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The Rotator Cuff: the little muscles with the big problems

by Lauren Muney

 

I have been receiving many emails from "Fit Over 40" readers asking how to help rehab a rotator cuff injury, since one of the authors mentioned how I "cured" his shoulder problem. I have learned a few "post-rehab" techniques which slowly build the muscles back to close to, if not as good as, before the stress or injury. I'll try to use all the resources and information I can muster, but first...

Disclaimer:

I am not a physical therapist nor am I a rehab specialist. I am simply a personal trainer with an interest in biomechanics. These professionals have undergone advanced training in biomechanics, anatomy, physiology, and a grueling education for the letters after their name, "PT" (physical therapist). These exercises SHOULD NOT REPLACE being attended by your doctor, sports medicine professional, physical therapist, massage therapist, osteopath, or chiropractic specialist.

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The below information will assist you in understanding your rotators and possibly starting rehab... Note that the rotator cuff is four (4) muscles, and any one (or several) could be injured. I have successfully assisted my own injuries as well as others', some who claim that these methods saved them from surgery.

 

The rotator cuff group

consists of four muscles, subscapularis, teres minor, infraspinatus and supraspinatus, which are positioned around the shoulder joint. These muscles are small, but their function is very important. Specifically, they act to keep the shoulder joint stable during movements of the arm by, in layman's terms, keeping the 'ball' in the 'socket'. Frequently these muscles can be pulled, strained, or weakened through sports or occupational activities. Repetitive movements can strengthen one muscles yet weaken the others, or harm them all.

This page will attempt to rehabilitate, or "rehab", these muscles by strengthening them in a slow method. These exercises have been taught in many rehab and post-rehab facilities. Do not try to rush the exercises or to load the muscles with weights, in an effort to "get back into the action" or because you "feel silly" doing such small movements. Rehab is not about 'looking cool' with heavy weights - it's about getting you back into your activities full strength as soon as your muscles are ready. Please follow this advice and exercises to the letter... and BE PATIENT. It may take several weeks or months but you may regain full and pain-free movement.

 

Another important note:

These exercises are for issue where the problem is muscular. These will not help any person who has worn away the harder cartilage or torn some of the tendons or ligaments. The whole shoulder socket is very dangerous and truly does need attention from a professional if you have been suffering chronically ("for a while") or acutely ("very intense recent pain").

 

One of the best websites for explaining these exercises is TheraBand Academy. Theraband makes some excellent elastic fitness bands. I have used some of their photographs and manipulated them to explain with one glance. Visit their pages to see what they can offer.

The main exercises I recommend to people are the internal rotation and the external rotation. There are other exercises which will hit every shoulder head, but these will start you on your way.

 

Equipment:

Both are performed with an elastic exercise/fitness band, which you can purchase at any sports store or department-store sports department. Here is a whole page of online retailers who sell travel exercise bands. Bands come in many strengths; I recommend you use buy the multi-pack which have several strengths, and begin with the lightest strength. When you feel stronger and in less pain, you can move to the medium strength bands. Note: do not use the heavy-duty strength elastic bands for any rehab exercises. The heavyweight band should be saved for resistance training only.

 

External Rotation:

  1. Tie a fitness band at waist height to a doorknob, stairs, or even a bedpost. Put a rolled-up towel under the arm to keep it away from the body -- and allow blood to flow freely.
  2. (Do NOT use dumbbells! The angle is wrong and therefore gravity will try to pull your arms down, not sideways. This will hurt you even more! USE A BAND.)
  3. Stand sideways with the arm at the side and the forearm parallel to the floor, pull back on the rubber band only at the elbow (not the entire arm)-- UNTIL FATIGUE. Don't go more than "fatigue". Don't count reps. How will you know what "fatigue" feels like? You'll know!
  4. Switch arms and do the other arm the same way. If you are only injured on one shoulder, doing both arms will do two things: it will help the poor arm mimic the good arm, and it will attempt to keep them even. (The good arm will be able to exercise longer than the bad arm; use your best judgment).

Internal rotation:

  1. Then turn 90 degrees facing away from the door; still holding the rubber band, push the arm out in front of the body with the forearm parallel to the floor UNTIL FATIGUE. You will be using the same rolled-up towel technique... and once again, you will be using only the arm at the elbow, and not swinging the upper arm at all.
  2. Again, do not use dumbbells.
  3. For most people, internal rotation is easier than external rotation - there seems to be less injuries in this rotator. Again, do not go beyond fatigue.

 

(Theraband images from Theraband Academy)

 

Equipment note:

You can use you use the cable-crossover at the gym --- but only use the crossover whose height can be varied.

Set the height at waist-level.

Use NO weight : use only the headplate as the resistance weight.

Do not use more weight than that; it might pull your shoulder.

Remember this is "rehab", not training.

 

Shoulder "Military Presses"

Next, if you aren't too weary, use VERY light weights (3-5lbs OR a sack of sugar!) and do military/shoulder presses.... you can actually use a band for these also, but I used light weights... even a soup can!

Note about military presses:

Do not face your palms outward (like in this video!) when doing these presses - they will hurt your shoulders when injured. FACE YOUR PALMS INWARDS TOWARDS EACH OTHER. This will protect your rotators but allow them to do the pushing which they need to rehab.

Only do these with VERY light weights -- remember that you are doing them to rehab from injury and NOT to "work out", and ONLY do them UNTIL FATIGUE. (Image from EXRX.net)

 

Exercise frequency:

The reason to exercise "only to fatigue" that when one exercises properly, the muscles makes micro-tears in the fibers. The body doesn't want torn muscles because there is a muscle weakness when muscles are lightly torn (you may feel this as "soreness" after exercise). The body rebuilds the muscles with new fibers to strengthen the 'torn' parts. so the biochemical processes in the muscle actually create newer, stronger fibers.

These fibers actually are creating "new" muscle. This is also the process by which you get "bigger" muscles - the continual tearing-down and renewal of new fibers makes stronger, larger muscles. This is how we repair muscles in physical-therapy rehabs as well as build lean muscle tissue for becoming sleek and fit.

By doing these exercises, your muscles are breaking down so they can build back up STRONGER. But do not push the muscles which are trying to heal. They cannot heal if they are pushed into doing "workouts"; instead, for your rehab, use light bands and light weights only to fatigue.

By exercising these muscles only to "fatigue",

your muscles know at the point they need to stop. Sometimes it's only 6 reps; sometimes it may be 13 or 20. Just go to "fatigue" (I can't stress this enough), and then rest those muscles. make sure that you do not do other exercises which will also work these muscles, such as bench press or heavy bicep work. REMEMBER YOU ARE REHABBING. You have more time in your life to get back to real training.

You can do these exercises every other day.

If you stay with the rehab program, you will be able to feel yourself getting stronger. The length of time spent working on these rehab exercises will depend on your willingness to allow your body the full process of healing. Remember, you are rebuilding your injured or weak muscles. You will know when you are full strength again, and then you will need to follow the Post-Rehab reminders below.

 

More exercises?

There are more exercises you can do, but start with the ones mentioned above. Below are several more exercise links, so once you are in less pain you can try the gamut of exercises... just remember the towel under your arm for rotations... and ONLY TO FATIGUE.

Remember to be gentle and REST afterwards. If there is pain, remember ICE for the first day, then alternate HEAT & ICE.

 

Post-rehab reminders

It is very important to always warm up your shoulders before training... of course I am talking about when you get back to training!

Here are some additional things to remember:

 

 

Good luck!


For more ideas on fitness, health, or "alternative" methods for your lifestyle, contact Lauren for coaching solutions!