Rotator Cuff Injury & Rehab
Michael Stewart, DC CCSP
With his eyes fixed on the catcher’s glove, a 17-year-old baseball pitcher wound up by cocking
his arm into external rotation and maximal extension with abduction. Acute, sharp, burning pain
started as soon as he accelerated forward and peaked at the follow-through. After leaving the
game earlier than expected, the young athlete iced it once for 20 minutes that night only to be
awakened by the pain while sleeping. Confused about what he had done, since he performed
victoriously in his last 6 outings, he consulted his local sports chiropractor for a professional
opinion.
In this case, the 17-year-old presented had redness and tenderness over the superior aspect of the
humeral head just inferior to the coracoacromial arch, and tenderness over the postero-inferior
aspect of the glenohumeral joint. Passive range of motion was normal. Active abduction was
restricted to 80 degrees due to pain. Active external rotation was restricted to 80 degrees with
end range pain. All other ranges were normal. Resisted ROM was weak and painful in abduction
and external rotation with the arm at his side and in 90 degrees of abduction. Orthopedic testing
revealed a positive Supraspinatus Test for moderate weakness and pain as compared to the
normal side, and a positive Codman’s Drop Arm Test. All other provocative maneuvers were
normal indicating no involvement of the labrum, capsule, bursa, or GH ligaments. Myotomes and
dermatomes were within normal limits. Cervical and TOS testing were negative. X-rays were
unremarkable with normal alignment and no apparent fractures. An MRI was not ordered at this
time. An MRI should be considered if examination findings include significant weakness, or if
the examination does not give a clear diagnostic picture and injury to multiple structures is
suspected. An MRI should also be ordered if the patient does not respond to care within the
expected time frame for improvement.
After a complete and thorough history and evaluation, the sports chiropractor has determined that
this aspiring big leaguer has a partial tear of the rotator cuff – Grade II Strain of the supraspinatus
– and a Grade I Strain of the teres minor. To most practicing chiropractors this is an easy
differential diagnosis. The difficult task is determining the severity of the injury, which muscle(s)
are involved, how to rehabilitate the shoulder back to health, and how to know if a ballplayer’s
career is compromised.
The first two weeks of rehabilitation focused on the reduction of pain and inflammation. In this
phase laser therapy, stimulation, and ice therapy were applied. Gentle mobilization was
performed to maintain joint motion. SPRT Taping passively helped in freeing the damaged
muscle from impingement and began the proprioceptive retraining process. Range of motion
exercises were instituted as soon as possible, outside the range of pain, to prevent scar tissue
formation and frozen shoulder. In the second phase of care, which lasted about four weeks,
isometric exercises were added. Tubing or therapeutic bands can be used to accomplish this task.
Once it was determined that the exercises were helping, resistance exercises through a pain-free
range of motion, such as external rotation, internal rotation, and abduction were added to isolate
the different rotator cuff muscles. After each session, ice was applied and light stretching was
performed. When exercises were performed pain-free and through a full range of motion, phase
three of rehabilitation began and focused on sport-specific training for six weeks. Resistance
training with a pulley system helped strengthen the muscles in the throwing motion. Following
that was a light toss program with a slightly heavier than normal baseball. Modified push-ups
were performed against a wall or table top on an angle. Spine and extremity adjustments, core
strengthening, and aerobic training were included in all three phases of rehabilitation
Although this rehabilitation program lasted twelve weeks, the amount of time to rehabilitate a
torn rotator cuff muscle can vary. A rehabilitation program lasting up to six months is common.
Determining factors can include adherence to the recommended schedule, self-care diligence,
innate healing capability, severity of the tear, and re-injury prevention. An exit evaluation is
imperative to determine at what level the ballplayer can compete. In this case the pitcher
regained seventy five percent of his strength but was pain-free with full range of motion. He was
released from care to participate in baseball again with instructions to properly pre-treat and posttreat his workouts and outings. A highly competitive athlete has an increased probability of reinjuring the rotator cuff if performing at the intensity of collegiate and professional sports.
Competitive athletes, with sports and competition flowing through their veins, live and die on the
field of battle regardless of their physical limitations and will continue their sport at whatever
level they are capable.
--------------ANJC Sports Council is dedicated to providing its members with high quality, sports-related continuing
education and practice management. We are committed to preparing our members to participate as sports
chiropractors on the field and in their office. In addition, we are dedicated to promoting sports chiropractic
throughout the greater medical community. For more information about our next free workshop or to join
the ANJCSC, contact Dr. Eric Nelson at sportscouncil@anjc.info.