Everyone has an opinion on the management of shoulder pain. Whether it is a family member, co-worker, or neighbor, you are bound to find someone that tried to rid of their shoulder pain conservatively or surgically. You will hear both sides of people’s experiences when it comes to having shoulder surgery. Some will say that it helped and they would recommend it. Others will say that it was a horrible and painful experience. This article will focus on providing you some basic shoulder exercises that will support a rotator cuff tendinitis or torn tendon diagnosis, and possibly avoid rotator cuff surgery.
Since we specialize in athletes’ shoulders, we will provide our spin for the more complex rotational athlete’s shoulder. This article is still very useful for the everyday shoulder. The difference between the athletes’ shoulders, such as baseball pitcher, swimmer, volleyball or tennis overhand serve, and an everyday person’s shoulder is that the athletes’ shoulder needs a continual obsession about maintaining the foundational basics that this article talks about. This is an article of the basics of rotator cuff function and performance, so you can resolve your tendinitis or torn rotator cuff myotendinous unit.
A muscle and tendon work together, so we are going to establish that they will be both called a contractile unit. All muscle and tendon, both help you to contract a muscle and move your arm. Your Sports Medicine Physical Therapist or Orthopedist Surgeon will decide that you have rotator tendinitis if you have “sharp” pin-point pain to the tip of your shoulder or “dull and achy” broad pain to the general region of your shoulder. It will hurt to raise your arm overhead. You may or may not have a limited range of motion. If you have fallen on your shoulder or had suffered a direct blow to your shoulder, they might suspect a tear over tendinitis. There is research that shows age is a contributing factor of one having a rotator cuff tendinitis or tear.
If you are wondering how your Orthopedist or doctor concluded your rotator cuff tendinitis after looking at your shoulder for 5 minutes, only to tell you to take painkillers, apply ice, and seek a Physical Therapist, it is because of the general guidelines listed above. It does not take long to tell your age. He hears your story for 1-3 minutes. Trauma? Occupation? He or she can see there is shoulder pain when you raise your arm. Touching your arm does not tell much more, so if the doctor is in a rush, he may or may not touch your arm. This might disgust and frustrate you even more.
The good news is that we will tell you the top 3 things you need to do for the best odd for better rotator cuff tendinitis recovery.1
1. Improve on your shoulder rotation strength in as many planes of motion possible, with high repetitions of 20-30. Perform for 8 weeks consistently.
Your shoulder joint is designed to allow you to move in multiple directions. To reach backward, sideways, and to lift overhead. This makes your shoulder unstable and tend to have subtle variation of a dislocation. The minor but consequential movement of the shoulder places a huge load demand to your rotator cuff contractile unit. The hard part is that a healthy shoulder needs to be reactive and demonstrate control at all times. Reactive means to add catching a ball, balloon, or objects in different positions.
If you are a pitcher, try having someone move in different positions around you. Have them throw a ball and you face forward the entire time. You can be in a double stance, long lunge stride, or wide stance. Catch the ball. Catch the ball as its falling in front of you, from behind. Be creative and make it fun.
The common movement to focus in all of these ranges are internal and external rotations. Keep your elbow in a 90 degrees and twist your arm outwards for reps and sets. Then bring them inwards for reps and sets.
The muscle fiber types of the rotator cuff muscles mirrors more of your postural muscles. It is different than the aesthetic muscles like your quadriceps and biceps brachii muscles. You have to train your muscles based on the muscle fibers it is composed with. You have to do high repetitions, low load exercises. It is more of a reactive type of muscles. You can build strength, but the power comes from the rotator cuff’s ability to support the shoulder power muscles of the deltoids, latissmus dorsi, and pectoralis muscles. You can add the triceps and biceps brachii muscles to the power group too.
In summary, your shoulder rotator cuff program needs to be in many different positions of ranges (arm in front, diagonals, side, and such), reactive and high repetitions. This can seem like alot to take in and consume your exercise work-out. Try picking the positions that mirrors your life’s goals. Make that as a 2x-3x/week frequency. Add uncommon movement positions like backwards, overhead, and cross-body to the other 2x/week. Aim for 60-90 repetittions. Start low weight.
The key is that you should feel your back of your shoulders on fire from working the infraspinatus and subscapularis muscles. These two muscles are crucial to any shoulder rehabilitation
2. Make time to practice isolating spinal thoracic movement, separate of shoulder movement.
This concept is important to build a sturdy foundation for the rotator cuff muscles to act upon. Your scapula, or shoulder blades bone, conforms to your thoracic spine and rib cage. The scapula is the foundation of all shoulder rehabilitation. Many research are showing that scapular is more important than the rotator cuff muscles itself.
If you have a dynamic and moveable thoracic spine, the scapula can glide and slide with ease. You have more support and stability for the rotator cuff muscles to work from. There are three basic movements to apply this concept: Pushing, Pulling, and Lifting.
With these three, we want you to practice rounding your middle spine. Imagine a camel’s hump. Make that posture as your push a wall. You know that you have a healthy spine-shoulder integration is when you make the camel hump (thoracic flexion), push into the wall, and still take deep inhale and prolonged 8-10 seconds exhalations without effort.
The second thoracic posture is extension. Imagine arching your spine and sticking your chest out. Many compensate by sticking their bottom ribs (also known as rib flaring) and stomach out. Imagine you have a short necklace with the pendant on your top chest bone (sternum). Show that off. You should feel pressure between your scapulas.
Incorporate this thoracic extension while pushing a wall, sled, or an object. Get in and out of extension and flexion (camel hump) while pushing hard into the wall.
Move towards pulling. Grab a rope, towel, or theraband. Loop it around a pole. Pull the towel hard while switching from thoracic extension and flexion. In between the positions, do the breath inhale and exhale test.
Lastly, grab a bag of groceries, dumb bell, or kettlebell. Hold tight and perform the thoracic spine and breath test.
You can practice pushing by getting on all 4’s (hands and knees).
You can practice pulling with a TRx suspension training device.
Stay within your comfortable range of motion and as you perform these over 4-10 weeks, you will notice more shoulder range of motion.
3. Your shoulder is a product of how well you can produce force from your legs.
All movement comes from your ability to leverage something stable. You cannot row a rowing boat if you are less stable. You pull and row a boat by pushing your feet twice as hard as your arms are pulling. This is counterforce and ground reaction force. Fancy physics words that means to leverage the only stable constant variable: the ground.
Your legs have to be strong and balanced for you to conduct the ground reaction force up to your arms. This is not utilized enough.
A pitcher would have more shoulder injury if they did not have the wind-up to bring momentum and leverage ground.
Your exercise is to sit down on a bench. Stand up with one leg. Repeat for 20 reps. Switch and repeat on the other leg.
Another exercise is to step up onto a step box. Drop one leg down and back up. You will feel your legs driving your weight down into the ground for stability, as you pop up. Repeat for 20 reps. Switch and repeat on the other leg.
Of course, there is more to a comprehensive shoulder rehabilitation program. There is a pitcher that we fixed their shoulder with lung and diaphragm strength. Another pitcher source of injury was an exaggerated wrist weakness and instability because a trainer prescribed and dosed his training inappropriately.
As you incorporate these three principals for 2 months, you may be surprised to find that the basics are all that you needed. It was a matter of appropriate dosing (rule 1), being comprehensive (or outside-the-box) (rule 3), and being precise (rule 2) with your rehab.
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Danh Ngo PT, DPT, OCS, SCS
Doctor of Physical Therapy
Board Certified Specialist in Orthopedic and Sports Medicine
Certified Advanced Movement Specialist – RockTape
Mind Body Health Results Coach