Rotator cuff physio, Inner West
Cuff pain responds to load, applied in the right direction and the right amount. Getting that right takes measurement, not guesswork.
The rotator cuff is four muscles whose main job is control: keeping the head of the humerus centred while the arm moves. When one of them is irritated or torn, the shoulder often hurts in a band down the outside of the upper arm, is worse reaching overhead or behind, and wakes you when you roll onto it.
Cuff pain is one of the presentations most improved by getting the loading right, and one of the easiest to make worse by doing too much too early or resting it completely. Both errors are common, and they pull in opposite directions.
Sorting a cuff problem from everything that mimics it
Several things produce pain in the same place. The examination is mostly about separating them.
Which movements load it
Testing the cuff in the positions that stress each part of it, and comparing what you can do actively against what the shoulder allows passively. That gap is often the most useful thing in the examination.
How much strength is missing
Measured on both sides with a dynamometer. A cuff that is weak in external rotation relative to internal rotation gives us a starting point and something to re-measure against later.
What the shoulder blade is doing
The cuff works off the shoulder blade. If the blade is not controlled the cuff is working from a moving base, and treating the cuff alone tends to go round in circles.
Whether it is the neck
Referred pain from the neck can sit in exactly the same place. It is quick to test for and worth ruling out before a program is written.
Tears, scans and surgery
A tear on a scan is not automatically an operation
Partial and even some full thickness cuff tears are managed without surgery, and plenty of people have a tear on imaging with a shoulder that works well. Whether an operation is the right call depends on the size and pattern of the tear, your age, what you need the shoulder to do, and how it responds to a proper loading program. That is a conversation between you and a surgeon, and we are happy to write to one.
What the loading program looks like
- Isometric work early, where the cuff is loaded without much movement
- Range through the positions that are tolerated, building outwards
- Progressive external and internal rotation loading, measured as it goes
- Shoulder blade and upper back strength work alongside it
- Overhead loading last, and only once the strength numbers support it
Shockwave
We have shockwave therapy in the clinic and use it for some cuff-related presentations alongside a loading program, not instead of one. If it is worth trying in your case we will say so, and if it is not we will say that too.
Questions we get asked
Should I rest it completely?
Why does it hurt more at night?
Do I need an ultrasound or an MRI?
Can I keep training?
Shoulder hurting to lift overhead?
Book a free 30 minute call and describe it. We will tell you whether it sounds like a cuff problem and what a first appointment would involve.
No gap on an accepted claim · You choose your own physio · Five Dock