By the numbers, 50% of 60 year olds have a rotator cuff tear. However, most don’t even know it and function quite well. Unless there is severe muscular impairment, the need for an MRI early in the course of shoulder care is unwarranted. A skilled practitioner can assess the shoulder without the need of soft tissue imaging. In most cases the MRI would not change the immediate course of care and obviously does not provide any symptom benefit. On the other hand, a film x-ray may prove beneficial to quickly assess bony based degenerative change, calcification of tendons (a direct correlative to moderate rotator cuff injury), and rule out any underlying systemic issues (ie benign or malignant growth within the bone). Again, a skilled assessment of the joint by a medical professional will determine if this needs to be done.
Managing an Aging Shoulder
The crucial component moving forward is how you are going to manage your gracefully aging shoulder girdle in order to maximize your enjoyment and success. Think about the process like brushing your teeth – it’s boring but necessary.
Remember not to put the cart in front of the horse. This is a common problem as patients try to jump-start the process with a return to the health club. Not being fully aware of the level of degradation can lead to further injury as one implements an overly aggressive exercise program.
The Gold Standard:
Restoring sport/lifestyle specific 3-dimensional mobility (motion) with sport/lifestyle specific exercise (strength) following immediately behind. This, within a context of safe loads and speed where normative functional mechanics (the rolling and gliding of ball on socket which equates to no pain at the extreme of the motion) can be maintained during exercise.
Unfortunately, most fall to the “Cardinal Sin of the Health Club” where the exact opposite occurs. If loads (weight) are moved at too high a speed into extremes of motion where the shoulder joint can’t roll as it should, there is the equivalent of a car crash with every repetition; the bigger the loads and higher the speed, the worse the crash. 30 to 40 reps, 3 days a week of this and one can now fully appreciate the stiff and sore shoulder the morning after a workout.
Our brains will only allow this to occur for a short period of time until it summons the body to take its inherent fight or flight response by slowly shrink wrapping the joint in the attempt to stop the person from inducing more trauma. In a full blown state, this is known as a frozen shoulder or adhesive capsulitis. For many, it’s hard to change since the “NO PAIN, NO GAIN” mind set is ingrained. Unfortunately, continuing down this path leads to an irreversible outcome and a chair in the orthopedic surgeon’s office.
No Pain, No Gain…No Brain
The majority of us don’t make a living with our pectoral muscles and we hope to be frequenters of the gym and pickle ball court for years to come. Thus the GOLD STANDARD needs to be adopted. Using the following program, where motion is first and progressively restored followed by low load / high repetition exercise, one can ensure maximal function with minimal fallout.