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What is a Rotator Cuff and Why does is Hurt so Much?

Updated: May 10, 2022

Rotator cuff and other shoulder pain is way up on the list of diagnoses we see in the clinic every day. It seems that everyone has or knows someone with a rotator cuff problem. Someone who's had therapy, has had surgery, has had a tear, or a Cortisone shot. So, what exactly is the rotator cuff and why does it give so many people so many problems?

Let's start with What the Rotator cuff is exactly

The rotator cuff is a group of 4 muscles that all start on and under your scapula "shoulder blade" and make their way around and attach to the front of the humerus "long bone of the upper arm" through their tendon attachments. They are innervated by the C5 and C6 nerves, meaning that some nerves come out of the lower part of the neck on either side and make their way to the rotator cuff muscles, allowing them the electrical signal to contract, relax, and do their job.

Why does the Rotator cuff get injured and painful so easily?

  • First of all, there are a TON of little structures all crammed into and around the shoulder, including muscles, tendons, nerves, bursae (little fluid-filled sacs that allow your tendons to move and glide without fraying), ligaments, and more. Any one of these structures can become painful if too tight, too weak, strained or torn. Or if you fall on it, that doesn't help.

  • Secondly, your shoulder joint has more range-of-motion than any other joint in the body, so it can do a lot of amazing things, but at the same time, a lot more can go wrong. With great freedom comes great responsibility, and some rotator cuffs are more responsible than others ;)

  • Third, any weakness or tightness that dominates one side of the shoulder can expose issues in the system, causing faulty movement patterns or mechanics, thus causing pain. It's kind of like a really annoying game of tug-of-war.

  • Fourth, with today's societal expectations and body demands (a.k.a. sitting in front of a computer or game for hours on end), we have developed poor postural control and habits that allow our shoulders to become tight in the front and weak in the back (this is a gross simplification, but you get the point), and this doesn't allow our shoulders to effectively do the work they were intended for: reaching, lifting, carrying, pushing, pulling

  • Fifth, the shoulder joint can get easily irritated with repetitive movements, especially if the mechanics are faulty. Washing windows, painting a wall, or scrubbing countertops are all examples of repetitive movements that can irritate the shoulder.

So many things can go wrong, so what can I safely do about my Painful Rotator Cuff, then?

  • Cortisone shot: NOPE just kidding. There are exceptions to this rule, but this should NOT be your first line of defense. Ortho's don't like to tell you this, but Cortisone breaks down your cartilage and tissues a little bit every time you have an injection. Have them on a regular basis and guess what, you're well on your way to a joint replacement!

  • Surgery: NOPE just kidding again. Though there are definite situations in which surgery is necessary and important for rotator cuff tears, many tears and injuries can heal without surgery with the proper guidance. There are several peer-reviewed research articles proving this.

  • Laser therapy: YES! Laser therapy is a great non-invasive way to help heal your injury, improve circulation, and reduce pain and inflammation at the cellular level for a better way to heal naturally and without side-effects.

  • Physical Therapy: DEFINITELY. You have to find out what is causing your problem in the first place. What's tight? What's weak? Where is your pain actually coming from? No Google search will tell you. A skilled Physical Therapist will, though. You have to have a professional take you through the proper evaluations and screens and determine what is happening and what should be done to fix it.

Rotator cuff pain and injury can be SO frustrating, and can take some time to heal, even with the guidance of a great PT. But for your health, mobility, and quality of life, it is SO important that you have a PT evaluate you, even if your Physician hasn't recommended it. Why some Physicians still don't recommend this, I will never know (though I suspect they've been burned by referring their patients to "mill-style, assembly line" PT clinics, who only made the problem worse and gave them a bad taste for PT?).

If you are dealing with a rotator cuff pain or injury and would like to learn how our Physical Therapy and Laser therapy can help you, or are wondering what to do next, register for a free phone or in-person consultation here: or shoot an e-mail over the and we'd be happy to help!

In good health,

Dr. Ashley Bertorelli, PT and Founder of The Green Room Physical Therapy


Clifton Park & Troy

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