What’s with all of the shoulder problems after 50?
Rotator cuff tears, tendinitis, impingement and bursitis… if you are 50 or older, chances are you have experienced one of these or know someone who has. These injuries can be incredibly disruptive to regular daily activities. Sometimes one can’t even predict what movements will illicit that gut wrenching sharp pain. When things start to get particularly bad, the aching interferes with sleep. So why is this so common in the 50+ group? More importantly, is there anything that can be done? Read on to learn the answers to these questions.
There are several contributing factors to rotator cuff injuries.
1. The rotator cuff muscles, tendons and bursa are packed into a pretty tight spot.
Essentially this means that there is less room for error. So, if the shoulder joint and surrounding areas aren’t tracking or aligning properly, the space can quickly become even tighter which results in impingement.
2. Shoulder and rotator cuff function is highly contingent upon the rib cage, spine, and shoulder blade working optimally to keep rotator cuff alignment ideal.
If there are muscle imbalances or coordination issues in these other areas, the rotator cuff might take the hit as it tries its best to keep the ball-in-socket joint stable. When the rib cage, spine, shoulder blade, and shoulder joint regions are all functionally optimally, the work load is equally distributed and there is less risk of injury.
3. A history of highly repetitive upper body tasks – whether it be occupational, sports-related, or a combination – can cause undue wear-and-tear.
Considering the small space that the rotator cuff occupies and the impact that mis-alignments in the rib cage, spine and shoulder blade regions can have, it’s not hard to imagine why layering repetitive movements on top of that may cause excessive wear.
4. Physiological changes in our 40s and 50s contribute considerably.
Blood supply and the rate of cell division decreases. In short, this means that our body’s ability to recover from micro-injuries becomes impaired, making the accumulation of these micro-injuries greater. Additionally, collagen and tissue elasticity decrease as we age. This means our tissues are less pliable and less durable to higher or unexpected loads.
Taking all of the above into account, by the time you get to 50+, the rotator cuff muscles and tendons might be pretty worn down. This is why the painful injuries seem to come on “out of nowhere” or a seemingly benign action can result in a tear. Frustrating, huh? But there’s good news! There are things you can do to improve your rotator cuff health and decrease your chances of injury. Not to worry if you already have an injury, I also have some solid advice for you. Read on for this key guidance.
How to improve your rotator cuff health
My first suggestion cannot be stressed enough: live a healthy lifestyle.
Before you skim through this section, hear me out. Part of why our body’s tend to suffer as we age is due to the accumulation of bad lifestyle habits. These bad habits make impair our body’s natural ability to heal and restore considerably. However, it is never too late. I have witnessed many clients have a significant improvement in their musculoskeletal health by simply eating a ton of fruits and vegetables, hydrating adequately, getting proper sleep, exercising regularly and downsizing their life to decrease stress.
Next, you need to address the function of your spine, rib cage and shoulder blade.
Note that the proper execution of these exercises is key in reaping the benefits. Quality is everything! Check out the video below for exercises to address these supporting body regions. I recommend doing this as one of your work outs 1-2 times/week as it will benefit much more than just your shoulder.
Now you need to address the rotator cuff muscles specifically.
Check out the video below to learn a few options. Once again, you can simply incorporate them into your regular work out 1-2 times/week.
Lastly, you want to maintain shoulder mobility.
The shoulder is already a relatively mobile joint, so most people don’t need much in this department. There are a few key motions that you want to keep flexible, however, so that your rotator cuff isn’t fighting against stiffness. Check out the video below to learn these mobility exercises.
What to do if you already have an injury
Whether you have tendinitis, bursitis, impingement, or a tear – find an expert physical therapist! They keyword being “expert.” Here are some things to look for when you choose a PT:
-an OCS physical therapist (Board Certified Orthopaedic Clinical Specialist)
-someone who assesses not only the shoulder thoroughly but also the spine, rib cage and shoulder blade comprehensively
-exclusive attention from the PT rather than being handed off to aides or assistants
-a therapist who individualizes the plan specific to your body and your problem rather than slapping on a standard set of exercises
-a therapist who carefully monitors the execution of your exercises to insure quality and precision
(Note that if you are not a Los Angeles local, I also offer virtual sessions for clients nationwide.)
“What if I have a full blown tear?!”
According to a 2018 research study in the Journal of Shoulder & Elbow Surgery, the answer remains – go to physical therapy. In this study, participants with chronic full-thickness rotator cuff tears underwent 3 months of comprehensive physical therapy. Here were the results:
-75% of the non-operative group were successful at the 5-year mark – meaning, they avoided surgery and were able to use their shoulder effectively.
-As compared to the group who did have surgery, there were no significant differences in outcomes at the 5-year mark.
As I mentioned above, consulting with the right physical therapist is key. Also plan on committing at least 3 months to the process. I say “at least” because it may take longer. At the 3 month mark you will know for sure whether or not the conservative route is working but you may need another few weeks to get the shoulder to where you want it to be.
At the end of the day, this is a win-win strategy. If you still end up needing surgery, having the pre-operative physical therapy will make your post-op recovery significantly better since you will go into it with better strength, mobility, and tissue function. Yet, considering that 75% number above, the odds are in your favor that the PT works and you avoid the risk, cost and headache of surgery all together.