Frequently Asked Questions

The rotator cuff is the name given to the group of muscles and tendons that starts on the shoulder blade, extending over your shoulder, with the tendons anchoring on the upper arm bone and surrounding the ball of the shoulder like a cuff – hence the term rotator cuff. The rotator cuff consists of the supraspinatus (the most commonly torn tendon), infraspinatus, subscapularis and teres minor muscles. The rotator cuff muscles are stabilising muscles, because they hold the ball of the shoulder in the socket by balancing the forces of the bigger shoulder muscles.

Rotator cuff tears are the most common cause of shoulder pain. Tears can be acute (sudden onset) or chronic (long-term tendon fraying). The outcome of your injury can be influenced by the size and location of the tear.

Acute tears involve an injury or trauma such as a fall on the arm while skiing, often in people who have had no prior shoulder pain. Chronic rotator cuff tears occur gradually and are more common as people age due to degeneration of the tendons that attach muscles to the upper arm bone. Up to 40% of people over 65 will have degenerative tears of their rotator cuff and most do not have pain, but they will notice their arm is weaker with overhead activities.

Younger people performing repetitive overhead activities in their job (eg carpenters, painters) or sporting activities (eg swimmers or throwers), are more at risk of injuring their rotator cuff. A family history of rotator cuff tears as well as poor blood supply (impacted by smoking) can predispose towards rotator cuff tears.

If you have an acute rotator cuff tear, you will experience intense pain in the shoulder and upper arm, and may have difficulty lifting your arm or you may have an arc of pain between 60 and 120 degrees when lifting your arm out to the side.

Chronic tears are not associated with the same level of intense pain as occurs in acute tears, but in both acute and chronic tears, there is a deep, dull ache in the shoulder and a difficulty sleeping, particularly when lying on the affected shoulder. Your arm will feel weak and you will have pain when reaching for your seatbelt or trying to brush your hair.

Partial tears of just one tendon respond well to physiotherapy. When the tear involves a second or third tendon in the rotator cuff, the effect on shoulder dynamics, pain and recovery, are much worse. In these cases, surgery may be required followed by extensive physiotherapy rehabilitation to regain strength, movement and confidence.

To confirm whether you have torn your rotator cuff your physiotherapist will ask you to perform certain movements and push against resistance to test for weakness and pain. They may also recommend an ultrasound scan to confirm their diagnosis and determine the size of your tear.

Pain and loss of function after a rotator cuff tear are not related to how long you have symptoms or even the size of your tear. The main factors that will affect your recovery are related to your shoulder blade muscles, how they work and how strong they are which means being committed to your physio program and the exercises your physio prescribes.

Your physio may also manage your rotator cuff tear by:

• taping your shoulder to decrease the pain and support the torn tendons
• incorporating dry needling treatments or trigger point therapy to decrease over-activity in surrounding muscles
• prescribing home exercises including light resistance exercises and stretches

The hamstrings are a group of four muscles on the back of the thigh. They are commonly injured during sprinting or in over-stretching incidents such as bending forward with straight knees, producing a sharp pain in the back of the thigh at the time of the injury. This pain is often accompanied by weakness and an inability to stretch due to the pain which usually resolves over a period of 7-10 days as the tear heals. A physio consult is recommended if symptoms persist beyond this timeframe.

Scientifically proven factors that lead to hamstring tears include age (older athletes being at greater risk) race, hamstring weakness, lack of flexibility of hamstrings or hip flexors and fatigue during sports participation. One of the key risk factors is previous injury. As recurrence is a likely outcome, it is important to do a strength and conditioning program to prepare for return to activity and minimise the risk of re-injury.

Although less common, the tendon within the muscle, or the tendon or bone at either end of the muscle can be damaged. These injuries may require medical intervention.

After your physio has carried out a series of tests and confirmed the diagnosis, they will advise you on which of the hamstring group of muscles has been torn, the severity of the tear, and how long it will take to return to sport and/or other activities.

Their management plan will include the following:

• Rest – relative rest causing no further harm
• Ice – 20 minutes every two hours, during waking hours for the first two days
• Compression – use a compression sleeve or bandage
• Elevation – put the leg above the level of the heart where practical

Although the muscle is already torn, the first four days are an important time to prevent further damage and compromised healing, after which your physio will prescribe a rehab program that includes:

• a progressive program of strengthening exercises to regain strength of the hamstrings
• a graduated running program to build speed, agility, sport-specific skills and then return to training
• return to sport or other physical activity with recommended guidelines and expectations explained

The quadriceps are a group of four muscles on the front of the thigh often referred to as ”the quads”. They are commonly injured when slowing down (a decelerating incident) during sprinting or agility sports. The quads can also be injured during kicking, either in sports or kicking out during hurdling. The muscle most commonly injured is the “driver muscle” (the rectus femoris) which crosses over both the hip and knee joints.

At the time of the injury there is an associated sharp pain in the front of the thigh. This pain is often accompanied by weakness and an inability to stretch due to the pain which usually resolves over a period of 7-10 days as the tear heals. A physio consult is recommended if symptoms persist beyond this timeframe.

Scientifically proven factors that lead to quads tears include a lack of strength or flexibility of the hip flexors at the front of the hip. In addition, we know that sprinting and kicking are risk factors and the chance of this injury occurring is higher in pre-season. It is therefore essential to be well-prepared for the rigours of fast agility sports.

One of the main risk factors is previous injury. As recurrence is a likely outcome, it is important to do a strength and conditioning program to prepare for return to activity and minimise the risk of re-injury.

Although less common, the tendon within the muscle, or the tendon or bone at either end of the muscle can be damaged. These injuries may require medical intervention.

After your physio has carried out a series of tests and confirmed the diagnosis, they will advise you on which of the quadriceps group of muscles has been torn, the severity of the tear, and how long it will take to return to sport and other activities.

Their management plan will include the following:

• Rest – relative rest causing no further harm
• Ice – 20 minutes every two hours, during waking hours for the first two days
• Compression – use a compression sleeve or bandage
• Elevation – put the leg above the level of the heart where practical

Although the muscle is already torn, the first four days are an important time to prevent further damage and compromised healing, after which your physio will prescribe a rehab program that includes:

• a progressive strengthening program of exercises to regain the strength of the quads
• a graduated running program to build speed, agility, sport-specific skills and then return to training
• return to sport or other physical activity with recommended guidelines and expectations explained

The calf comprises a group of muscles on the back of the leg travelling from the knee down to the Achilles tendon on the back of the heel. Injuries commonly occur while sprinting or pushing off to move forward during sports such as netball, basketball, squash and tennis, but long-distance running can be a cause in the older athlete. At the time of the injury there is an associated sharp pain in the back of the leg. This pain is often accompanied by weakness and an inability to stretch due to pain. This usually resolves over a period of 7-10 days as the tear heals. A physio consult is recommended if symptoms persist beyond this timeframe.

Factors that lead to calf tears may include age, with older athletes being at greater risk; lack of calf strength or endurance and lack of sports-specific training (eg commencing touch football without any speed or agility training). One of the main risk factors is previous injury. As recurrence is a likely outcome, it is important to do a strength and conditioning program to prepare for return to activity and minimise the risk of re-injury.

After your physio has carried out a series of tests and confirmed the diagnosis, they will advise you on which calf muscle has been torn, the severity of the tear, and how long it will take to return to sport and/or other activities.

Their management plan will include the following:

• Rest – relative rest causing no further harm
• Ice – 20 minutes every two hours, during waking hours for the first two days
• Compression – use a compression sleeve or bandage
• Elevation – put the leg above the level of the heart where practical

Although the muscle is already torn, the first four days are an important time to prevent further damage and compromised healing, after which your physio will prescribe a rehab program that includes:

• a progressive strengthening program of exercises to regain the strength of the hamstrings
• a graduated running program to build speed, agility, sport-specific skills and then return to training
• return to sport or other physical activity with recommended guidelines and expectations explained