Rahul started playing badminton at a very early age. He was a star in school, went about playing through his college and graduation. However, by the time he was 30, he started loosing his touch. His shoulder would frequently freeze with pain. He would be uncomfortable playing volleys. In short he started loosing his touch in the game. He went to his doctor, who got his MRI done and found that he has partial tear of rotator cuff and sprain of biceps.This is not the story of Rahul alone. 

Lot of people get these bouts of shoulder pain either due to sports or due to profession which involves prolonged sitting, forward tilting and active use of arm in sitting position.

What happens normally?

Let’s first understand what’s the function of these seemingly small muscles.Rotator cuff is a group of 4 small muscles which arise from shoulder blade and insert on humeral head. They intimately surround the shoulder joint and hence play important role in controlling the movements of shoulder and impart it stability. They primarily function is pivot to shoulder, so that the other big muscles (like deltoid, pecs, trapezii, rhomboids do their function of heavy loads efficiently. Any problem with the rotator cuff can just make other big muscles ineffective and inefficient. But for the rotator cuff to function efficiently, they need a stable and proper functioning shoulder blade (scapula). The scapula holds steady on the rib cage, lets rotator cuff function correctly and thus the whole business of shoulder joint runs smoothly.

What goes wrong: The problem arises when the excessive loads on shoulder are not matched by strength of shoulder blades. When shoulder blades are weak and inefficient, it remains tilted in abnormal position. This in turn compromises the functioning of rotator cuff. They are overworked and over the period of time face excessive wear and tear. This result in insufficiency of cuff and further compromises shoulder function. This vicious cycle ultimately leads to complete rotator cuff tear and bring shoulder function to standstill. 

How does It affect your life: Right from our day to day activity to intricate functions like art, music and sports, smooth functioning of shoulder is paramount. When shoulder function compromises, the elevation of arm, rotation of arm, forceful movements of arm are compromised. Every small function becomes painful. Slowly the pain remains even at rest. It disturbs sleep, causes total compromise in quality of work and life.

What can be the solution: The best solution is prevention. Prevention is thousand times better than cure.

First, whether you are a player or an office goer or a homemaker, you need to understand the importance of posture. Keeping the back straight and keeping the shoulders from slouching is the first thing you need to do. This will prevent the shoulder blades from going into abnormal position.

1. Get up frequently, sit upright with a support at the back.

2. Every few hours, stretch out your back and shoulder blades.

3. If you are a sports enthusiast, gym person, focus on strengthening your core muscle; back, abs, shoulder blades.

4. It is utmost important that you stretch the pectoral muscles. Pectoral muscle tightness is the prime reason for tilted shoulder blades(scapulae).

What to do once It happens: The moment you start discovering shoulder discomfort, you must become alert.Do not work through the pain. Do not think that pain will die down on its own.

Take the following steps;

1. Stop doing whatever activity that aggravates the pain.

2. Get yourself examined by a qualified shoulder doctor to find out the origin and the root cause of pain

3. Follow up strictly the rehabilitation program to strengthen the shoulder blades, rotator cuff and core muscles.

4. For people who play sports, stop playing the shots which put excessive loads on shoulder. Sit down with your coach and find out if there is any fault in your actions or your shots. Chart out a strict regimen to improve your core strength.

Role of surgery: Surgery has a role when there is frank tear of rotator cuff resulting in significant compromise in shoulder function. Arthroscopic repair of torn rotator cuff is required to bring back the integrity of rotator cuff function.However, once surgery is done and rotator cuff heals, we need to go back to the previous goals of re establishing strength of rotator cuff and shoulder girdle. Any resumption in high intensity activity is only possible when shoulder assumes normal function compared to other side.