In the case of a rotator cuff injury or restriction, I would start by assessing the client’s levels of discomfort and range of motion at the shoulder joint. I would also assess the cervical and thoracic vertebrae, and the entire arm, as these are connected and could play a part in whatever is going on at the shoulder. I would look for where a range of motion is restricted to find which muscles are short and which are longer. This will determine which muscles I spend longer stretching and lengthening. I will stretch and work on all of the involved muscles though to ensure maximum freedom of the joint and to encourage healing of every tissue. I will continue to assess constantly as I then work on the client, finding trigger points and additional restrictions.
If there is any inflammation present, I would apply cryotherapy before beginning. I would couple this with lymphatic drainage, making sure to open pathways to the lymph ducts so that waste materials and toxins immediately have somewhere to go as I free the muscle tissue. If the inflammation is severe enough, I would focus only on cryotherapy and lymphatic drainage for the first session, and have the client come back when the inflammation is subsided to do more intense work.
Once the tissue is ready to be worked on, I would start with some decompressions of the neck and shoulders by stretching the spine and the arm, and moving the joint through its current range of motion. I would then apply Trigger point therapy starting with the bellies of the rotator cuff muscles, and then the attachments if the Trigger points persist there. I would then move on to the surround muscles of the arm, neck, and shoulders to release any Trigger Points that may have been caused by referral from the original rotator cuff issue.
I would then move on to STR once I have worked on the Trigger Points sufficiently. If necessary, I would reapply cryotherapy to bring inflammation back down for further work. I would begin my STR at the hand and move up the arm, making sure that the entire arm is freed up and not pulling on the shoulders. I would then, with the client side lying, work on the muscles of the back – especially latissimus dorsi, QL, and erectors as necessary. I would decompress the diaphragm. I would repeat on the other side, but spend more time on the side that is tighter.
Then I would do STR on the neck and shoulders, freeing up everything surrounding the rotator cuff. This would likely focus on the Levator S., Trapezius, and rhomboids. Once everything around the rotator cuff is freed up, I would do STR on the rotator cuff itself. I would alternate between joint mobilizations, STR, compressions, and cryotherapy / lymphatic drainage as necessary until the shoulder is freed up nicely. I would finish with friction, effleurage, lymphatic drainage, and cryotherapy of all the areas I worked on.
Finally, I’ll have the client move their shoulder through its ROM, to see what difference we have made. If restrictions or tension are still present I would do a few more minutes of STR coupled with Proprioceptive Neuromuscular Facilitation, having the client push against my resistance and then relax into the stretch.
If you suffer from Rotator Cuff Pain, make an appointment with one of our therapist calling 610.670.1010