Initial management of rotator cuff injuries includes relative rest, modification of painful activities, and an exercise program guided to regain motion and strength. Additionally a comprehensive treatment of rotator cuff injuries could incorporate a number of rehabilitation strategies based on patient-specific assessment findings including, but not limited to:
• Manual Therapy (nerve mobilization, soft tissue massage, triggerpoint, IASTM)
• Acupuncture (local, segmental and distal stimulation sites)
• Education on Psychosocial Factors (eg. BPS framework of pain, fear avoidance)
• Remedial Loading Programs (eg. static stretching, concentric, eccentric, isometric)
Managing Inflammation and Swelling
In some cases pathoamatomical explanations do not account for why pain persist (Wylie et al. 2016), which is why is it important to take into account patient-specific assessment findings.
In other cases pathological changes (eg. fibrosis, interstitial collagen deposition, and inflammatory cells) may be associated with sensorimotor declines (Fouda et al. 2017). So in addition using massage therapy to manage pain, prophylactic treatments may play a role in maintaining cellular organization and facilitating tissue repair by mediating differential cytokine production (Bove et al. 2016).
Maintaining and Restoring Range of Motion
If the goal is improving shoulder range of motion (ROM), a number of papers have demonstrated the effects of soft tissue mobilization or stretch training on improving internal rotation and horizontal adduction.
- 4 weeks of soft tissue mobilization had an affect on tissue stiffness, shoulder internal rotation and horizontal adduction in baseball players with posterior shoulder tightness (Yamauchi et al. 2016).
- Modified cross body stretch and modified sleeper stretch leads to decreased the stiffness of the teres minor and infraspinatus (Umehara et al. 2017)
- Instrumented manual therapy with self-stretching significantly reduces ROM deficits in baseball players (Bailey et al. 2017)
- A 4-week treatment program of manual therapy or dry needling demonstrated a significant improvement in pain pressure threshold, muscle elasticity, and stiffness of neck and shoulder muscles (De Meulemeester et al. 2017).
- A 8-week posterior shoulder stretching program significantly increased internal rotation and horizontal adduction ROM in university-level overhead athletes (Chepeha et al. 2017).
The Complex Clinical Picture of Musculoskeletal Pain
The responses to massage therapy are multifactorial - physiological and psychological factors interplay in a complex manner. A biopsychosocial framework is a practical approach for investigating the complex interplay between massage therapy and the experience of pain.
A treatment plan should be implemented based on patient-specific assessment findings and patient tolerance. I often treat this area while passively moving the arm through a wide range of motion. Gently stretching the muscles, neurovascular structures and investing fascia of:
• the rotator cuff
• teres major
• triceps brachii
• pectoral muscle group
• serratus anterior
• latissimus dorsi
More to Explore
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