The rotator cuff is a group of four muscles the supraspinatus, infraspinatus, subscapularis and the Teres minor muscle. These muscles work synergistically to stabilise the humerus in the glenoid or your shoulder joint making sure that the humerus glides perfectly within the joint and preventing the humerus from compressing the structures around the joint. The muscles of the rotator cuff also act as synergists to the bigger surrounding muscles. Unfortunately these muscles are neglected and are rarely exercised well enough or at all by most active individuals. Therefore they become weak and unable to check the force generated by the much larger chest and back muscles leading to dysfunction and later to injury.
Rotator cuff tears (RCT) are a fairly common orthopaedic complaint. Typically people who suffer a RCT are usually from two different camps. First is the degenerative RCT typically affecting people of 60+ years old and the second camp are usually athletes or sports enthusiasts who play racquet sports and especially throwing sports such javelin, water polo and rugby. The causes of a RCT vary from person to person however, for those who are playing sports the cause is usually traumatic or overuse with inadequate conditioning of the shoulder complex. However for the degenerative RCT there are several intrinsic and extrinsic causes.
Intrinsic and Extrinsic Factors
The most widely excepted factor for RCT's is chronic overuse of the rotator cuff that leads to micro-tears within the tendons that overtime build up to cause a rupture of the tendon (usually the supraspinatus). Some researchers believe that degeneration of the rotator cuff is a normal and natural part of ageing. A study back in 1991 found that 97% of 891 tendons examined had signs of degeneration. This would certainly support the ageing theory. However, just because something is normal does not make it optimal. As their is no research that has investigated our modern lifestyles effect on degenerative RCT. In other words how does our lack of exercise, high stress jobs, poor food quailty etc have on our bodies ability to heal itself and prevent things like RCT's. Whilst there are no studies that factor in all the various variables as it would be impossible to quite frankly. There are studies available that single out certain lifestyle choice, such as smoking as well as looking at diabetes and high cholesterol (Essentially the effect of a poor diet/lifestyle) and the increased incidence of RCT. I will link to those papers at the end of this blog.
A winged scapula or shoulder blade is caused by a weakness to the serratus anterior muscle which has the job of keeping the shoulder blade flush against the rib cage, as you can see in the picture above the shoulder blade is raising from the rib cage causing the winged effect.
Is this a serious problem?
Well that depends. A true winging scapula is due to a paralysis of the long thoracic nerve which is a more serious cause and may not be able to be corrected. However, the vast majority of people who say, or have been told they have a winged scapular, either have a weakness of the serratus anterior muscle itself or who have a co-ordination issue with the shoulder complex. This typically develops over time and usually affects office workers who end up slouching at the desk. If you are an active individual that requires good mobility and stable shoulders then it can cause problems, as the serratus anterior muscle is important for shoulder stability. However, if you are currently not super active then it may not cause you many problems to begin with, but overtime the muscle can begin to become irritated and develop what osteopaths call trigger points (irritable painful areas within the tissue), that can refer pain elsewhere in the body. As you can see in the images below. More on this in a later blog post.
Correcting this postural imbalance does require some time and effort as you need to learn how to control your scapula and strengthen the serratus anterior muscle. Below is a few exercises that will help you get started.
These exercises can be done as a gradual progression to begin the re-strengthening process and help reintegrate the serratus anterior with the shoulder complex and the whole body as a unit.
If you are experiencing shoulder or neck pain and would like to speak to someone about your problem you can contact me on 07500059064 alternatively you can email firstname.lastname@example.org
I hope this helps
Cwmbran, Pontypool & Abergavenny Osteopath
Andy has been involved in the health & fitness industry for over 10 years, specialising in corrective exercise, injury prevention and rehabilitation of low back, neck and shoulder pain. He also has an interest in the use of Osteopathy for the management of headaches.