Both is the right answer but not in that order. A lot depends on how much damage you have done to it. Most cuff tears will respond to rest and exercise but any serious tear or full tear may require surgery before any therapy will help.
What is important with any torn rotator cuff treatment is to rest and let the injury begin to heal. Carrying on through the pain of a rotator cuff is likely to leave you needing surgery as you do more damage to the tendons, so rest is the first thing that you need to do.
At the same time as rest, you need to reduce the inflammation before you can consider starting any form of exercise. The rotator cuff is a group of four muscles that help to keep the shoulder stable by pulling the head of the upper arm bone into the socket of the shoulder joint. They are small but important muscles that cover the shoulder joint forming a cuff of muscle that supports it, in doing so they run over and sometimes under the bones of the shoulder.
Any inflammation to these tendons can cause pain as the inflamed tendon can impinge or catch on bone. A classic example of this is the supraspinatus muscle which runs under the collar bone and the acromion of the shoulder blade. When this muscle swells it catches on the channel of bone and start to wear or fray. Worst case scenario is that you could end up with a snapped tendon that would leave you needing corrective surgery.
So let the muscles rest. This means steering clear of any movement that is causes pain. If your job includes a lot of overhead movement you might need to modify how you work. If you spend the day sitting at a desk, you might need to change the setup of your desk to avoid reaching or stretching movements with the damaged shoulder. It might even be necessary to take a few days off to rest the shoulder properly.
At the same times start to reduce the inflammation. This could be by using non-steroidal anti-inflammatory drugs such as Ibuprofen and also by using ice packs on the damaged tendons to help to bring down the swelling. If symptoms persist you may need to have a cortisone injection into the muscle to reduce the inflammation. Your doctor should be able to do this for you.
When the muscle has begun to settle down you can start simple exercises designed to strengthen the rotator cuff muscles. Do not rush off to the gym thinking that any type of exercise will do the trick. It won't. Pushing weights before the muscle has healed properly is likely to cause more damage.
Rotator cuff exercises use little or no resistance when recovering from an injury. They will start with gentle exercises that do not cause any pain. If you do feel pain or discomfort when exercising stop immediately as this is an indication of further damage being done. It may be that you started exercising too soon.
And finally, when your shoulder is fixed and back to its full pain free movement, don't just give up on the exercises. Rotator cuff injuries are common but a lot of them can be avoided by keeping the rotator cuff muscles healthy so just take five or ten minutes a day to keep them happy.
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If you want to know how torn rotator cuff treatment stopped me needing surgery check out my story at my blog
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