Case Study: Rotator Cuff Injury
Written By: Madison Smith LMT
A rotator cuff injury is one of the most common injuries to occur, and I believe all massage therapists should have a thorough education on what exactly this condition entails, how to spot the signs of this injury, and most importantly: how to fix clients that have this injury. A rotator cuff injury includes four main muscles and tendons that surround the glenohumeral joint of the shoulder which holds the head of the humerus firmly secure in the glenoid cavity. These muscles are the supraspinatus, infraspinatus, teres minor, and subscapularis. Injury to these muscles can also radiate pain to the surrounding muscles like the deltoid, trapezius, rhomboids, pectoralis minor, etc. The people that usually acquire this injury are ones that use repetitive overhead movements in their jobs or in sports, such as painters, carpenters, or people who play baseball or tennis. The risk of this injury also increases with age, and sometimes can be linked to adhesive capsulitis (also known as Frozen Shoulder Syndrome). A key indicator that a client may have a rotator cuff injury is if they complain of a dull aching pain in their shoulder, have difficulty sleeping on that side of their body, or have trouble reaching their arm behind their back or over their head. The good news is that– as massage therapists– we have many techniques and modalities to help clients relieve pain and tension with this injury to avoid surgical repair.
- First, I interviewed my client with in-depth and detailed questions to properly understand his injury. It is very important to find out WHEN the injury occurred. If it happened over two years ago, there may be an accumulation of scar tissue that is causing restriction in the shoulder and it may not be able to be broken down with massage techniques at that stage of progression. Fortunately for my client, he said that his injury happened only 2 months ago while replacing ceiling tiles for 6 hours at work. I continued to ask my client questions such as, “On a scale of 1-10, what is the pain like?”, “What makes the injury feel better?”, “What makes the injury feel worse?”, “Is it a sharp shooting pain or a dull aching pain?”, “Does the pain ever send numbness or tingling down your arm?”, “What physical activities do you do in your daily life?”, “Are there any normal activities that you cannot do because of this injury?”, etc.
- After completing the interview process, I assessed my client’s injury to confirm that it was in fact a rotator cuff injury and not another condition (i.e. bicipital tendonitis, arthritis, adhesive capsulitis, or other conditions that may cause pain to the shoulder region). I compared his injured shoulder to his non-injured shoulder with assessments including shoulder adduction, shoulder abduction, shoulder flexion, shoulder extension, medial and lateral shoulder rotation, and horizontal shoulder adduction and abduction. During these assessments, I was recording the degrees that I measured with a goniometer to compare the changes before and after my session. I also palpated the injury to check for current inflammation; if his shoulder was too inflamed, I would use cryotherapy to reduce swelling and possibly reschedule the appointment for after the inflammation had died down (roughly 72 hours later). However, my client did not have any current inflammation so I was able to perform 30 minutes of massage per shoulder to help fix the injured shoulder as well as to release tension from the compensating shoulder.
- After I finished my client interview, performed assessments, and checked for inflammation, I palpated the muscles involved in the injury– as well as the surrounding muscles– to further understand where the pain was coming from. With firm pressure, I asked my client to rate the pain in the specific area that I was pressing on– on a scale from 1-10. I recorded higher (more painful) numbers in his infraspinatus, rhomboids, supraspinatus, and pectoralis minor– and I recorded lower (less painful) numbers in his deltoid, upper trapezius, scalenes, and levator scapula.
- Once I completed all of the necessary assessments, I was able to rule out that it was unlikely bicipital tendonitis, arthritis, adhesive capsulitis, etc. and that my client was likely suffering from an acute rotator cuff injury. With this knowledge, I was able to work on each shoulder for 30 minutes (I chose not to work over 30 minutes per shoulder because I did not want to overwork his muscles or create more damage). I first warmed up the muscles to increase mobilization of the joint and decrease the risk of further injuring the muscle. I utilized different soft tissue release techniques and stretches to his shoulder joint, as well as trigger point therapy around his rhomboids, infraspinatus, pectoralis minor, and supraspinatus where I could feel trigger points under the surface. I also used different active and active-resisted range of motion exercises to see how much movement the client could perform on his own. I completed these techniques and modalities in the seated, prone, and supine positions.
- As I finished the session, I applied cryotherapy to both of my client’s shoulders to reduce any inflammation caused by the massage and to aid in the healing process. I recommended that my client stay hydrated and drink plenty of water after the session to help flush any toxins out of his system, as well as to help his injury heal faster. Though it is out of my scope of practice to give my client exercises to complete, I was still able to encourage him to stretch his shoulder at home and ice the painful area in 20-minute increments. As part of the treatment plan, I suggested that my client return for consistent sessions every 5-6 days to continue improving his current restricted range of motion, reduce scar tissue build-up, and relieve pain from his injury.
Handling a condition like a rotator cuff injury is inevitable in the field of massage therapy, so it is crucial to have a firm understanding on how to help your clients heal properly. It is equally important to understand how to not further injure your client, or make the condition worse. With the right education and experience, you will be able to help clients in this situation, too!