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Aug 26

Preventive or Remedial Exercises for Rotator Cuff Injuries

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The July Newsletter discussed Rotator Cuff injuries, which is a common syndrome in many sports. During my coaching career (over 50 years at this time), I have always fostered a personal philosophy of ‘preventive TLC’ for the athletes. Thus, it was not luck, but my approach to create a safe training/coaching environment with the application of preventive principles in the sports I coached for all these years (swimming athletics, artistic gymnastics, modern pentathlon).

As stated previously, there are two major causes of Rotator Cuff injuries: overuse and poor technique; both of which can be prevented. However, it must start with the Warm-up and the Cool-down procedures.

The design of the Warm-up and Cool-down time should be based on the percent of total training time (at least 20% plus and 10% plus respectively) and depends on the level of fitness of athletes or the group. I usually plan 30-40 minutes for the Warm-up session, which is in addition to the actual training time. Warm-up exercises should be based on the skills and movement patterns to be taught in the specific training session instead of traditional and haphazard exercises one can often observe.

The swimmers in my 8-year study of developmental programming remained injury free throughout. However, after joining other clubs when the study was completed,  most suffered lower back pain (mostly due to incorrect movement of the butterfly stroke) and Rotator Cuff problems because of lack of preventive exercises in programming and Warm-up and Cool-down sessions that lacked the appropriate time allotment and exercise selection.

In addition to overuse and poor technique, Rotator Cuff tears are also prominent among athletes with prolonged or sudden stress, such as falling on the shoulder (wrestling, football, etc.) or lifting heavy weights, which can cause the tendons to pull away from the bone or tear. The injury is usually indicated by sudden pain that can range in severity. The shoulder becomes more difficult to use and the athlete may be unable to raise the arm above the head. Movement may result in snapping or crackling noises.

Seeking Medical Help

Preventive or remedial exercises can help build strength after a minor injury. A major or recurring injury, however, requires more attention.

A doctor should be consulted if the athlete is experiencing the following:

  • Pain or a deep ache
  • Swelling (occurs whenever the organs, skin, or other parts of the body enlarge. It is typically the result of inflammation or a buildup of fluid. It can occur internally or it can affect your outer skin and muscles)
  • Difficulty raising the arm
  • Difficulty sleeping on the arm more than a few days after your injury

The above are symptoms of a more severe injury.

Before embarking on an exercise regimen, the athlete should consult a doctor or physical therapist, who can help to develop a safe program and observe how the shoulder moves, how the spine looks, check the shoulder’s range of motion (ROM), and test various muscles for weakness or stiffness. The long-term goal of these exercises is to eliminate or reduce shoulder pain entirely while teaching proper movement to avoid re-injuring the Rotator Cuff. In addition to ROM exercises and physical therapy, the shoulder should be iced two or three times per day, according to medical experts.

Selected Remedial Exercises

1. Side-lying External Rotation

  • Lie down on the side opposite the injured arm
  • Bend the elbow of the injured arm to 90 degrees and rest the elbow on the side. The forearm should rest across the abdomen
  • Hold a light dumbbell in the injured side’s hand, and keeping the elbow against the side, slowly raise the dumbbell toward the ceiling.
  • Stop rotating the arm if feeling a strain
  • Hold the dumbbell up for a few seconds before returning to the start position with the arm down
  • Repeat 3 sets of 10 up to 3 times per day
  • Increase Reps to 20 when a set of 10 becomes easy.

2. Doorway Stretch

  • Warm up the muscles by standing in an open doorway, spreading the arms out to the sides
  • Grip the sides of the doorway with each hand at or below shoulder height, and lean forward through the doorway until feeling a light stretch
  • Keep the back straight when leaning and shifting the weight onto toes
  • Feel a stretch in the front of the shoulder
  • Avoid overstretching

3.  High-to-Low Rows

  • Attach a resistance band to something sturdy at or above shoulder height
  • Secure the band so it doesn’t come loose when pulling on it
  • Get down on one knee so the knee opposite the injured arm is raised. The body and lowered knee should be aligned
  • Rest the other hand on the raised knee
  • Holding the band securely with the outstretched arm, pull the elbow toward the body
  • Keep the back straight and squeeze the shoulder blades together and down when pulling
  • The body should not move or twist with the arm
  • Return to start and repeat 3 sets of 10

4.  Reverse Fly

  • Stand with the feet shoulder-width apart, knees slightly bent
  • Keep the back straight, and bend the elbows to 90-degrees
  • Squeeze the shoulder blades together
  • Avoid raising the arms above shoulder height
  • Return to start and repeat 3 sets of 10

5. Lawn-Mower Pull

  • Stand with the feet shoulder-width apart
  • Place one end of a resistance band under the foot opposite the injured arm
  • Hold the other end with the injured arm, so the band goes diagonally across the body
  • Keeping the other hand on the hip and without locking the knees, bend slightly at the waist so the hand holding the band is parallel to the opposite knee
  • Like starting a lawn mower in slow motion, straighten to upright while pulling the elbow across the body to the outside ribs
  • Keep the shoulders relaxed, and squeeze shoulder blades together while standing
  • Repeat 3 sets of 10

Mobility Exercises

Rotator Cuff exercises to improve shoulder mobility should begin as soon as pain allows. The aim is to restore full and pain-free mobility to the shoulder joint. Sometimes, mobility could already be good depending on the severity of the injury, and therefore less time should be spent on these exercises before moving on. Mobility exercises should be done at least once a day and sometimes 2 or 3 times per days is recommended. If any of the exercises become painful, avoid doing them and/or stay within pain-free state of ROM.

1. Pendulum Swing

The aim is to increase mobility in the shoulder joint. If the injury is mild and the shoulder has not been immobile for very long, it is likely that one can skip through the exercise relatively quickly and move onto more suitable flexibility and stretching exercises.

  • Gently swing the arm in a circular motion while lying on the front or leaning the body forward at the hips
  • Gradually increase the size of the circle to increase the ROM
  • Try to relax the arm and use the momentum of the swing

2. Pole/Wand Lift

  • A pole/broom handle/long stick/wand can be used to assist the weak shoulder
  • Hold it in each hand, wider than shoulder width
  • Use the good arm to move the injured shoulder high to comfort level
  • Stop if the action becomes painful
  • Try to relax the injured arm so it is not working
  • Repeat several times a day, trying to gradually increase the range

This can be done in a number of different positions such standing upright, bending the trunk forward parallel to the floor, on supine position (on the back) on an elevated surface, table, or bench.

Stretching Exercises

Stretching exercises should be performed as soon as pain allows. If it is a Rotator Cuff strain, then the involved muscle may have gone into spasm or shortened and will need stretching. Try to find the stretching exercises that feel most effective and perform them regularly throughout the day. Have an expert select the exercises with regular check up to make sure there is progress.

1. Wall Shoulder Stretch

  • Place one forearm against a fixed point (such as a doorway), elbow and shoulder at 90 degrees
  • Gently turn the body away ( stepping forward) to stretch the front of the shoulder and chest
  • Hold the position for 20 seconds and repeat 3 times
  • Feel a gentle stretch in the front of the shoulder
  • You should not feel pain

2. Back Shoulder Stretch

  • Place one arm across the chest and pull it in tight with the other
  • Feel a gentle stretch at the back of the shoulder
  • Hold the position for 20 seconds and repeat 3 times
  • Feel a gentle stretch in the back of the shoulder
  • You should not feel pain

Strengthening Exercises

Strengthening exercises usually begin with isometric or static exercises, progressing to dynamic ones with resistance using medicine balls.

Isometric Shoulder Exercises

Static (or isometric) exercises are some of the first torn Rotator Cuff exercises because they do not involve any movement.

  • Push against a stationary object such as a wall, doorframe, or resistance provided by another person
  • Since there is no movement, static exercises can be performed soon after injury, usually within 3-7 days provided they are pain-free
  • Rest for a longer period until exercises feel comfortable
  • If any exercise becomes painful, discontinue
  • They can be done for a range of different shoulder movements to strengthen the muscles around the entire joint, including adduction, abduction, flexion, extension, and rotation

1. Scapular Squeeze

  • In a sitting position elbows by the side, squeeze the shoulder blades together
  • Hold for 5-10 seconds
  • This strengthens the rhomboids and middle trapezius. The aim is to strengthen those muscles, which stabilize the scapula or shoulder blades during the early phase of a rehabilitation program
  • Squeeze the shoulder blades or scapulae together while ensuring the elbows stay down
  • This can also be continued into the mid-stages

Dynamic Strengthening Exercises

These exercises involve movement and can be done with a resistance band or dumbbell weights. They can be performed in many different positions and can easily be progressed as strength improves. The exercises can replace the static exercises (above) as soon as pain allows (usually 7 days plus).

1. Lateral Rotation – Standing

  • Use a resistance band to work the lateral rotator muscles in the shoulder
  • Attach a band to a fixed point and keeping the elbow close into the body to rotate the shoulder so the arm moves outwards
  • Move through as large a ROM at comfort level
  • The movement should be felt at the back of the shoulder after few repetitions

2. Lateral Rotation – Prone Position

  • Assume the prone position (on stomach) with each arm out to the side of a bench or table
  • Lift the dumbbell as the shoulder rotates upwards
  • Try to move through as large a ROM as possible performing the exercise in a slow and controlled manor
  • Feel it at the back of the shoulder

3. Lateral Rotation – Abduction

  • Stand, holding the band, elbow abducted in 90 degrees
  • Elevate the arm ensuring the elbow is elevated
  • Maintain the shoulder at 90-degree abduction without horizontal adduction or abduction

4. 90/90 External Rotation – Standing

  • The resistance band is anchored in front, and the other end is held in the hand, the arm is raised and the elbow is bent at the horizontal
  • Rotate the arm so that the fist points upwards
  • Slowly return to the starting position and repeat

5. Internal Rotation – Standing

  • Start with the band attached to a fixed point at the side
  • Hold the other end of the band in one hand, elbow bent and upper arm by the side
  • Keeping the elbow by the side, move the hand towards the stomach as to comfort level
  • Slowly return to the starting position

6. 90/90 Internal Rotation – Standing

  • Rotate the arm so that the forearm moves forwards to a horizontal position
  • Slowly return to the starting position

7. Diagonal Plane Exercises

  • Hold one end of a resistance band starting with the arm raised out to the side above shoulder height
  • Pull the arm down across the body so that the hand reaches the opposite hip
  • It is important to maintain joint stability

Illustrations of these exercises can be found on sportsinjuryclinic.net

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