Rotator Cuff Tears Rock Climbing Injuries with Wil Seto

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Wil Seto of Insync Physio in Vancouver, one of Vancouver's best pair of physiotherapy clinics. And we're gonna talk about rotator cuff tears from rock climbing. This sounds really sore and hurting already Wil. 

Wil: Yeah. So what is a rotator cuff tear? So, first of all, your rotator cuff, there's four tendons and muscles that make up what's called your rotator cuff in your shoulder. And there's one on the front that's called your subscapularis, they basically attach from your shoulder blade all onto your humerus, which is basically the bone of your arm.

And the subscapularis is the one in the front and then you have one on the top called your supraspinatus. So that's one of the major ones as well. And then your other two, which is in the posterior part or the back part of the shoulder blade, which is basically your infraspinatus and your teres major.

So those are the four that make up your rotator cuff muscles. Now essentially when we look at which one usually tends to get injured, it's typically your supraspinatus. Or your infraspinatus and your teres major, sorry I said teres major before, I meant teres minor. Teres minor is the fourth rotator tear cuff. So the terrace minor and the infraspinatus are the two posterior ones that attach on the back of the shoulder blade. And then one that attaches on the top is the supraspinatus. Those are the ones that tend to be more prone. 

Now the reason why is because they tend to be the ones that get compromised in a few different ways. So you can either have an acute tear, which means like it's, you know, basically a traumatic thing can happen. You can fall on your shoulder and then all of a suddenly tear it and strain it. Or you can have something that's kind of more of like a chronic sort of overuse thing that happens over time.

I previously talked a little bit about shoulder impingement and how to distinguish between that and a rotator cuff. There are certain tests that we do to figure out if it's one or the other. But essentially, when you're looking at the more chronic aspect of a rotator cuff, it's sort of like that slow you know, boil. It's kind of like the frog and the hot water. You know you've done something like as soon as you go into the hot water, you know it's hot and something's happened. That's like the acute tear. 

Whereas like, you know, you kind of keep training and you go to the gym or you're going into the climbing crag outside, you know, three days a week or whatever you're doing. And you start to just get a little bit tighter. You start to notice it and you may not be doing any stretching or any mobility work, and then you just, like suddenly you just wake up one morning, it just feels a little bit more sore. And then now you start to get a bit of that impingement stuff. So it can present like an impingement type of pain for sure.

But then there's certain tests that we can determine whether or not that pain that you're getting is a result of like, maybe something going on more sinister like. In the rotator cuff, like a tear. And ultimately we can only assess in probability. You know, and based on our clinical experience that you know, you look at certain tests that can help you sort of determine whether it is or it isn't. But ultimately the better standard is getting some scans and that'll give you some more information. But rehab is actually very good for even rotator cuff tears. 

Mark: And what does the rehab actually consist of? 

Wil: If it's an acute sort of tear, then we wanna obviously address any of the acute inflammation or anything like that that's happened, like initially. And then as it kind of moves past to like, you know, as it starts to heal, we always wanna consider what that healing timeframe, right? You know, for any kind of soft tissue. But then particularly when you look at a rotator cuff injury tear you know, it's gonna be a little bit longer. So, typically you're looking at anywhere from four to six weeks as sort of a minor tear.

And even something that's more moderate, it can fully heal and it does really well with rehab and physiotherapy. So there's a lot of good studies out there that show that and our clinical experience, we've had a lot of good results with that. And so essentially you know, when we treat it, we wanna also treat the acute aspect of it looking at starting to like build the strength back up into that injured rotator cuff, that tear. But then we also need to address a lot of what's going on in the muscle imbalances, particularly in the shoulder blade. 

So if it was more of an impingement type of issue, where it's chronic, and it kind of led up to more, you know, like this last straw that broke the camel's back kind of thing. Then we want to look at, Okay, well why did this happen? And usually there is a lot that kind of stuff going on, you know, with climbing where there's imbalances. And so we need to address those at the same time because if you don't, then you're not really able to address the proper mechanics of what you wanna have occur in the shoulder joint as you start to rehab the actual tear.

Because you need to actually have a proper moving functioning shoulder blade with all the muscles working properly. Cause you have so much different motions even in and around the whole shoulder blade that help with your actual area of that rotator cuff. So it's not just like your arm and your shoulder moving.

Your shoulder also consists of your shoulder blade, which is called your scapula. And so there's that shoulder blade moves, it actually assists with the whole mobility of that whole shoulder joint. So that becomes a little bit more complex and we address what those deficits and deficiencies are.

And then if there's like tightness in certain areas in the capsule, then we need to address that and do a lot of things to help facilitate that manually. And then exercise is a really important aspect of making sure that we reinforce the mobility gains, and then also just proper specific ones for whatever's going on, like with a tear. So you make sure that we're not going too hard too fast, if you've come in acutely. Or, you know, doing the appropriate things when you've waited a long time and getting you activated. 

Mark: So if you're having some shoulder pain and you suspect maybe it's a tear, get some expert diagnosis with the experts at Insync Physio. You can reach them and book at insyncphysio.com. They have two locations, one in Vancouver. You can also call to book if you wanna talk to a human being, (604) 566-9716. You can book, both clinics online or you can call the Burnaby office (604) 298-4878. They'll get you back moving well, back climbing again. Thanks Wil. 

Wil: Thanks Mark.