Welcome back, I hope you had a great weekend and your are enjoying the blogs. A couple of people have asked me, how I pick the topics. They are usually of interest to me or friends, or even things I am interested in studying. Today we are looking at shoulder rehab, yes we did a piece on shoulder mobility not that long ago. Shoulders are a favorite subject of mine, and so many people have trouble with them like myself. Last time we addressed mobility issues, but what we would do in a rehab type setting. In this article we will go over a couple of different shoulder rehab, prehab and ongoing care type of protocols.
The rotator cuff is made up of four muscles supraspinatus, infraspinatus, subscapularis and the teres minor. They are responsible for attaching the humerus to the shoulder blade, allowing for arm elevation and rotation while keep the humeral head depressed at the same time. This depression of the humeral head is what prevents impingement of the rotator cuff. The signs of shoulder impingement syndrome are pain when sleeping on the affected side, pain reaching overhead or behind the back, a loss in range of motion, shoulder weakness and catching, grinding or cracking sounds during arm movement.
The idea of shoulder impingement was introduced in 1972 by Dr. Charles Neer, who stated that it results from mechanical impingement of the rotator cuff tendon beneath the anteroinferior portion of the acromion, especially when the shoulder is placed in the forward-flexed and internally rotated position. The three stages of shoulder impingement are; Stage 1 commonly affecting people younger than 25 years old. The symptoms are acute inflammation, edema and hemorrhage in the rotator cuff. This stage is reversible and can be treated non-operatively. Stage 2 usually affects people between 25-40 years old, resulting asa continuum of stage 1. The rotator cuff tendon progresses to fibrosis and tendonitis, which commonly does note respond to conservative and requires surgery. Stage 3 commonly affects people over 40 years old. As this condition progresses, it may lead to mechanical disruption of the rotator cuff tendon and to changes in the coracoacromial arch with osteophytosis along the anterior acromion. The surgical repair for this stage involves acromioplasty and rotator cuff repair.
Lets look at ways to avoid surgery. In Pills, Lasers and Tape I outlined a multiple ways to address soft tissue injuries. It lays out the what supplements to take in the first 24 hours, 48 hours and 72 hours. As well as some of the vanguard treatment options available to you. It is suggested that you follow an anti-inflammatory diet removing dairy, gluten and soy. Lets get to why we are here
- Isometric shoulder external rotation: Stand in a doorway with your elbow bent 90 degrees and the back of the wrist on your injured side pressed against the door frame. Try to press your hand outward into the door frame. Hold for 5 seconds. Do 2 sets of 15.
- Isometric shoulder internal rotation: Stand in a doorway with your elbow bent 90 degrees and the front of the wrist on your injured side pressed against the door frame. Try to press your palm into the door frame. Hold for 5 seconds. Do 2 sets of 15.
- Wand exercise, Flexion: Stand upright and hold a stick in both hands, palms down. Stretch your arms by lifting them over your head, keeping your arms straight. Hold for 5 seconds and return to the starting position. Repeat 10 times.
- Wand exercise, Extension: Stand upright and hold a stick in both hands behind your back. Move the stick away from your back. Hold this position for 5 seconds. Relax and return to the starting position. Repeat 10 times.
- Wand exercise, External rotation: Lie on your back and hold a stick in both hands, palms up. Your upper arms should be resting on the floor with your elbows at your sides and bent 90 degrees. Use your uninjured arm to push your injured arm out away from your body. Keep the elbow of your injured arm at your side while it is being pushed. Hold the stretch for 5 seconds. Repeat 10 times.
- Wand exercise, Shoulder abduction and adduction: Stand and hold a stick with both hands, palms facing away from your body. Rest the stick against the front of your thighs. Use your uninjured arm to push your injured arm out to the side and up as high as possible. Keep your arms straight. Hold for 5 seconds. Repeat 10 times.
- Resisted shoulder external rotation: Stand sideways next to a door with your injured arm farther from the door. Tie a knot in the end of the tubing and shut the knot in the door at waist level. Hold the other end of the tubing with the hand of your injured arm. Rest the hand of your injured arm across your stomach. Keeping your elbow in at your side, rotate your arm outward and away from your waist. Make sure you keep your elbow bent 90 degrees and your forearm parallel to the floor. Repeat 10 times. Build up to 2 sets of 15.
- Resisted shoulder internal rotation: Stand sideways next to a door with your injured arm closest to the door. Tie a knot in the end of the tubing and shut the knot in the door at waist level. Hold the other end of the tubing with the hand of your injured arm. Bend the elbow of your injured arm 90 degrees. Keeping your elbow in at your side, rotate your forearm across your body and then back to the starting position. Make sure you keep your forearm parallel to the floor. Do 2 sets of 15.
- Scaption: Stand with your arms at your sides and with your elbows straight. Slowly raise your arms to eye level. As you raise your arms, spread them apart so that they are only slightly in front of your body (at about a 30-degree angle to the front of your body). Point your thumbs toward the ceiling. Hold for 2 seconds and lower your arms slowly. Do 2 sets of 15. Progress to holding a soup can or light weight when you are doing the exercise and increase the weight as the exercise gets easier.
- Side-lying external rotation: Lie on your uninjured side with your injured arm at your side and your elbow bent 90 degrees. Keeping your elbow against your side, raise your forearm toward the ceiling and hold for 2 seconds. Slowly lower your arm. Do 2 sets of 15. You can start doing this exercise holding a soup can or light weight and gradually increase the weight as long as there is no pain.
- Horizontal abduction: Lie on your stomach on a table or the edge of a bed with the arm on your injured side hanging down over the edge. Raise your arm out to the side, with your thumb pointed toward the ceiling, until your arm is parallel to the floor. Hold for 2 seconds and then lower it slowly. Start this exercise with no weight. As you get stronger, add a light weight or hold a soup can. Do 2 sets of 15.
- Push-up with a plus: Begin on the floor on your hands and knees. Keep your arms a shoulder width apart and lift your feet off the floor. Arch your back as high as possible and round your shoulders (this is the "plus" part or the exercise). Bend your elbows and lower your body to the floor. Return to the starting position and arch your back again. Do 2 sets of 15.
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- Face Pulls attach a rope to the high pulley of a cable station or lat pulldown. Grab a handle with each hand with an overhand grip, step back and pack your shoulders squeeze your shoulder blades together. Pull the middle of the rope to your face. Pause then reverse the movement and start again.
- TRX Y Deltoid Fly
- TRX T Deltoid Fly
- Ball Cobra
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