By Garrett Holle, DPT Student
The function of the rotator cuff is colossal in the performance of our athletes and everyday individuals. So much so, in fact, it has formerly been called the kiss of death for the career of overhead athletes. Rotator cuff injury in sports is climbing in part due to an increased emphasis on strength in college programs. Moreover, in a study of NCAA college football players, rotator cuff injury was the 3rd most commonly reported shoulder injury (1). This high rate of occurrence holds true in the general public as
this study showed that of a random sample, 20.7% of patients had full-thickness rotator cuff tears (3).
As you can see, the ability to treat rotator cuff injuries and treat them well is going to be a valuable skill in your practice. The rehab is not easy, but we can make a huge difference with our patients if we handle them correctly.
How to Avoid a Common Oversight of Rotator Cuff Rehab
When prescribing exercise for the small intrinsic muscles of the cuff, it can be easy to throw the typical 3 sets of 12 to a patient. However, I think we should reconsider this. In addition to the typical explanation that every patient is different, there is also physiological evidence that supports this notion. This study explored the fiber composition of the rotator cuff muscles, indicating a mixed composition of fast and slow twitch (2). Although 44% of rotator cuff fibers labeled positively as slow twitch, the remaining fibers lie somewhere on the fast-twitch continuum.
Now if that study is a little too far into the physiology for you, let me make this applicable.
This knowledge of fiber type composition allows us to better determine and prescribe exercise volumes and intensities that satisfy the demands for muscle development. This concept aligns with the strength and conditioning principle of specificity. In the training realm, if you’re working with a sprinter, you’re going to utilize high intensity, low volume and if you’re training an endurance runner, you will use lower intensity with higher volumes. This example applies to training of the rotator cuff as well.
This concept is no nuance in the strength and conditioning realm, and it is a great illustration of how we can successfully begin to close the chasm between our two professions.
Garrett Holle is a DPT student at the University of Kansas Medical Center. You can find him on all social media platforms @Holle_Per4mance
1. Kaplan, L. D., Flanigan, D. C., Norwig, J., Jost, P., & Bradley, J. (2005). Prevalence and Variance of Shoulder Injuries in Elite Collegiate Football Players. The American Journal of Sports Medicine, 33(8), 1142–1146. https://doi.org/10.1177/0363546505274718
2. Lovering, R. M., & Russ, D. W. (2008). Fiber Type Composition of Cadaveric Human Rotator Cuff Muscles. Journal of Orthopaedic & Sports Physical Therapy, 38(11), 674–680. https://doi.org/10.2519/jospt.2008.2878
3. Yamamoto, A., Takagishi, K., Osawa, T., Yanagawa, T., Nakajima, D., Shitara, H., & Kobayashi, T. (2010). Prevalence and risk factors of a rotator cuff tear in the general population. Journal of Shoulder and Elbow Surgery, 19(1), 116–120. https://doi.org/10.1016/j.jse.2009.04.006
4. Rotator Cuff Image: Henry Vandyke Carter [Public domain], via Wikimedia Commons