Physical Therapy for Rotator Cuff Tears

Shoulder injuries are common occurrences and affect many people at some point in their life. Especially since we use our shoulders in almost all tasks. These include movements from work, to household chores, to working out, and especially in sports. Although there are many injuries and tissues within the shoulder, one of the most common shoulder injuries is a rotator cuff (RTC) tear. The rotator cuff is a group of four muscles and their respective tendons that surround the shoulder joint. The cuff provides support of the shoulder joint and allowing a wide range of shoulder movements. An injury or tear in any of these muscles/tendons is commonly referred to as a rotator cuff tear. 

Rotator Cuff Tear Diagram

These tears can occur due to various reasons. These include repetitive overhead movements, overuse, aging, and sports. Especially those that require lots of upper extremity use including basketball, tennis, baseball, or weight lifting; or traumatic injury. Severity of the rotator cuff tears varies depending on the mechanism of injury and chronicity of the injury. 

Grading of Rotator Cuff Injuries

Grading of RTC injuries: A true diagnosis of a potential RTC tear can only be completed by professional medical imagining such as an MRI. The grades are as follows: 

Grade I:

In a Grade I tear, the rotator cuff tendon is minimally damaged but not completely torn. This is a minor tear that often involves only a small part of the tendon or muscle. It may cause mild pain and discomfort but usually does not significantly impact shoulder function.

Rotator cuff tear stages

Grade II (Partial Thickness Tear):

Grade II tears involve a slightly increased portion of the rotator cuff tendon. These tears are moderate in severity and may result in moderate pain and some loss of shoulder strength and function. The tendon is partially torn, but some of it remains intact.

Grade III (Full Thickness Tear):

Grade III tears are full-thickness tears, meaning the tendon is completely severed. This type of tear can lead to disuse of the arm, inability to lift arm fully overhead. It often requires additional medical attention, potentially through methods including surgical intervention, depending on recommendations from the proper medical professionals.

How can Physical Therapy Help my Rotator Cuff Injury?

Here at Symmetry Physical Therapy, we address rotator cuff tears/injuries by looking at all impairments that are noted during the initial evaluation and factors that may have contributed to the injury. Signs include a lack of mobility or flexibility, decreased strength or improper movement patterns. All these must be addressed in order to decrease the amount of stress being placed on the affected tissues. 

Physical therapy is essential in managing the pain associated with rotator cuff tears. With the use of soft tissue mobilization (STM), Winback TECAR therapy, joint mobilizations, and dry needling, physical therapy can help to decrease pain and regain mobility in the affected shoulder. Dry Needling in combination with Winback TECAR therapy specifically can be used to alleviate pain and inflammation. This creates a favorable environment for healing to improve healing time frames and decrease length of the overall rehabilitation process. 

We as physical therapists also use therapeutic exercises and strengthening. This helps improve function, regain strength and assist in muscle or tendon healing of the rotator cuff. Education on proper posture and body mechanics to prevent future injuries is another important step. Proper education will reduce the chances of future injuries. We uses exercises specifically for the rotator cuff muscles. These improve blood flow to the muscles which promote proper repair and healing, and improve stability within the joint. We also advise on what movements to avoid doing in the future.

Rotator cuff tear physical therapy

Exercises target specific movements including external rotation (ER), internal rotation (IR), flexion and abduction which are the RTC muscles primary movements. Precise grading and progression of exercises is necessary for rehabilitation and avoiding further injury or flare-ups of the current tear. Set up a physical therapy visit to avoid further progressing the injury and to allow for proper muscle use and rehab.

Dry Needling for Rotator Cuff Tears

Rotator cuff dry needling

Dry needling is a treatment used within physical therapy to assist the reparative response of tissues. Used in combination with electrical stimulation, dry needling can be very effective. The combination increases the opioid production by the body and adenosine. This helps to block pain in tissues, and increases blood flow. These benefits combined act to decrease pain and drive more efficient repair response by the body. Latest evidence suggests that running electric stimulation is important to maximize the results of dry needling. Through a process called mechanotransduction we are able to physiologically release the chemicals needed from the body which assist in restructuring the tissue, repairing the cellular dysfunction, reorganizing the collagen fibers and decreasing pain and inflammation.

Benefits of Physical Therapy

For grade I/II RTC tears, conservative management including a tailored physical therapy plan can help to decrease your pain, improve function and even avoid the need for surgical intervention. If you’re dealing with a rotator cuff tear, getting an initial evaluation with a Physical Therapist at Symmetry Physical Therapy can be a crucial step toward recovery and regaining a pain-free, active lifestyle. Grade III tears possibly require surgical intervention and it is best to consult with an orthopedic doctor to address any further questions.

Importance of Treatment

Rotator cuff tears can lead to a multitude of other shoulder impairments due to the loss of the rotator cuff’s functions of support and stabilization. If the rotator cuff is injured, the shoulder joint can become less stable, making it susceptible to abnormal movements and increased stress on other tissues for support, such as the shoulder labrum and other ligamentous structures.

This instability can result in secondary issues such as a labral tear, or a shoulder impingement, where the damaged rotator cuff tendon or muscle may get pinched during arm movements, leading to pain and limited range of motion. If the shoulder is being used less to avoid pain, you might be susceptible to frozen shoulder, also known as adhesive capsulitis. All of these additional shoulder pathologies can further impact shoulder function and your overall quality of life. Therefore, addressing rotator cuff tears properly and quickly through appropriate physical therapy and other conservative treatment and rehabilitation is essential to shoulder health.

Closing Thoughts

A rotator cuff tear can significantly impact your daily life and physical abilities. However, with the help of physical therapy, you can reduce pain, improve mobility, and prevent future issues. By addressing the root causes, decreasing pain, strengthening muscles, and promoting better movement, physical therapy plays a crucial role in managing rotator cuff pathologies. If you suspect you have any sort of rotator cuff tendonitis or muscle tear, and are looking for a Physical Therapist, come see us at Symmetry Physical Therapy, located in Miami/Brickell downtown area, where we provide an in-depth assessment and treatment strategies so we can help you return to a pain free lifestyle. 

Feel free to give us a call at (305) 331 2277 to schedule an appointment.

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