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Rotator Cuff Strain

The term “Rotator cuff” describes a group of four small muscles that hold your shoulder in its shallow socket while larger muscles move it. Strains and injuries to the rotator cuff are the most common cause of shoulder problems, accounting for 4.5 million doctor visits per year. Injuries are classified by the amount of damage as “partial tears”, “full thickness tears” or “ruptures”. A “partial
tear” means that one side of your tendon has been partially frayed. A “full thickness tear”, sometimes called a “complete tear”, describes a hole or slit in your tendon, much like what would be created by running a knife length-wise down a rope. A “rupture” is the most serious injury and means that your tendon has been torn into two pieces.

Less than 10% of rotator cuff tears are the result of an acute injury like falling, pushing, pulling, throwing or lifting. The vast majority of injuries are the result of repetitive strains over a long period of time. One of the most common reasons that patients develop a rotator cuff tear is something called ”impingement”. Impingement basically means that the area where your rotator cuff tendon lives has become too crowded and the rotator cuff tendon is being pinched each time you raise your arm. Those who perform repeated overhead activities are at greatest risk for impingement and rotator cuff tendon problems. This includes athletes who play baseball, volleyball, tennis, rowing, weight lifting, swimming and archery, and jobs that include carpentry, painting, wall paper hanging, cleaning windows and washing/waxing cars. Other known risk factors for rotator cuff problems include smoking, obesity, high cholesterol and prior cortisone injection.

Patients who have suffered an acute rotator cuff injury often report a “tearing” or “snapping” sensation accompanied by severe pain and weakness. Most chronic strains begin silently with symptoms becoming more evident as the tear progresses. Pain is often localized to the front and outside of your shoulder but can sometimes radiate down your arm. Symptoms are usually aggravated by overhead activity and may progress to the point that you have difficulty raising your arm overhead. Pain is often worse at night, especially when you lie on the affected shoulder. Be sure to tell us if you suffer from significant neck pain, shortness of breath, chest pain or chest pressure.

Young patients who have suffered an acute tear or rupture may require surgery, while most others will benefit from conservative treatments, like the type provided in this office. Be sure to avoid painful overhead activity or carrying heavy objects. Try not to sleep on your irritated side, especially with your arm stretched overhead. You may benefit by sleeping on your unaffected side with a pillow between your arm and trunk. Smokers should consider a program to help them quit, and overweight patients will recover quicker if they begin a diet and exercise program. Performing your home exercises is especially important.
Here is a brief description of the treatments we may use to help manage your problem.
Joint Manipulation
Your chiropractor has found joints in your body that are not moving freely. This can cause tightness and discomfort and can accelerate unwanted degeneration i.e. arthritis. Your chiropractor will apply a gentle force with their hands, or with hand held instruments, in order to restore motion to any “restricted” joints. Sometimes a specialized table will be used to assist with these safe and effective “adjustments”. Joint manipulation improves flexibility, relieves pain and helps maintain healthy joints.
Therapy Modalities
We may apply electrotherapy modalities that produce light electrical pulses transmitted through electrodes placed over your specific sites of concern. These comfortable modalities work to decrease your pain, limit inflammation and ease muscle spasm. Hot or cold packs are often used in conjunction, to enhance the effect of these modalities. Another available option is therapeutic ultrasound. Ultrasound pushes sound vibrations into tissues. When these vibrations reach your deep tissues, heat develops and unwanted waste products are dispersed.
Myofascial Release
Overworked muscles often become tight and develop knots or “trigger points”. Chronic tightness produces inflammation and swelling that ultimately leads to the formation of “adhesions” between tissues. Your chiropractor will apply pressure with their hands, or with specialized tools, in order to release muscle tightness and soft-tissue adhesions. This will help to improve your circulation, relieve pain and restore flexibility.
Therapeutic Exercise
Muscle tightness or weakness causes discomfort and alters normal joint function, leading to additional problems. Your chiropractor will target tight or weak muscles with specific therapeutic stretching and strengthening to help increase tissue flexibility, build strength, and ease pain. Healthy, strong, and flexible muscles may help prevent re-injury.
Foot Evaluation
Fallen arches and faulty foot mechanics are common problems that can perpetuate your condition. Our office will carefully evaluate your feet and consider the need for a change in shoe style, arch supports or even custom orthotics.
Nutritional Counseling
Good nutrition and supplementation are keys to health and healing. Our office is available to help with your nutrition and dietary supplement needs. We may make specific recommendations for dietary supplements to assist with your health.
Ankle Brace
Our office may recommend using a support brace to protect your ankle from further injury. Your doctor will discuss the specific type of brace and provide instructions for use.
 
 
After this initial course of treatment we will reassess your progress. We will determine the need for any additional care after your reassessment.
Sleep Posture
Your mattress and the position you sleep in may affect your condition.
Choose a mattress that provides medium or firm support, such as a traditional coil spring or adjustable airbed. Avoid waterbeds, thick pillow tops and soft, sagging mattresses.
Always sleep on your back with a pillow either underneath your knees or on your side with a pillow between your knees. Avoid sleeping on your stomach.
Keep your neck and back covered while sleeping to avoid drafts that could cause potential muscle spasms.
Exercise- Aerobic
Aerobic exercise requires your heart and lungs to work harder. Aim to get at least 20-30 minutes of exercise daily, 4-6 times per week to help prevent problems ranging from heart disease to back pain.
Start off gradually, and consult your doctor to determine your appropriate level of exercise.
Vary your activities to prevent overuse injuries. Examples include – Walking, swimming running, bicycling and low impact aerobics.
Work out with a friend for motivation.
Make sure that you are still able to talk while exercising (referred to as the “talk test”).
Workstation Ergonomics
Ergonomics is the science of adjusting your workstation to minimize strain in the following ways:
Maintain proper body position and alignment while sitting at your desk - Hips, knees and elbows at 90 degrees, shoulders relaxed, feet flat on floor or footrest.
Wrists should not be bent while at the keyboard. Forearms and wrists should not be leaning on a hard edge.
Use audio equipment that keeps you from bending your neck (i.e., Bluetooth, speakerphones, headsets).
Monitors should be visible without leaning or straining and the top line of type should be 15 degrees below eye level.
Use a lumber roll for lower back support.
Avoid sitting on anything that would create an imbalance or uneven pressure (like your wallet).
Take a 10-second break every 20 minutes: Micro activities include: standing, walking, or moving your head in a “plus sign” fashion.
Periodically, perform the “Brugger relief position” -Position your body at the chair’s edge, feet pointed outward. Weight should be on your legs and your abdomen should be relaxed. Tilt your pelvis forward, lift your sternum, arch your back, drop your arms, and roll out your palms while squeezing your shoulders together. Take a few deep cleansing breaths.
Nutrition-Expanded
The typical American diet is high in foods that cause increased tissue acidity and have high levels of free radicals which may initiate and/or amplify pain and many other conditions, including cancer, heart disease, decreased immunity, diabetes and arthritis. The foods we eat have a dramatic impact on how we feel and our bodies will perform best with quality foods.
The Sugar Cycle:
Routinely eating products that contain sugar leads to a vicious sugar-craving cycle.
Sugars are absorbed into our blood and travel to the brain.
Sugar in the brain releases a chemical called serotonin that produces a sense of happiness and well-being.
As our sugar blood levels fall due to insulin production and sugar absorption, we move from a hyperactive state to more of a tired, irritable and weak state.
Concentration levels fall, and our cells begin to become acidic.
Our brain then once again sends a message that we need more sugar, and the cycle begins again
Decrease consumption of red meat & refined carbohydrates like sugar and white flour
These are easily converted to fat and the byproduct of this breakdown is arachidonic acid
Arachidonic acid and prostaglandins (formed when animal fats and proteins are broken down in the body) are highly pro-inflammatory and intensify pain and initiate disease throughout the body.
When possible, substitute darker whole grains for refined white grains. Examples include: 100% whole grain bread made without hydrogenated oil, brown rice, whole grain pastas, couscous and others.
Red meat should be limited and may be replaced by fish, especially the cold-water fish such as salmon, mackerel, tuna or herring. These fish also contain a chemical called DHA, which has been shown to increase brain circulation and function.
Choose “healthy” oils like avocado, olive, coconut, or canola
Choose your oils carefully. Omega 6 oils are bad- these include the “warm weather Southern oils” of corn, sunflower, peanut and most others. This would also include oils from red meat, dairy products, and shellfish.
Omega 3 oils or “cold weather Northern oils” are better. These would include flax, soy, wheat germ, canola and fish oils.
Olive oil is classified as an Omega 9 and has been shown to have anti-inflammatory properties. It has also been shown to have numerous other biological benefits including the reduction of harmful free radicals.
Avocado oil is primarily an Omega 9 oil and is an exceptional health choice with numerous health benefits including anti-inflammatory properties and reduction of harmful free radicals. As a bonus, Avocado oil has higher smoke/flash points than olive oil - making it a better alternative for searing or frying.
Coconut oil, while higher in saturated fats, has been shown to lower bad cholesterol and increase levels of beneficial antioxidants.
When possible, choose organic, extra virgin oils. “Organic” means that it was grown in pure soil without the use of pesticides, and extra virgin means that it was pressed without the use of heat or chemicals.
Increase consumption of vegetables and fruits
The average American diet contains one and-a-half servings of vegetables and one serving of fruit per day. The minimum recommended daily allowance is five servings of fruits and vegetables. Optimally, we should eat 9+ servings of fruits and vegetables.
High fiber intake improves gastrointestinal function and decreases our risk of colon cancer.
We should ingest 25-30 grams of fiber per day. Good sources of fiber include beans, lentils, fruits, vegetables, whole grains and nuts.
Fruits and vegetables neutralize acids.
Fruits and vegetables are also high in vitamins and minerals, which are necessary for good health.
Fresh fruits and vegetables contain phytonutrients, which are known as the “guardians of health.”
Phytonutrients have been shown to protect us from several chronic diseases including heart disease, cancer, diabetes, hypertension and arthritis.
Standing
To avoid extra stress on your spine while standing:
Avoid high-heeled shoes or boots
Use a footrest measuring 10% of your height
To decrease stress on your back and feet consider leaning on a tall chair.
If excessive standing can’t be avoided, consider shock-absorbent shoes or an anti-fatigue mat.
When transitioning from a sitting workstation to a standing desk, begin gradually by standing 20 minutes per hour and not necessarily in a continuous period. Add an extra 10 minutes per hour each day as long as there is no prolonged stiffness or discomfort.
Footwear
Improperly supported feet can affect the alignment of all of the structures above. To improve your overall comfort:
Choose shoes with good arch support.
Avoid going barefoot or wearing shoes that lack support (i.e. flip-flops). The following brands of sandals provide better than average arch support: Naot, Fit Flops, Orthoheels, Abeo, Vionic and Yellow box.
Avoid high-heeled shoes or boots (keep heels to a maximum of 1½ inches, especially if you are going to be doing a lot of walking).
“Cross-trainer” athletic shoes tend to provide the best all around support and shock absorption for daily activities.
Patients with fallen arches should consider adding arch supports or orthotics.
Repair or replace shoes with worn soles or heels.
Running Shoes
Running shoes need to be replaced every 250 miles. There are three basic options:
Motion Control Shoes – Designed for people with low or no arches, these shoes are for runners who strike the ground on the outer edge of their foot. Avoid overly stiff shoes as these decrease you perception of ground strike and lead to new injuries.
Stability or Neutral Shoes – Designed for people with normal or average arches and running mechanics. The shoe contains some cushioning to absorb shock and prevent injuries and some rigidity to avoid pronation.
Cushioned Shoes – Designed for people with high arched feet. Their footprint will typically leave a thin band along the foot’s edge. As they run weight is distributed from heel strike to the outer edge of the foot and small toes that bear the brunt of “lift off.” This shoe is more flexible and absorbs the shock created by the lack or rotation (under-pronation) created by their running style.
Exercise- Water Aerobics
“Water Aerobics” simply means that you are exercising in the pool. Water exercise adds resistance but reduces the effect of gravity, and is usually less stressful on your joints. Water Aerobics are better tolerated by people who have joint problems like arthritis.
You do not need to be a swimmer to exercise in the water - most classes are held in chest-deep pools. Check with your gym or local YMCA to inquire about classes.
Working out in a group class can help with motivation.
As with all aerobic exercise, you should start gradually and don’t exceed the “talk test”- meaning you are still able to talk while exercising.
Sports Cream
Sports creams come in a variety of styles that produce either a sensation of heat or cold. These creams do not speed healing, but may provide temporary relief. Their effect is to pleasantly irritate the skin by stimulating the highly sensitive surface nerves, so that your brain can temporarily "forget" about your underlying deeper pain.
Sports creams have no known side-effects when applied in small amounts but do not apply more than a 2-3 of times per day unless otherwise directed.
Racquet Sports
Here are a few pointers for selecting your racquet:
Improper grip size is a known contributor to elbow problems. When you grip the racquet, you should be able to snuggly slide the index finger of the other hand between the tips of your fingers in the base of your palm.
A good grip overwrap can help prevent slipping and decrease the amount of force required to hold the racquet. (Factor the extra wrap into grip size, though)
Players should quickly release their grip tightness after ball-to-racquet strike in order to reduce stress on the elbow.
Increasing the size of your racquet head can help to reduce arm stress.
Avoid choosing “longer” or “heavier” racquets that will increase the amount of stress on your elbow.
Graphite is a light racquet but does not absorb vibration well. When possible, choose a more flexible frame that helps to absorb some of the shock of the ball’s impact.
Avoid playing with old or wet tennis balls as the additional speed and mass of the ball increases stress on your elbow. “Softer” or “stage 2” tennis balls weigh less than standard tennis balls which will produce less stress on your elbow when you strike the ball. These balls can also slow down the game slightly.
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