Rotator Cuff Pain Relief Without Surgery
Many individuals are seeking rotator cuff pain relief as it is a fairly common condition featuring shoulder pain, stiffness, muscle weakness, and decreased motion. It is an injury of one or more muscles/tendons in the rotator cuff caused by advanced age, shoulder overuse, trauma, and arthritis.
If you suffer from shoulder pain and limited motion due to a rotator cuff condition, this may be able to provide relief and, in some cases, can avoid surgery for confirmed tears specifically and perhaps shoulder strain in general.
Dr. Fishman is a rehabilitation doctor and has devised a method for rotator cuff pain relief that most people can do in under 5 minutes. In a published study fifty patients with partial or full-thickness supraspinatus tears confirmed by magnetic resonance imaging had immediate and long term pain relief after using this method for rotator cuff syndrome.
The method has proven effective for tears of the supraspinatus, infraspinatus and teres minor, however, if you have a tear of the subscapularis, although activation does occur, this method will not work. According to a 2019 study in the Journal of Orthopedic Surgery & Research, tears involving the subscapularis tendon are a predictive factor for persistent pain without surgery.
A non-surgical method for rotator cuff pain relief is most welcome, especially in those who have very large tears and the elderly, for which surgery is not frequently the best option. Clinical improvement is not always correlated with tendon integrity after surgery. Conservative methods usually focus on lengthy physical therapy visits. In some instances, this can make a tear worse.
The following maneuver can be done in modified forms to simulate scapular stability and kinesiological therapy for muscular activation in one exercise and can be effective in as little as 30 seconds.
The exercise is a triangular forearm support and can be done seated, standing or on the floor. On the floor, the motion may go all the way to a headstand, however, modifying the motion is still effective for rotator cuff pain relief and you should take your time by gradually getting into these.
The modified positions should be used and caution with any of the following:
- Subscapularis tear
- Altered sensations, numbness, or pain that radiates below the mid arm
- Neuromuscular diseases like multiple sclerosis, stroke, or myopathy
- Previous shoulder surgery or injury
- Neck problems or other conditions contraindicating pressure on the head or neck
Use common sense and consult your health care provider if you have any questions.
A note from personal experience:
I have had shoulder surgery – two of them! The first was repair of the subscapularis and biceps tendon, which healed very well. The second was two years later for a supraspinatus tear and acromioplasty. Due to an overzealous therapist, in one session, the subscapularis from the previous surgery and the supraspinatus were both torn and beyond surgical repair. Both tears remain on the left side.
I do this exercise everyday. I thought you said do not do with a subscapularis tear? That is the recommendation, however, I do have problems with the right shoulder and I am not going to have another shoulder surgery! So, does it help and what about the left shoulder? Yes, it helps the with rotator cuff pain relief in the right shoulder and it does not hurt the left. The left is not improving, however, it does not make it worse or cause undue pain.
Which method do you use? I do the floor modification with knees bent and sometimes use the feet in a plank position and slowly head towards the headstand, however, with neck problems, I do not do the full headstand which does compress the neck – opposite of traction therapy. I will let the head hang or lightly sit in my folded hands.
I have not used this method in practice, only on myself. I would treat shoulder problems using Active Release Technique, which I found very successful for rotator cuff pain relief in many cases, especially with athletes. It is used for minor tears, muscular dysfunction, and adhesions from scar tissue. I originally learned directly from the inventor Dr. Leahy, who started Active Release Techniques® over 30 years ago. Now, there is a certification process and I highly recommend seeing a certified doctor because I have seen some professionals claim to know the techniques and they do not!
I would suggest starting with the wall position – a sturdy wall. This can give you a general idea of how it should feel and give you some time to experiment. This may be all you need or all you can do. If you tend to experience back problems, you should stick to the wall or use the knee bent position on the floor.
Maneuver For Rotator Cuff Pain Relief
The position is to make an equilateral triangle with the arms with the little finger side of the forearms and clasping the hands together. If you use the head, use the heels of the hands instead of the palms to contact the back of the head. Press down with your forearms to lift your shoulders away from your ears, raise and widen your shoulders (shoulder blades back, down and apart) and hold the position for 30 seconds. If you feel any sharp increase in pain, stop and consult your health care provider.
This method of rotator cuff pain relief is not a cure-all. It does not work for everyone. In the study, at almost 3 years after treatment, there were no new tears and all maintained their increases in range of motion and decrease in pain. It can be said that it appears to decrease pain and disability levels in a quick manner, permanently for some. The patients also had some conservative therapy, so I would also look at the other shoulder exercises.
A subsequent study using EMG revealed the subscapularis holding down the head of the humerus as the deltoid abducts the shaft of the bone. This successfully compensates for a torn supraspinatus and is learned rapidly.
Is It Working?
The most immediate sign would be rotator cuff pain relief. This does not necessarily mean the pain is completely gone, but a tendency towards relief is a good sign. However, one of the main factors is restoration of function. How to tell?
Rotator cuff problems generally involve the supraspinatus and can be from injury, degeneration, and/or attrition. One or more muscle tendons may be involved and for an acute injury, a health care professional should examine and x-rays should be taken.
A sign that immediate attention is needed is pain with the inability to raise the arm above the shoulder, both out to the side and in front. This is shoulder abduction and flexion respectively. After the 30 seconds in any of the maneuver positions, you should be able to have increased motion in flexion and abduction above the shoulder. This does not mean pushing through pain. The range of pain free motion should increase and this is a good sign of rehabilitation – functional improvement.
Will I Need Surgery?
If it is a subscapularis tear, most likely. Surgery is an effective solution for large and full thickness rotator cuff tears. Arthroscopic repairs are minimally invasive and single muscle/tendon repairs tend to go well. Problems do arise with tears larger than 5cm or where there is more than one tendon being repaired. A good therapist post-surgery is crucial to recovery and avoidance of re-injury, especially with complicating factors. My recommendation is avoid chain clinics; you are looking for high quality, experienced and caring therapists, not fast food physical therapy.
There tends to be higher re-tear rates with larger size tears and the degree of muscle atrophy and fatty degeneration. It is important to keep as much motion as possible. Years after my second surgery and with residual iatrogenic tears in two tendons, I do shoulder stretching and specific exercises as well as the modified maneuver described here. This helps keep relief and function maximized even with two irreparable tears and a shoulder full of titanium screws. If I fail to do this, and sometimes I cannot, the pain and stiffness increases.
Here are some videos of the techniques: You can do some research or seek professional assistance, however, I do not like the seated version at all, so it is not presented here. Why? It may increase back pain and it seems to pose a reasonable risk of falling off the chair on your head.
A 2020 study in Clinical Orthopaedics and Related Research found patients with a symptomatic rotator cuff tear show compensation movement with abnormal activity of the biceps brachii and posterior deltoid muscles. There may be a benefit of addressing the long head of the biceps tendon in treatment and the posterior deltoid can be trained to help compensate motion.