Shoulder Rotator Cuff (RTC) What Went Wrong?

There’s more to the following conversation/dissertation about WHAT WENT WRONG and how you knew it, know it, and care for it. You functioned in an erroneous way. So you created a formation of pain and dysfunction needing attention. Hippocrates admonished: “First, do no harm”! He may have been speaking to physicians but it’s good advice for you also.

I have found RTC injuries or pathologies are fully explainable. They occur because of:

1) Sudden trauma as might occur in sports: tug, jam, twist

2) Inadvertent work or other daily activity trauma: resulting from the same above reasons.

3) Repetitive trauma:

a. cumulative trauma disorder:
Sports or work activities may repeatedly damage circulatory tissues of tendons (impingement syndrome).

b. repetitive strain injury (RSI):
Overworking of the RTC tissues and their environment (constant tugging/pulling); such as sports or work throwing or holding activities.

4) Some sleeping postures (a passive type of cumulative trauma).

You may remember the “3 F’s” aphorism in my blog on healing: Form Follows Function.

All joints have muscle and ligament control mechanisms but also a morphological relationship (surface shape, menisci, labrums) for determining articular (surfaces of each bone where they meet/touch) motion (referred to as accessory motion by John McMennell). The RTC is one of those muscle groups helping to control the shoulder motion activity and keeping the gleno-humeral (shoulder) joint surfaces pretty much indispensible for throwing sports.

But it’s all in the head. It may be correctly stated: “No brain, no kinetic chain”. But with a functioning brain, much can be directed to correct “what went wrong” with your RTC.

The nervous system includes the tools for establishing a muscle’s resting length, over all tone, and honing one’s coordination. The general umbrella terms may be proprioception, gamma bias, mechanoreceptors, free nerve endings, stereognosis, and others. It helps to have a normal functioning circulatory system as the shoulder ages, but even that will be notably influenced by the nervous system’s learned patterns of rest and function.

Resting posture (doing nothing) influences RTC training outcomes. It all has to do with brain interneuronal agility training and requisite engrams. If you do nothing, nothing will happen. If you train poorly, results will be poor. If you train properly…we wouldn’t be having this conversation.

In some ways we function like an oligarchy (government by the few). Most of the time mechanoreceptors reign supreme in nervous system traffic. They speak to the thalamus (a kind of president or ombudsman of the body located in the head) and provide a lot of the cabinet members who influence important (and instantaneous) decisions for the corpus (our body) to function. Washington D.C. should be so efficient.

Free nerve endings sit at the same table in the oligarchy. They know the pain you are experiencing and have the thalamus’ ear. You touch a hot stove (A delta fiber free nerve endings), your RTC won’t show much concern for the mechanoreceptors except to yank away the hand attached to the arm; but also your tongue and larynx yelp “ouch”. You have achy arthritis, delayed onset muscle soreness, or chronic RTC tendinitis, your C fibers of pain keep a low reminding tone to you to protect your functioning self (healing blog); that is: don’t make yourself worse using the pathological tissues without good reason.

You have to become an autocracy (self management), take control of your oligarchy through the abovementioned representatives. How? through proper exercise and body ergonomics instruction.

In all likelihood, after her/his examination, your orthopedic surgeon will first send you to a physical or occupational therapist:

1) To be examined for fitness to be a patient.

2) Receive supervised instruction and education with a Home Exercise Program (HEP) for RTC personal care.

3) Perhaps become a patient if #2 doesn’t work out.

4) Be offered a recurring therapist supervised exercise program predicated on Form Follows Function; as your RTC heals, repairs, and maintains its health, to hold up its proper responsibilities to the autocracy.

The next blog. When did your Knee pain begin?