The shoulder is the most mobile joint in the body. Unfortunately this mobility also makes it quite susceptible to injury.

Many different ligaments are involved in stabilizing the shoulder joint, particularly in the front.

The rotator cuff is a group of four muscles in your shoulder that helps keep the ball of your shoulder bone (the humerus) against the cup on your shoulder blade (the scapula).

If you make a fist with one hand (the fist representing the ball of your shoulder) and then grasp your fist with your other hand (fingers spread apart to represent the tendons of the rotator cuff), you will have an idea of how the muscles hold your shoulder in its socket. A rotator cuff injury is an injury to one or more of these muscles.

There are two main types of rotator cuff injury. Injuries associated with a specific event such as a fall are termed acute rotator cuff injuries.

Rotator cuff injuries that get gradually worse with time, because of some activity that aggravates the muscle, are termed chronic rotator cuff injuries. These are often found in people with occupations or sports requiring excessive overhead activity.

The symptoms are different for each type of rotator cuff injury. Chronic rotator cuff tears generally occur in a person’s dominant arm. It is more commonly found in people older than 40 years of age.

The pain from the injury is generally worse at night and if it is severe enough can interfere with sleep. The pain gradually gets worse with time and is followed by weakness. As the shoulder gets weaker it may become more and more difficult to move the arm.

If a chronic tear is allowed to progress for long enough it may become difficult to lift the arm above shoulder height. Chronic shoulder problems can also become a “pain in the neck” as the neck muscles try to compensate for the weaker shoulder muscles.

Acute rotator cuff tears are usually accompanied by a sudden tearing sensation followed by severe pain in the arm.

Movement in the shoulder is usually immediately limited by pain and muscle spasm, and there may be a very sore spot to touch. With very large acute tears it may also be difficult to raise the arm above shoulder level.

Most rotator cuff tears can be treated without surgery. In fact, it is the small minority of patients who end up undergoing surgical treatment for a rotator cuff tear.

Non-surgical treatments may include physical therapy, anti-inflammatory pain medications, and cortisone injections. The goal of physical therapy is to improve the function of the muscles that surround the shoulder.

Most people, athletes and weightlifters included, only strengthen a few of the large muscles around the shoulder. Physical therapy targets the smaller, but important muscles around the shoulder that are commonly neglected.

By strengthening these muscles, therapy can help compensate for damaged tendons and improve the mechanics of the shoulder joint.

If you have shoulder pain, get it checked. The longer you leave it, the more difficult it is to treat.

Early treatment with physiotherapy, or other conservative means can often prevent the need for surgery, and save you lots of time and pain.

Rehabilitation in Motion has four Island locations including two in Campbell River: Willow Point, 923-3773; Quinsam (across from SaveOn Foods), 286-9670; Comox Valley, 334-9670; Port Alberni; 723-9675. Ben Chatterson works at the Comox Valley Clinic. Visit www.rehabinmotion.com