Brutally Honest Advice to Heal Rotator Cuff Tear and Avoid Surgery

[00:00:00]Don't focus on strengthening your rotator cuff muscles. Reaching overhead if you have a rotator cuff tear. Not recommended by health care professionals, but I disagree. A lot of people assume that the rotator cuff muscles become weak just over time because of your age for degenerative reasons. But if you think about it, here's brutally honest advice to avoid surgery and heal a rotator cuff tear.

[00:00:24]Number one is that we know there's research out there that shows that you can get better in your shoulder pain from a rotator cuff tear without having surgery. And what they did is they've compared people that have had a rotator cuff surgery. They had a repair surgery and people that went through what they call conservative treatment or physical therapy treatment and they followed them up 6 months and 12 months later and they found that both groups get better the same amount and by better they were measuring pain and function. So this raises the question of why even get a rotator cuff tear surgery. Now, sure, there's some situations where it might be the best decision, and you'll have to discuss with your doctor about that. But I think what this sheds light on is that there's probably a lot of situations out there where if you do the right things and you figure out what is the main problem of your rotator cuff tear, then you have a chance at healing it, at treating that problem, and being able to avoid having a surgery. Number two is that the research out there, the medical literature is highly focused on surgeries. If you do a search on Google Scholar, for instance, and you type in rotator cuff tear, rotator cuff repair, all that stuff, and you start going through all the articles, you'll find that eight to nine out of 10 of them are going to be related to surgery. And there just isn't much out there on how to heal a rotator cuff naturally, which doesn't mean that it can't happen. We just don't know. We just haven't looked into it as much. So, as a result of that, we're kind of shooting in the dark whenever it comes to what to do to heal a rotator cuff tear without surgery. My third advice tip for you is that upper trap muscles, the muscles that are connecting from the neck to out here on the shoulder blade and the collar bone, these are weak and that's the root cause of a rotator cuff tear. The way this works is whenever you're reaching your arm up overhead, you should be able to get up about 180°, get your armbbone up overhead, but you only have 120° in the ball and socket joint. And those motions here in the ball and socket joint are mainly driven by some of the muscles in this area like your rotator cuff muscles, your deltoid muscles. But what is missing is that last 60° of motion which is accomplished by this shoulder blade bone rotating upwards. And you get that motion a lot heavily from that upper trap muscle. So if that upper trap muscle is weak when you reach up overhead, you're not going to get the full motion. and it adds a lot of tension and stress to the rotator cuff tendons here in the joint. And over time, that sets up the rotator cuff tear. But if you can get your upper traps working properly and stronger, then you're going to be protecting your rotator cuff tendons so that you don't tear it in the future any worse or tear it at all if you're looking to prevent it. My fourth bit of advice here is surgery does not fix the root cause. If you do end up having a rotator cuff tear surgery or you already had the repair done, you're you you've already had one.

[00:03:39]Then they surgically reattach your rotator cuff tendon and that's fantastic. Like I it's if you had it done, it's okay. I'm not saying it's a bad thing, but it didn't fix the root problem. It didn't get your upper trap any stronger. Surgery does not do that.

[00:03:53]In fact, oftentimes you're recovering afterwards and you can't move your arm very much for weeks, usually like six to eight weeks. So all the muscles get weaker and it kind of makes the muscle imbalance worse. Your upper trap ends up not working as good afterwards. So you have to go through the rehabilitation process afterwards to get your ball and socket joint moving in your shoulder.

[00:04:15]But you also need to consider getting that upper trap stronger so that the root problem is fixed and you're not dealing with a second rotator cuff tear and possibly getting a second surgery, which some people do have. And it's because the surgery never fixed the root problem. they just repaired the torn tendon. Number five is romboids are not as weak as we think they are. The romboid muscles are often focused on by healthcare professionals and they're muscles that attach from the inner edge of the shoulder blade right here to the spine. And so often times people get instructed to do shoulder retraction exercises where they're pinching their shoulder blades together like this. And usually they're pulling some bands or cables and working on pulling the shoulder blades back with the intent of getting stability in the shoulder blade.

[00:05:00]But if you look at the angles of pull of the romboid muscles, they kind of go in this direction. They go from the middle outwards and downwards. So when they contract, they're they'll pull yeah they do do retraction. They do pull the shoulder blade inwards, but they also pull this part right here in this direction, which downward rotates the shoulder blade, which pushes the socket downwards and actually lengthens the upper trap, which feeds into the muscle imbalance. So, it actually counteracts fixing the muscle imbalance. And if you truly muscle test, which physical therapists are usually going to be able to do this, if you muscle test that romboid, which is rarely ever done, it's rarely ever weak. I've I've never found anybody with weak romboids and people that have rotator cuff tears, but I consistently find people with weak upper traps. And when we work on that, just to prove the point, we work on upper traps quite a bit. We'll do shoulder shrugging exercises, eventually overhead reaching exercises with weights, and their shoulders get better consistently, and we don't even touch the romboids. Number six, rotator cuff muscles are weak because of the imbalance. So, a lot of people assume that the rotator cuff muscles become weak just over time, because of your age, for degenerative reasons. But if you think about it, the main action of the rotator cuff is to pull because of all these muscles here, the rotator cuff muscles, they are pulling the ball within the joint here into the socket. They're creating stability. If you look up the actions of the suppinatus, infraspanatus, the tererry's minor muscle right here, and the subscapularis, that's all they do is pull the ball into the socket. It says compress and depress the head of the humorris into the socket, the glenoid of the scapula.

[00:06:54]There's a bunch of other muscles that are pulling the that joint in different directions. And the the main job of these muscles though is to give it stability.

[00:07:02]But because they're named the rotator cuff muscles, people start thinking that they produce rotation of the ball on the socket. And maybe they do a little, but that's not their main action. There's a bunch of other big muscles like your lats, your pec muscles, the there's there's other muscles that connect around the ball and socket joint that produce rotation and the big arm movements, your deltoids. There's many other muscles that can move that ball and socket joint. And these rotator cuff muscles are just providing stability. So when you think about the muscle imbalance, it's not the rotator cuff muscles being weak as the primary reason for the rotator cuff tear. that's secondary. So strengthening the rotator cuff muscles isn't going to be the best thing. If we can strengthen the upper trap muscles, then you'll allow the rotator cuff muscles to do their job, which is to stabilize the ball in the socket, and then they're not going to be weak anymore. You just they're just doing too much work, and over time they get overworked and then become weak.

[00:08:05]Number seven is don't focus on strengthening your rotator cuff muscles.

[00:08:09]Like I was saying before, they're already weak. But if you go to any health care professional, especially physical therapists, doctors, surgeons, if you ask them, "What exercises should I do to help my rotator cuff tear so that I can avoid surgery?" One of the first exercises they're going to tell you to do is rotator cuff exercises that involve rotation this way or maybe this way. And they'll tell you, get a band or get a cable machine at the gym and set it up to where the line of pull is outwards like this and you're pulling this way. rotating your arm this way with the intent of strengthening your subscapularis muscle, for example. It's one of the rotator cuff muscles. Or they'll tell you to get the band this way and pull outwards. Or maybe they'll put you in this position right here with the band behind you and they'll have you rotate forward this way or from the bottom up this way. Doing these rotational exercises is kind of focusing on the rotator cuff muscles. But here's the thing. Like I said, there's a bunch of other big muscles, your pecs, your deltoids, there's muscles back here that help you rotate your shoulder as well.

[00:09:13]And you'll often find that as the resistance gets harder, your muscles start to all work. And the way the body works, the way that it should work anyway, is the deepest muscles, which is the rotator cuff muscles, should be activating first to provide stability.

[00:09:29]And then the outer more superficial muscles like your pecs and deltoids for instance should be next in line because they're providing motion because you need stability and then motion. So if you're doing this rotator cuff exercise very often you're just training the bigger muscles and you're not taking care of the rotator cuff muscles. You're overworking them because everything's contracting and then you're also training your rotator cuff muscles to work inappropriately because that's not their main action. And the main action is not rotation. It's compression into the ball and socket joint. Number eight, hanging is important. Now, if you have an active tear right now, if it hurts, I'm not saying go start hanging immediately. You need to work into it.

[00:10:11]When you're feeling better, when you feel like you can tolerate it, when it doesn't bother you anymore, then it's time to start bringing in hanging. What I mean by that is literally get a pull-up bar or somewhere where you can hang your weight from. And don't hang your full weight either. You want to start with partial body weight hanging.

[00:10:27]You want to have your feet touching the ground or a box or something, a step stool, something that can support your feet so that you can begin to sink your weight through your arms. Because when you do that, you start to pull the joint apart, which is decompressing things, and it starts to have the rotator cuff muscles and tendons act the way they should. They're pulling the ball into the socket. As you get this better over time, as you can tolerate more hanging and you build the strength within the shoulder, then you're going to be healthier for the long term. You're also training the bones around there to be shaped a certain way. You're you're training the the other tissues. There's a a big ligament, the the coroco chromial ligament right here that needs to be stressed in a positive way. And hanging is golden for this. And one of the biggest things that I love about hanging is that it makes your shoulder blade move into the position that it should whenever you're picking up your arm overhead. You need to be able to shrug upward rotate and elevate that shoulder blade all the way. And if you can hang in a in a way that promotes that, then it's good for you. And it just feels great in your spine. It's strengthening your grip. It's challenging for most people. They can't do it for more than a few seconds at a time. But as you age, as you get into the later decades of your life, 50s, 60s,7s and beyond, it becomes ever more important because it's preventing things like weakness in the hand. It leads to arthritis in the hand. It's helping you with your neck and shoulder strength. It is so good for you to practice hanging to some degree. You don't have to do pull-ups. You can if you want. You don't have to do specific exercises, just dangling like when you were a kid and you did the monkey bars or some similar action like that. some similar activity like that. It is good for you just like it's good for children. Number nine is that shoulder impingement sets up a rotator cuff tear. So oftent times people that are in their younger years, usually like 20s and 30s, will complain of shoulder pain that might be labeled as shoulder impingement syndrome.

[00:12:26]They've got new names for it that I actually like better than shoulder impingement syndrome. All it is, I'm going to use the general terms for it, is it's pain in the shoulder that doesn't have a rotator cuff tear yet.

[00:12:40]But it's the same problems. It's the same root problem that sets up the rotator cuff tear. It comes back to the weakness in the upper traps, bad movement of the shoulder blade. We call that scapular disynesia. And you're getting as a result of that too much tension and pressure and bad mechanics inside the ball and socket joint. and then something starts to hurt. Some people get berscitis, some people get tenonitis, some people just call it shoulder impingement syndrome. There's different names for it, but at the end of the day, it's bad movement of the shoulder blade and weakness in the upper trap and that's causing other things to work inappropriately. If you keep that up, if you have that now and you keep that up over the next years, you're going to eventually develop a rotator cuff tear. You increase the likelihood anyway. And I saw a statistic recently that said that if you had shoulder impingement syndrome, there's a 44% chance that within about five years, you're likely to develop a rotator cuff tear, a partial rotator cuff tear, and then soon after that, I think it was two years after that, a full thickness rotator cuff tear. So, it's on a spectrum. My next point number 10 is that if you already have a rotator cuff tear on that same spectrum, shoulder impingement, rotator cuff tear, next after that is osteoarthritis of the ball and socket joint of the shoulder.

[00:13:58]Shoulder arthritis. If you already have a torn tendon in there, then the mechanics, the way that the ball moves on the socket is is going to be altered.

[00:14:08]And over the course of months and definitely years with bad mechanics in there, the the bones where they rub, the ball and socket joints, it doesn't rub appropriately and you begin to develop osteoarthritis. By the time you hit your 60s, 70s and beyond, this leads to grinding sensations in there, discomfort with sleeping, which you probably already have if you have a rotator cuff tear, but it just gets tremendously worse. And eventually after it gets too bad, people end up getting a shoulder replacement surgery. And not everybody's the happiest with their outcome afterwards. They tend to be a lot better than they they they have less pain, but they lose a lot of function. And sometimes they still have pain afterwards because a root problem still isn't addressed by a shoulder replacement surgery. They still often have weak upper traps. Even worse, because now they went through replacement surgery, it can set up other problems around the shoulder. Number 11.

[00:15:00]talking about other problems around the shoulder. Neck pain is often related to a rotator cuff tear. And it's because of that upper trap muscle. It's that root problem that causes so many other issues. And if you fix that upper trap muscle strength and use it properly, then you fix neck pain very often. And it's because the weight of the arm, your arm has weight to it. It dangles off your shoulder. You can see the only connection that it has, bony connection that it has to your body is through the collar bone to the sternum. the rest of it's floating in muscle and so the muscle has to control the posture of your shoulder. If you don't have good strength in that upper trap, then gravity starts pulling down on your arm throughout the day and eventually starts yanking on your neck causing neck pain.

[00:15:44]So if you have neck pain in addition to a rotator cuff problem, don't see them as separate things. They're almost always related and it's because of that muscle that's in between the neck and the shoulder, the upper trap muscle. The next point is the nerves because sometimes people will complain of a pinched nerve in the neck and maybe even tingling that goes down into the hands.

[00:16:05]These yellow things right here in the neck, these are all the the nerves that come off the spine. They converge and they actually go under the the collar bone right here and then they go in different directions. Some go around the back of the shoulder joint, some go into the armpit. Many of them go into the armpit. But think about this. If you have weak upper trap muscles, remember that trap comes from here in the neck and it connects to the outside part of the shoulder blade and the collar bone and then gravity's pulling down on your shoulder. That means your collarbone is going to go down and it's going to compress the nerves right there. We call it the brachio plexus. So now you're adding tension to the nerves in this area. And it's no wonder why you might get some tingling in your hand. Maybe at night or after sitting in a certain position holding up the phone, you'll get tingling very often because of that weak upper trap. People mistaken that for carpal tunnel syndrome or it could be even related to carpal carpal tunnel syndrome or other nerve problems. And that nerve pain can go both ways. It can go down into the arm but also be a root source of the problem for your neck pain. Number 13, popping is not always related to the rotator cuff tearing.

[00:17:13]When you have this muscle imbalance of the upper trap not doing its job and now the mechanics get messed up in the ball and socket joint because the mechanics are not normal, the ball might move oddly on the socket. Plus, all the other muscles and tendons in the area can shift around and cause popping sensations. It is normal to have popping. It doesn't always mean that something's tearing. Just be aware that it's going to pop. It's if if you have a good sensation afterwards, like it pops and you feel better, it's probably a good thing. It means that the cartilage unstuck itself. If you have a pop and then have immediate pain that lingers afterwards, I'm talking lingers for like minutes, hours, days, that I would be concerned about. But if you had a pop that maybe it hurt for a moment, but then it was fleeting, you know, within seconds or a minute at most, it's gone.

[00:18:05]Don't worry about that. That's natural.

[00:18:07]Although it's a sign that you probably have too much pressure going through the joint. The mechanics are off. You need to fix that muscle imbalance and hopefully that popping should reduce overall. Number 14. Medications and injections don't fix a rotator cuff tear. They just give you temporary relief. If you get an injection right here, cortisone is one of the most common ones or other steroid medications that are injected. They can help with the pain and relieve inflammation in the area, but they don't fix the muscle imbalance. And even if you take medications by mouth, they might help systemically all over your body. They'll help with pain, but they don't fix the muscle mounts. We need to get those muscles stronger in order to fix the root problem and not make a rotator cuff tear any worse and heal so that we can avoid surgery. But medications can be a good short-term solution for you, but don't focus on them fixing the problem. Just understand that they're only going to give you temporary relief. And when you do get some relief, you need to be working on the things that fix it for the long term. Number 15 is worrying about different types of tears is not helpful.

[00:19:09]It's only helpful if you're going to have a surgery. Because when you look at an MRI report, for instance, they'll tell you if you have a full thickness tear, a partial thickness tear, articular side, or bal they have all these words to describe the way the tear looks. And if you're trying to heal it without surgery, don't get too hung up on it because think about it. I'm telling you here that the root problem is the upper trap. You're not even dealing with putting any extra stress or strain on the rotator cuff. You're actually trying to take it off. So getting worried about, well, I have an articular sided partial thickness tear or I have a a full thickness complete tear. What whatever it is, it's not going to be the main concern for you. If you have decent arm motion and it improves with fixing the upper trap, which often happens doing the shrugging exercises that I recommend, then you're going to improve regardless of the type of tear that you have. Now, if you're going to have a surgery, if it's a if you're set on that, this is okay. That's fine. Then your surgeon does need to look at that stuff because it's going to help their strategy when they go in to perform the the repair on your rotator cuff tear. Number 16, and this is one of the most controversial ones that I get asked about all the time, reaching overhead if you have a rotator cuff tear. It's not recommended by healthcare professionals, but I disagree. I think you should reach overhead. I think you need to learn how to do it safely, properly, and eventually with weights, with small weights to challenge that upper trap muscle because in order to strengthen your upper trap, you have to reach overhead. You, yeah, you can shrug this way, but it's not the same as reaching up overhead and raising your arm up. And if you can train to do your to to reach up overhead with your upper trap like this properly and feel this muscle activate and use it and then put a little weight in your hand and practice doing that, then it's going to be beneficial for you. But often times health care professionals are advising people with rotator cuff tears to avoid reaching up overhead. And what this does is in the short term it might be okay.

[00:21:24]You might need to actually rest it, but once you feel like you can start to move it overhead without making it any worse, it's time to do that. You can't just stay in never reaching overhead mode forever. You have to get out of that and begin to gradually reach up overhead.

[00:21:39]You might use a pulley like they have in physical therapy clinics and practice reaching up overhead with proper shrugging. And eventually once you don't need the pulley anymore, then do it without anything. No weights, nothing, just your arm weight. Then gradually add some weights over time. And what you should be doing eventually long term, as long as you're healthy and you feel great, is picking up some decent weight, something that challenges you because then you're going to maintain strength in the upper trap. And that's going to be protective on your rotator cuff tendons out here so that you don't have a tear get any worse in the future. If you want help to heal your rotator cuff tear, then you need to check out the rotator cuff tear recovery program. I've put my entire treatment approach taking you from really painful, difficult to sleep on shoulder all the way to being able to pick up some small weights overhead and going even further than that if you want, picking up some heavier weights. But that way, you're able to fix the muscle imbalance. That's what the program's focused on is fixing that muscle imbalance and getting the right movements through your shoulder blade so that your tendons in your rotator cuff are not overpressurized and they can have a chance to begin to heal.

[00:22:47]Check out the link in the description to that program to learn more about