Rotator cuff tears may result from direct trauma to the shoulder joint, such as falling on the shoulder, or from chronic overuse, such as that described in the previous article on shoulder injuries – a question of balance. Strain on the rotator cuff results in over-load of the tendons, tears are more likely to occur in the supraspinatus tendon but can also occur in any of the other three rotator cuff tendons. There is an area within the supraspinatus tendon, which does not receive much blood supply, the critical zone; this means that damage to this area is poor to recover. Faulty mechanics in the shoulder and muscular imbalances result from poor posture and stabilisation of the head of the humerus and the scapular, leading to the cascade of muscle imbalance and further injury. Ultrasound and ice/heat treatment help to reduce the inflammation and then to promote good circulation to the damaged tendon to aid a prompt recovery. Rounded shoulders lead to the origin and insertion of the supraspinatus muscle in particular being taken away from each other. This leads to mechanical inefficiency of the muscle and stress on the tendon. Simply put, whenever you use your muscle it requires more force to be generated by the muscle and more stress on the tendon to be able to lift the same load if the load stays the same but the resting length of the muscle is longer. In some cases you may be lifting 1.5 to 4 times the weight of an object, that’s like lifting a bag of sugar weighing 0.45kg and your muscles having to generate enough force in the faulty position to lift the equivalent of 0.675kg to 1.8kg. Simply put, rounded shoulders = more force generated = more use of the tendon = more stress on the tendon = ageing of the tendon = poor recovery= further injury = compensatory mechanics = surgery! Hopefully rounded shoulders would provoke a warning sign in most, mainly because they are not as pleasant to look at as straight upright shoulders. Most of this sequelae is fortunately preventable through good advice and postural re-education of the shoulder muscles and stabilisers. At Perfect Balance Clinic we work with the best personal trainers in Hertfordshire and London, which means that we can integrate a treatment plan which can be carried forward into all aspects of your training primarily to help reduce rounded shoulders. By carrying out a preventative programme we can prevent stress on the tendon by showing you correct form and posture during exercise and day-to-day activities. If you have unfortunately suffered from torn rotator cuff muscles we have the best therapists all equipped with the knowledge to help you recover from this debilitating injury and prevent further recurrence. If you’ve found this article too late and have a complete tear then we refer to the best orthopaedic shoulder specialists in the country to help repair the tendon. Our physiotherapist and osteopath team are able to guide you through your rehab and return you to active sport or daily activities. Of course, like your mother always told you ‘prevention is better than cure!’ so we would prefer to help people sooner rather than later after needing surgery, so rounded shoulders = contact us for a preventative plan!