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26 m a s s a g e & b o d y wo r k n ove m b e r/d e ce m b e r 2 0 2 3 The intricate structures of the tendons and muscles in the shoulder play a pivotal role in the function and stability of the joint. When they are compromised, daily activities like reaching for something on a high shelf or getting a restful night's sleep can become painful challenges for your clients. Shoulder pain that interferes with mobility and quality of life can often be traced back to one culprit: rotator cuff disorders. We look at key treatment strategies in this second part of our two- part series on rotator cuff disorders. In the previous installment (Massage & Bodywork, September/October 2023, "Put Your Shoulder Into It, Part 1," page 24), we looked at the structure and function of the rotator cuff muscles, along with common evaluation strategies. Rotator cuff disorders represent a range of conditions affecting the tendons and muscles of the shoulder joint. The supraspinatus, one of the primary tendons, is commonly involved and can suffer from tears or inf lammation. This is often due to overuse or acute injury, which leads to pain and restricted movement. Similarly, the posterior cuff, comprising the infraspinatus and teres minor, plays a crucial role in external rotation and stabilization. Injuries to the posterior cuff often develop due to strong eccentric loads from decelerating the arm at the end of throwing motions. On the anterior aspect of the shoulder, the subscapularis muscle, responsible for internal rotation, can also become compromised. Disorders in this muscle may result in sharp pain at the front of 26 m a s s a g e & b o d y wo r k n ove m b e r/d e ce m b e r 2 0 2 3 Put Your Shoulder Into It, Part 2 Treating Rotator Cuff Disorders TECHNIQUE By Whitney Lowe CLINICAL EXPLORATIONS KEY POINTS • Rotator cuff issues can vary from mild strains to severe tears, posing treatment dilemmas. • Massage can play a key role in conservative treatments if the therapy is well-designed and targeted to the client's individual presentation. the shoulder, especially during pushing or lifting actions. Due to shoulder mechanics and other synergistic muscles, subscapularis injuries are the least common, as other, stronger shoulder muscles aid this muscle in its primary actions. The four rotator cuff muscles can sustain injuries as a result of various mechanisms and causes. It's essential to understand that each muscle requires a unique treatment strategy. Unfortunately, many individuals are diagnosed with a "rotator cuff tear" without clarifying which specific muscle(s) are affected. These vague descriptions can result in generalized treatments that may be less effective. An accurate assessment is the key to tailoring treatments to ensure optimal client results. Rotator cuff issues can vary from mild strains to severe tears, posing treatment dilemmas. Treatment choices range from noninvasive methods to surgical procedures. Noninvasive treatments include physical therapy, massage, heat or cold applications, and nonsteroidal anti-inf lammatory drugs (NSAIDs). These therapies are meant to reduce pain and inf lammation and improve mobility. These conservative treatments can successfully aid healing and restore functionality for those with less severe injuries or at high surgical risk. Surgery is recommended for more severe tears or when conservative treatment fails to bring relief. It involves repairing the torn tendon and, in some cases, removing bone spurs or inf lamed tissue. While surgery can provide a definitive solution to the structural problem, it also comes with inherent risks and requires an extended recovery