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<strong>Rotator</strong> <strong>Cuff</strong> Injuries Injuries to the rotator cuff and its tendons are very common. In younger patients, injuries are usually caused by either repetitive actions or sudden trauma. With older patients, we often see these injuries occurring with activities that require reaching overhead, and are typically caused by a decrease in the elasticity of muscles and tendons with increasing age. No matter what the cause, it is often quite difficult to pinpoint the actual location of a rotator cuff tear. Patients often describe the pain as covering a broad area over the shoulder, often with pain radiating down the arms and elbows. For most cases, a simple physical examination is all that is needed to diagnosis this condition. The exception occurs when there are indications of a complete tear such as an inability to perform certain motions. Tears to the rotator cuff cannot be seen on X-rays. Typically, you will need an ultrasound to confirm a full tear of the rotator cuff. These are tests that the doctors a kinetic health can order for their patients. Fortunately, most tears of the rotator cuff do not need surgical intervention. In most cases, a rotator cuff injury can be easily treated with a combination of manual therapy procedures and exercise. Effective treatment of a rotator cuff injury requires a good understanding of the anatomy, biomechanics and the shoulders kinetic chain, since much more than just the rotator cuff should be addressed in any treatment protocol. Incredible Mobility at the Cost of Stability Your shoulder is the most movable and flexible joint in your body. Most people take for granted the amazing synergy we have between our shoulder actions. This very fine balance between mobility and stability in the shoulder is what allows us to have such an incredible freedom of motion through this joint. The shoulder is a “ball and socket joint” held in position by a fine balance of muscles, ligaments, tendons, and fascia. This fine balance can easily be disrupted by trauma, repetitive motion (micro trauma), poor posture and many other causes. Once an injury does occur, in the shoulder it is extremely important to understand how your body works as interlocking segments in a larger kinetic chain.
Kinetic Chains Form Kinetic Webs The structural inter-dependencies between the muscles, tendons, ligaments, joints, and fascia of your body comprises a Kinetic Chain. You can think of your body as being comprised of a series of small kinetic chains, each linked to other kinetic chains to form a complex bodyencompassing Kinetic Web! Tension or injury to any part of this kinetic chain would affect the function of all its linked components. Visualizing the Kinetic Chain You can visualize the kinetic chain from your shoulder to hand as a layered, multi-level spider web. In your body, this web is made up of soft-tissue fibres (muscles, tendons, ligaments, and connective tissue). In some areas where are there are multiple layers of muscle and soft tissue, this complex web can be seven-oreight layers thick. Like all natural webs, each kinetic web is unique to each individual’s unique anatomy, and can vary structurally depending on that person’s environmental and genetic factors. Just like a spider’s web, if you were to pull or increase tension in one of the fibres, this tension would resonate throughout the entire web. However, unlike the two-dimensional spiderweb, this resonance would be felt above, below, beside, and behind the affected fibre. Thus, damage to muscle fibres in one area would affect the function of tissues in multiple layers, through multiple planes of motion, and at multiple locations. Unfortunately, the majority of medical schools do not teach anatomy with these interconnections in mind. Sadly, anatomy is usually taught as if each separate structure was floating in space, with little or no emphasis on the effects of that structure’s interconnections to its surrounding tissues. A better way to learn anatomy would be to understand how each structure’s fibres connects into the next structure, and how each component of our musculoskeletal system affects the function of every other structure. When a muscle contracts, many other muscles also contract (or relax) in different directions, gliding over each other. All of these actions are supported by the core of your body and directed by your nervous system. This synergistic dance of complexity is truly amazing!
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