Rotators cuffs, we hear of those all the time, almost every shoulder issue it seems are attributed to the rotator cuffs. But is that fair?
Rotator cuffs have two general functions, to provide internal or external rotation of the humerus and to draw the head of the humerus into the acromium so the humerus can abduct correctly. That is it, so why is it being attributed to all those other shoulder injuries out there?
Well, the health of these, the deepest muscles of the shoulder is integral to the health of the shoulder overall. Let me explain further. The first place I start when assessing any shoulder injury, is with the position of the humeral head, relative to the acromium process. It should sit centrally if the rotator cuffs are balanced and working correctly. Most commonly the humeral head will be positioned anteriorly and this position usually accompanies a pronated shoulder girdle. What many practitioners say is, oh the shoulder girdle is protracted, we need to strengthen the rotator cuffs...... Can you see where we are going here? The rotator cuffs attach onto the scapular and the head of humerus, there is no possibility of them causing a protracted shoulder girdle in themselves.
However, having an anteriorly positioned humeral head will, over time, lead the anterior shoulder muscles to overwork and the posterior ones to weaken, as a medially rotated head of humerus will put the pecs into a strengthened position biomechanically over the rhomboids, and that will lead to the scapula rotating forwards and causing a protracted shoulder girdle. You need to work out which came first the protracted head of humerus or the protracted scapula. This is important, because if the humeral head is causing the issue then strengthening the rhomboids and loosening the pecs will only partially resolve the issue. If you ignore the rotator cuffs you will remain with an anteriorly positioned humeral head and over time the problem will return. Similarly, if the issue is the shoulder girdle, strengthening the rotator cuffs is a fruitless task. Checking the position of the humeral head will give you your answer.
To resolve the issue permanently, you first need to loosen the subscapularis muscle (not impossible, but a challenge I accept), and strengthen the teres minor and infraspinatus muscles. Before strengthening the wider shoulder girdle. It is also worth finding out why the problem occurred in the first place..... desk work is often a culprit.
If you are using this for CPD, here is a task for you..... Take a look at the rotator cuff muscles. Why do you think we have two muscles for external rotation and only one allocated to internal rotation? Clinically reason your answer the write it all up in your CPD log.
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