torn rotator cuff, such as falling or being hit in the shoulder, such as in football or rugby but also unexpectedly falling during an activity. Overuse from repeated actions, such as lifting, painting, cleaning windows, swimming, swinging a tennis rack or golf club, or throwing a baseball, are common causes as well. Unfortunately, issues can also show up from natural wear and tear that comes from aging.
A rotator cuff tear is one of the most common injuries suffered from the shoulder area and is specifically an injury or tear to the rotator cuff tendon. Symptoms may include weakness and/or pain in the arm and is a common cause of pain and disability among adults. It has been reported that in 2008, close to 2 million people sought medical advice and/or treatment from a doctor for a rotator cuff problem in the U.S. alone. (4)
Besides a rotator cuff tear, rotator cuff pain can also be causes be these problems:
- Rotator cuff tendonitis is the repetitive overhead use of the arms during activities such as gardening, raking, carpentry, house cleaning, shoveling, tennis, golf and throwing. (5)
- Rotator cuff impingement is when the tendons of the rotator cuff are squeezed between the humerus and a nearby bone called the acromion. (6)
- Frozen shoulder occurs when the humerus adheres to the shoulder blade, causing shoulder pain and stiffness.
- Subacromial bursitis happens when there is inflammation of the small sac of fluid, called the bursa, that cushions the rotator cuff tendons from a nearby bone called the acromion. (8)
Symptoms of Rotator Cuff Problems
An injury to the rotator cuff area can make it very painful and annoying to lift your arm out to the side. Tears that happen suddenly usually cause intense pain right away, indicating that there is a problem. There may even be a snapping sensation and immediate weakness in your upper arm area. When one or more of the rotator cuff tendons is torn, the tendon no longer fully attaches to the head of the humerus. Most tears typically occur in the supraspinatus muscle and tendon; however, other parts of the rotator cuff may be involved in an injury.
Tears that develop slowly over time due to overuse also cause pain and arm weakness. You may feel pain in the shoulder area when you lift your arm to the side, or you may feel pain that moves down the arm. The pain may be mild and only noticeable when performing common activities that require you to lift your arm over your head. Eventually, the pain may become more noticeable, even when the arm is at rest. Some of the most common symptoms of a rotator cuff tear include:
- Pain at rest and at night, particularly if lying on the affected shoulder
- Pain when lifting and lowering your arm or with specific activities
- Weakness when lifting or rotating your arm in different directions
- Crepitus, which is a grating sound or sensation produced by friction between the bone and cartilage or a crackling sensation when moving your shoulder in certain positions
Rotator Cuff Tests, Analysis & Conventional Treatment
There are a few different ways to assess issues that may be occurring with the rotator cuff such as magnetic resonance imaging commonly known as a MRI, a CT scan, traditional X-rays, a physical exam, ultrasound, arthrogram or a simple painful arc test. (9)
There are many treatments available such as anti-inflammatory pain medications, sports and fitness tape, cortisone injections, and surgery. But while an injection of a local anesthetic and cortisone may be helpful and provide some profound immediate relief, it ‘s temporary and probably masks the problem more than anything.
Cortisone is an effective anti-inflammatory medicine, but it comes with possible side effects: effects to the color of the skin where you get the shot, infection, bleeding from broken blood vessels that may occur within the skin or muscle, soreness, aggravation of the inflammation in the injured area because of reactions to the medication (post-injection flare), and weakened or even ruptured tendons. (10) (11)
11 Natural Treatments for Rotator Cuff Pain and/or Injuries
A study of serious injury of the rotator cuff of young athletes through contact sports shows that through the proper treatment, most can get back to a normal routine to include sports. However, early identification and efficient management are critical to achieve the best results, according to the medical journal Sports Health. “These injuries may initially be dismissed as brachial plexus neuropraxias or cuff contusions, particularly in the football population. If overlooked, the rotator cuff tear is likely to progress and may become irreparable by the time of diagnosis.” (12)
But rather than opt for steroid injections or even surgery, I strongly encourage you to take advantage of the following 11 natural treatments. In fact, it’s been reported that approximately 50 percent of patients are relieved of pain and experience improved function in the shoulder through non-surgical methods of treatment. (13) Especially keep in mind that strength building through physical therapy and special exercises (see next section) may be required to regain normal shoulder function.
If you know that you’ve injured yourself, make sure you apply an ice pack to the area immediately afterwards. This will reduce inflammation and swelling (and hopefully your rotator cuff pain).
If the ice pack or bag is extremely cold, cover the shoulder with a thin towel or clean cotton T-shirt. Apply for 15 minutes every other hour for the first few hours, and then three times a day until you’re free of pain — this including after any physical therapy or exercising.
2. Rest & spend less time doing normal activities
Often, the initial step to any injury, or even potential injury, is rest. Rest could include more sleep as well as limiting overhead activities. Your doctor may also prescribe a sling to help protect the shoulder area by keeping it still. This can also help you avoid trying to use it during this rest period.
Overall, for healing to occur, the inflammation needs to be reduced. One of the ways to do that is to avoid activities that cause shoulder pain. If you have rotator cuff pain or an injury and continue using the shoulder, even if there isn’t increasing pain, you can cause even more damage. For example, a rotator cuff tear can get bigger and more inflamed over time.
To speed blood flow to the damaged tissue, reduce inflammation and increase healing, an ultrasound can heat up deep tissue and address rotator cuff pain. (14)
4. Heating pad
Related to the above fact that heat can improve healing, a physical therapist may also use a moist heating pad for 15 to 20 minutes before exercise, and it can be useful to do this at home, too. (15)
5. Physical therapy
Overall, physical therapy and occupational therapy may be the best treatments long-term and could get you back to a normal routine and restoration much faster than steroid injections and/or surgery. Evidence through clinical trials suggest that physical therapy with prescribed exercises can help provide healing of conditions such as shoulder impingement, rotator cuff tendinopathy, rotator cuff tears, glenohumeral instability, adhesive capsulitis and stiff shoulders when applied to rehabilitating patients. (16)
Physical therapy involves various exercises that can improve flexibility and strength of the other muscles in the rotator cuff, ultimately providing support to help it heal. Occupational therapy is somewhat similar to physical therapy in terms of the end results, but occupational therapy for rotator cuff injuries focuses on day-to-day activities that require basic shoulder movements. Over time, this strengthens and supports the rotator cuff area and can provide natural healing. (17)
6. Anti-inflammatory foods & natural painkillers
While drugs like ibuprofen can reduce pain and swelling, they’re also dangerous. So when possible opt for non-synthetic methods such as avoiding highly inflammatory foods. Consider anti-inflammatory foods that will help you heal much faster while providing other useful benefits to your health. There are some great natural painkillers for shoulder pain and tendonitis in the rotator cuff that can be very useful as well.
7. Essential oils
One such natural painkiller is peppermint essential oil. By applying a peppermint essential oil rub twice daily, you can provide the rotator cuff with natural healing alternatives. Peppermint oil is a very effective natural painkiller and helps relax the muscles. Simply blend it with coconut or almond oil and rub onto the affected area.
Other effective anti-inflammatory oils include arnica, evening primrose and lavender oils.
As noted above, specific exercises can help restore movement and strengthen your shoulder and the muscles and tendons that support it. I have provided a great exercise program below that includes strengthening exercises for the shoulder area. The goal is to strengthen the muscles that support your shoulder so that you get much needed pain relief while preventing additional injury to the area.
The other side of the rehab coin to strength moves is stretching exercise. This can help improve flexibility and range of motion but keep in mind that it takes time and your commitment to performing these exercises 1–2 times per day/3–4 times per week. Also, while you are likely to feel discomfort, if you feel any pain when performing these exercises, please stop immediately and consult your doctor.
A 2012 study done by Memorial Sloan-Kettering Department of Epidemiology and Biostatistics aimed to determine the effect of acupuncture for four chronic pain conditions: back and neck pain, arthritis, chronic headache and shoulder pain.
The researchers reviewed clinical trials involving over 17,000 patients, and the results showed that patients receiving acupuncture had less pain than patients in the placebo control group. (18) The conclusion was that acupuncture is effective for the treatment of chronic pain and is “more than just a placebo effect, therefore it’s a reasonable referral option for doctors.”
11. Transcutaneous electrical nerve stimulation
Transcutaneous electrical nerve stimulation (TENS or TNS) is the use of an electric current that’s produced by a device in order to stimulate the nerves for therapeutic purposes, such as to address rotator cuff pain. One meta-analysis revealed in the medical journal Current Rheumatology Reports showed the positive treatment effects of electrical stimulation for relief of chronic musculoskeletal pain, and randomized controlled trials consistently showed the effectiveness of TENS for acute, emergent as well as postoperative pain conditions. (19)
Rotator Cuff Exercises and Stretches
As I noted earlier, a proper conditioning program of physical therapy will require some dedicated time, but you should see some great results. Also, if you have concerns, ongoing pain or sudden pain, please see your doctor or a physical therapist. Try to do this program for 4 to 6 weeks, unless otherwise specified by your doctor or physical therapist.
Once you have recovered, you may want to continue with these exercises as part of a great maintenance program. Performing these exercises 2–4 days a week can help maintain strength and range of motion in your shoulders.
It’s best to warm up the muscles before doing these, or any, exercises.
Choose a low-impact activity for 10 minutes such as walking, riding a stationary bike, elliptical or even arm circles, forwards and backwards, while marching.
Remember: You should not feel pain during an exercise. Talk to your doctor or physical therapist if you have any pain while exercising. If you are not sure how to do an exercise, or how often to do it, contact your doctor or physical therapist.
3 Rotator Cuff Stretching Exercises
1. Crossover Arm Stretch
Stand with feet hip-distance apart. Relax your shoulders and gently pull one arm across your chest as far as possible, holding at your upper arm area, not the elbow (avoid putting pressure on the elbow area). Hold the stretch for 30 seconds and then relax for 10–15 seconds and repeat 5 times on each side.
2. Back Rotation
Hold a stick or small hand towel rolled lengthwise behind your back grabbing one end with one hand, and lightly grasp the other end with your other hand. Pull the stick or towel horizontally so that your shoulder is stretched to the point of feeling a stretch without pain. Hold for 20–30 seconds and then relax for 10–15 seconds. Repeat 4 times on the each side. Maintain good posture, standing with feet hip-distance apart, knees slightly bent and keep your core tight.
Lean forward with knees slightly bent and place one hand on a counter or table top for support. Allow the other arm to hang freely at your side. Gently swing your arm forward and back 3–4 times, then repeat the exercise moving your arm side-to-side 3–4 times. Next, move the arm in a circular motion 3–4 times. Repeat the entire sequence with the other arm. Careful not to round your back or lock your knees. Do 2 sets of 10 on each side.
4 Rotator Cuff Strengthening Exercises
1. Standing Row
Using an elastic stretch band or a resistance band of comfortable tension, make a loop with the elastic band and put it around a doorknob or sturdy post. You can tie the ends together or, if using the common resistance bands, grab the handles with one hand. Stand in the start position holding the band with your elbow bent and at your side. Keeping your arm close to your side, slowly pull your elbow straight back. Then slowly return to the start position and repeat. Do 3 sets of 10 squeezing your shoulder blades together as you pull.
2. Upward Rotation
Similar to the exercise above, make a 3-foot-long loop with the elastic band and attach the loop to a doorknob or other stable location. Stand holding the band with your elbow bent at 90° with knuckles/fist facing forward at shoulder height. Maintain the positioning with your upper arm and shoulder, making sure your elbow stays in line with your shoulder; then slowly raise your hand until the forearm is vertical. Return to the start position and repeat. Perform 3 sets of 10.
3. Inward Rotation
Using the same band, stand holding the band with your elbow bent and at your side, fist vertical and facing forward. While keeping your elbow close to your side, bring your arm across your body then return to starting position and repeat. Perform 3 sets of 10.
4. Outward Rotation
This time, instead of rotating inward, simply rotate the arm away from the body. Stand with feet hip-distance apart, knees slightly bent and abs tight. Using the same band, arm down at your side then bend the arm at the elbow. Keeping your elbow close to your side, slowly rotate your forearm outward and away from the body, then return to the starting position. Squeeze your shoulder blades together as your rotate away from the body. (20)
Rotator Cuff Risk Factors
It’s important to note that since most rotator cuff tears are caused by normal use that comes with aging, most people over 40 are at greater risk. People who do repetitive lifting or activities that require lifting or reaching overhead, such as painters and carpenters, are also at risk for rotator cuff tears and injuries.
Of course, athletes, especially in contact sports and any sport that requires repetitive use, such as tennis, baseball and swimming, are very vulnerable to overuse tears and should exercise caution and awareness to any onset pain.
While those under 40 can experience issues with the rotator cuff, most of their shoulder injuries are caused by a traumatic injury, like a fall. (21)
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