A torn Rotator Cuff could be healed through allopathic treatments and surgical repair, but; physiotherapy and natural treatments like panchakarma, yogasana, and following a healthy diet routine, as necessary could heal the torn Rotator Cuff safely and effectively. The Rotator Cuff is a group of muscles and tendons that surround the shoulder joint, keeping the head of the upper arm bone firmly within the shallow socket of the shoulder. The Rotator Cuff is a common name for the group of 4 distinct muscles and their tendons, which provide strength and stability during different shoulder movements like abduction, adduction, flexion, extension, internal and external rotation to the shoulder complex. They are also referred to as the SITS muscle, relating to the first letter of their names Supraspinatus, Infraspinatus, Teres minor, and Subscapularis, respectively. The muscles arise from the scapula and connect to the head of the humerus, forming a cuff around the Glenohumeral joint.

Causes of injury to Rotator Cuff – 

Generally, Rotator Cuff injuries are common and can occur at any age. In younger ones, most injuries arise from overuse due to overhead activities like weightlifting, volleyball, tennis, etc. Incidents of injuries increase as we age. The Rotator Cuff muscles can fall victim to muscle degeneration and tearing with age. Inappropriate biomechanics cause disruption in the body’s natural alignment causing postural dysfunctions that prematurely affect the quality of the Rotator Cuff muscles and tendons. There are two main causes of Rotator Cuff tears; acute tear due to injury and degenerative tear (wear-related) due to age. As we get older, the blood supply in our Rotator Cuff tendons lessens. Without a good blood supply, the body’s natural ability to repair tendon damage is diminished. This can ultimately result in the tearing of the tendon.

The most common injuries to the Rotator Cuff are known as:

• Rotator Cuff Tears – Micro or macro tearing of the muscles or tendons;
• Rotator Cuff Tendinitis – Acute inflammation of the RC soft tissue;
• Rotator Cuff Tendinopathy – Chronic irritation or degeneration of the RC soft tissue;
• Impingement syndrome – Biomechanical dysfunction of the shoulder complex which causes abnormal wear and tear on the RC soft tissue.

Symptoms of torn Rotator Cuff – 

We must keep in mind that the torn Rotator Cuff is not always associated with pain or a patient-reported loss of function. Besides, it should be noted that an asymptomatic patient may develop symptoms in relatively short intervals of time.

The common symptoms of Rotator Cuff tears are:

• Pain– At rest and night, particularly if lying on the affected shoulder
• Painful range of motion – Painful external rotation, internal rotation or abduction
• Muscle weakness – In the shoulder joint, particularly abduction and External Rotation.
• Functional impairments – Difficulty lifting, pushing, overhead movements, and movements with internal rotation.

Rotator Cuff tears that happen suddenly, due to a fall, generally cause severe pain. There may be a snapping sensation and weakness in the upper arm. Tears that develop slowly due to overuse of the arm may also cause pain and arm weakness.

Diagnosis of torn Rotator Cuff – 

Physical and clinical tests as mentioned below can help detect Rotator Cuff tears.

• • Palpation Test for pain, swelling, or malformation
  • Range of motion or functional movements
  • Visual inspection of the shoulder or cervical and thoracic spine
  • C-spine CT scan Test to rule out referred pain and/or radiculopathy
  • Strength Test with a hand-held dynamometer
  • X-rays – It is less accurate in detecting torn Rotator Cuff muscles unless a suspected avulsion fracture, calcifications, arthritis, or bone deformities
  • Magnetic Resonance Imaging (MRI) Test is the best practice for visibility of soft tissue 
  • Ultrasound (US) Test.

The most common imaging method to evaluate Rotator Cuff pathologies is MRI. It can detect tears and pain and may help determine the size of the tear to establish a proper treatment method. Although MRI is the standard imaging method, Ultrasound can be used as it has good diagnostic accuracy. Moreover, it is cost-effective and generally available.

How to heal a torn Rotator Cuff naturally?

Apart from the tears due to injuries, the Rotator Cuff tears due to aging or otherwise, in the Ayurvedic context, are linked to an imbalance in one or more of the three Doshas, such as Energy of movement (Vata), Energy of digestion or metabolism (Pitta), and Energy of lubrication and structure (Kapha). The shoulder is primarily governed by the Vata dosha, which is responsible for movement and circulation in the body. In older adults, a Rotator Cuff tear could indicate an excess of Vata, causing dryness, brittleness, and a reduction in the body’s natural lubrication.

Ayurvedic fundamental regulatory principles of the body (Doshas) and their effects are as follows;

• The energy of movement (Vata):  As this is essential for movement and circulation in the body it governs the shoulder movement; an imbalance might result in dryness and brittleness.
• The energy of digestion or metabolism (Pitta): As this is essential for transformation and metabolism in the body; an imbalance may cause excessive inflammation and pain post-injury.
• The energy of lubrication and structure (Kapha): As this is essential for maintaining structure and lubrication in the body; an imbalance may lead to weakened shoulder support and flexibility.

Ayurvedic Treatments for torn Rotator Cuff –

Ayurveda doesn’t just treat the symptoms but addresses the root cause, ensuring a more comprehensive healing process. Ayurveda emphasizes personalized treatments based on one’s distinct body composition and imbalance and consult with a qualified Ayurvedic specialist before the commencement of any treatment. Ayurvedic treatments primarily use herbs, oils, and natural substances, reducing the risk of side effects.

Herbal Oils and Panchakarma:

Oil Massage (Abhyanga): A warm medicated oil specific to one’s dosha imbalance is used in this therapeutic massage. This treatment can enhance blood circulation, reduce inflammation, and therefore; promote healing.

Oil Pooling (Janu Basti): This treatment involves pooling warm medicated oil over the injured area of the shoulder or its joint and allowing it to deeply penetrate and nourish the tissues of the affected muscles.

Ayurvedic Herbs:

Winter Cherry (Ashwagandha): Known for its revitalizing properties, Ashwagandha promotes tissue regeneration and strengthens muscles and ligaments.

Gum Resin (Guggul): Acclaimed for its anti-inflammatory properties, Guggul helps reduce swelling and pain.

Yogasana for torn Rotator Cuff – 

• Cow Face Pose (Gomukhasana):

In general, this posture is excellent for the Rotator Cuff as it stretches and strengthens the whole group of Rotator Cuff muscles.

How to do: 

• Sit in any comfortable position and stretch the spine by rooting down through the sit bones and stretching up through the top of the head.
• Reach the right arm out wide and up toward the sky and bend the elbow deeply. Take hold of the right elbow with the left hand and very gradually draw the right arm closer toward the midline of the body behind the head. Carefully lean the weight of your head back against the arm.
• Release the left arm out wide toward the left side. Turn the palm to face back behind. Then bend the elbow deeply, drawing it toward the torso, and slide the back of the left hand up the back as far as possible.
• Interlock the fingers. If the hands don’t touch, release the right arm momentarily and hold a yoga strap in the right hand, return the arm to the position mentioned above, and then hold the strap behind your back and grab the other end with the left hand.
• Maintain the length created in the spine. Avoid rounding the spine or tucking the chin to draw the hands closer toward each other.
• Hold for a few deep breaths, when you’re done, release the position and change sides.

• Bound Warrior Pose (Badhha Virabhadrasana)

In this pose, the lower arm is in internal rotation, the upper arm is in external rotation, and slight abduction is needed to initiate the shape.

How to do:

• Take a posture as shown in the figure i.e. Warrior II Pose (Virabhadrasana II). Alignment with the right foot forward.
• Lean the weight of the upper body toward the right leg and rest the right elbow on the right knee. Press down against the thigh and resist that energy by pressing the thigh into the arm to lift and stretch both sides of the waistline twisting the chest toward the left.
• Stretch the left arm, and sweep it behind the back, and bend the elbow as deeply as possible. Press the back of the hand against the back of the pelvis.
• Use the yoga strap if necessary.
• Hold the position for a few deep breaths and change the side.

• Tabletop Pose (Bharmanasana)

Tabletop Pose is considered essential to build shoulder stability and activate and strengthen the Rotator Cuff.

How to do:

• Sit in the Diamond Pose (Vajrasana) and stretch the arms forward in line with the height and width of the shoulders.
• Extend the wrists, point the palms forward and the fingers upward, spread the fingers wide, and press the palms forward in space as if you are trying to press against the wall.
• Without movement, actively squeeze the arms toward each other. Slightly broaden the chest and the collarbones.
• Now holding this position gradually place your hands on the floor in front of you so that they align under the shoulders and the knees align under the hips as shown in the figure.
• Maintain this pose to activate and stabilize the core.
• Hold the position for a few deep breaths and repeat a few times to develop strength in the shoulders.

Recommended physiotherapy for a torn Rotator Cuff – 

• Isometric Shoulder Flexion – Stand facing a wall, and bend the elbow of the affected shoulder 90°, and make a fist. Place a folded soft cloth between the fist and the wall, and gently press the hand into the wall. Hold the position for five to ten seconds, and then slowly release. Continue for at least 5 to 10 repetitions.

• Isometric Shoulder Abduction – With the body perpendicular, stand a few inches away from the wall. Place the affected shoulder close to the wall and make a fist. Place a folded soft cloth between the fist and the wall and press gently into the wall as if you are trying to lift your arm out to the side, and hold it there for five to ten seconds. Slowly release pressure on the wall and repeat for at least 5 to 10 repetitions.

• Isometric Shoulder Internal Rotation – Position the body so that you are facing an outside corner of a wall. The affected shoulder should be near the wall corner. Bend the elbow 90 degrees, make a fist. Place a folded soft cloth between the fist and the wall and gently press into the corner wall as if you are trying to rotate your hand inward towards your belly button. Press and hold for five to ten seconds. Slowly release pressure on the wall and repeat it for at least 5 to 10 repetitions.

• Isometric Shoulder External Rotation – With the body perpendicular, stand a few inches away from the wall. The affected shoulder should be close to the wall. Bend the elbow 90 degrees, make a fist. Place a folded soft cloth between the fist and the wall and press the back of your hand into the wall as if you are rotating your arm outwards. Gently press into the wall for about five to ten seconds. Slowly release pressure on the wall and repeat it for at least 5 to 10 repetitions.

Diet for a torn Rotator Cuff –

Tendon repair can be accelerated through targeted nutrition. Tendons are primarily made up of the protein collagen. Lack of nutrients that help build collagen slows down tendon healing. Foods that provide the raw materials for collagen formation and help expedite tendon repair are mentioned below;

• Vitamin C –  Regulates the function of enzymes that produce collagen. Common sources of vitamin C are tomatoes, broccoli, and citrus fruits.
• Protein – Stimulate tendon growth, and protein deficiencies have the potential to impede the healing of muscles and tendons after a Rotator Cuff injury. Protein-rich foods, such as beans, lean meats, poultry, and fish, aid tendon repair.
• Minerals – Such as manganese, zinc, and copper found in nuts, seeds, legumes, and shellfish promote the production of collagen. A deficiency of these minerals impedes collagen production.
• Amino acids – Such as leucine, glutamine, and arginine, are the building blocks of collagen protein. Protein-rich foods, such as meat and milk provide these amino acids.
• Bromelain – An enzyme found in pineapples, helps break down protein to produce amino acids. These amino acids are then used to produce new proteins, such as collagen.

Significant Note:

Following natural healing practices in our lives results in our overall well-being and consequently, nurture our relation with the natural world. Natural remedies are powerful and they could be considered as useful and effective substitutes for professional allopathic medical care and practices.

However, before resorting to any natural healing program, especially when we are on any medications or have any treatment going on for our existing health conditions we must always consult our concerned healthcare experts  so that, considering the limitations of our health or whether we are allergic to certain remedies we can have significant guidance of our health experts.

By adopting natural remedies and believing in their healing power we can enhance our physical and mental health leading to a more balanced and satisfying life. We must respect traditional practices and religiously follow natural healing practices for the benefit of mankind and nature.