Torn Rotator Cuff

The rotator cuff is a term used to describe the tendons and muscles that support, stabilize and allow the arm to move up and down, as well as rotate. The four muscles include the supraspinatus, infraspinatus, subscapularis, and teres minor.

Injuries and inflammation to these muscles can cause pain and decreased range of motion. A torn rotator cuff muscle can severely limit movement and strength in the shoulder joint.

A common symptom of a rotator cuff injury is aching, and weakness in the shoulder when the arm is lifted overhead. A less severe injury may result in swelling, bleeding and bruising. This creates pain and inflammation as the swollen muscle pushes on the nearby bone. This can last several months before the muscle is entirely healed. Continued activity can increase the swelling, and lengthen the recovery time.

A torn rotator cuff is much more severe and more serious. The symptoms include pain, decreased range of motion, weakness and a deep ache. These symptoms are often worse at night or in the morning.

A tear needs to be seen and evaluated by a physician and MRI to determine if surgery is needed to repair the muscle. If large tears are left alone, they often lead to arthritis, due to continual rubbing and inflammation of the joint.

Recovery involves medication to reduce inflammation, and physical therapy exercises to increase range of motion and strength.

The most important part about treating a sore shoulder is to get the right diagnosis. The treatment of a strain is different that a tear, so see your physician if you have an injury to the shoulder that results in pain.

Stretching and strengthening the shoulder can help prevent injuries, and should be a part of a warm up and general conditioning program.

NEVER BEGIN A REHABILITATION PROGRAM UNTIL YOU HAVE CONSULTED YOUR DOCTOR!

ROTATOR CUFF REHAB PROGRAM

PHASE I

Unconditioned, imbalanced muscles of the shoulder area can cause rotator cuff injuries. As the rotator cuff fatigues from excessive use, weakness, or lack of endurance, the ball of the shoulder joint becomes more mobile and moves upward. This causes the rotator cuff tendons to come in contact with bone, which can lead to irritation of the tendon, then inflammation and pain, then ultimately an injury (shoulder tendonitis, bursitis, impingement, etc.). Along with keeping the ball firmly in its socket, the rotator cuff has functions related to performance in sports. The rotator cuff provides power and control for the golf swing, tennis stroke, baseball/softball throw and pitch, volleyball serve and spike, and swimming. The exercises described below are to help you strengthen the muscles in your shoulder (especially the muscles of the rotator cuff–the part that helps circular motion). These exercises should not cause you pain. If the exercise hurts, stop exercising. Start again with a lighter resistance.

RESISTANCE The exercises described below are designed to improve endurance of the shoulder musculature, with strength gains being secondary. Therefore the emphasis is on controlled movement with low resistance and high repetitions. The use tubing is required for several of the exercises below with the others utilizing body weight or small dumbbells. . You should strive for perfect execution throughout your routine to help restore the proper movement patterns and reduce the symptoms in your shoulder.

FREQUENCY Perform all the exercises 5 days per week, 1-2 times per day. Begin by performing 15 repetitions of each exercise for the first 3 days and then progressing to 2 sets of 15 repetitions. After 10 days progress yourself to performing 3 sets of 15 to 20 repetitions.

POSTURE Perfect posture is one of the key elements in maintaining a healthy shoulder. Think of a skeleton hanging in a classroom. Its shoulders are naturally hanging back and down, giving it perfect posture and alignment. Unfortunately, most people have a tendency to slump forward, with their shoulder blades sliding forward and up. If you spend much of your day in front of a computer, as many Americans do, you’re probably slumping over, even if you’re not conscious of it. Keep your Shoulder blades pulled Back and Down (SBD) towards your waist, as if you’re thrusting your chest up. It is important to keep your shoulders in this position throughout the exercises and in life.

EXERCISES

1. PULLDOWNS Place the band above your head so you’re pulling it down at a 45 degree angle. Standing with great posture (SBD) grab the band with both hands, elbows straight, and thumbs pointing up. Pull the band down to your pockets and about 6-8 inches away from your body. Pause for 2 seconds in this position emphasizing a squeeze between your shoulder blades. Slowly return the band to the starting position.

2. STANDING ROWS Place the band at mid sternum height so you are pulling in a straight line. Standing with great posture (SBD) grab the band with both hands, elbows slightly bent, and thumbs pointing up. Pull the band towards your chest by contracting your shoulder blades and bending your elbows. The finish position should have a great SBD, elbows bent at 90 degrees and located at mid torso. Hold that position for 2 seconds then return to the starting position.

3. EXTERNAL ROTATION Place the band at mid sternum height so you are pulling in a straight line. Standing with great posture (SBD), place your elbow at your side, bent at 90 degrees and gripping the band with the thumb pointed up. Hold a towel between your elbow and your side to you remind you to maintain this position. Your forearm begins by pointing across your body. Slowly rotate your shoulder out, keeping your elbow bent, and fixed to your side. Rotate out as far as possible by limits of motion or pain. Hold that position 2 seconds and slowly return to the starting position.

4. INTERNAL ROTATION Place the band at mid sternum height so you are pulling in a straight line. Standing with great posture (SBD), place your elbow at your side, bent at 90 degrees and gripping the band with the thumb pointed up. Hold a towel between your elbow and your side. Your forearm begins by pointing away from your body. Slowly rotate your shoulder in, keeping your elbow bent, and fixed to your side. Rotate in as far as possible by limits of motion or pain. Hold that position for 2 seconds and slowly return to the starting position.

5. STANDING HITCHHIKER Stand with perfect posture (SBD) with hand placed on your thighs and your thumbs pointed upward. While gliding your shoulder blades back and down toward your waist raise your arms up at a 45 degree angle. Raise your arms to shoulder height only and keep your elbows straight. Hold this position for 2 seconds and slowly return to the starting position. Begin this exercise with no resistance and gradually progress to 1-5lb dumbbells. Do not use weights heavier than 5lb. The smaller muscles of the rotator cuff are difficult to isolate using heavy weight.

6. BICEP CURL Stand with perfect posture (SBD). Keep your elbows next to your torso while holding a dumbbell or band. Initiate the movement by flexing your elbow and then slowly returning the starting position while maintaining good posture.

7. TRICEP PRESS Begin the exercise with great posture (SBD), elbows by your side and bent to 90 degrees. Extend your elbows against resistance until you reach full extension. Hold this position for 2 seconds then slowly return to your starting position.

8. SERRATUS PUNCH Begin the exercise with the band wrapped around you thumb, sitting underneath your armpit, and your elbows bent to 90 degrees at your side. Extend your elbows forward until they are straight and then round your shoulders at the end of the movement. Hold this position for 2 seconds then slowly return to your starting position.

CAUTION If any of these exercises increases your shoulder pain, stop doing that exercise and contact your physician or therapist.

PHASE II For those individuals requiring further strengthening to perform overhead activities should be progressed to PHASE II. Exercises for this phase require instruction from a therapist.