Monday, June 27, 2016

10 Most Common Problems: Rotator Cuff issue

                                                                Rotator Cuff Issues

The Rotator Cuff is a group of muscles and tendon tie-ins that are crucial for the proper functioning of the shoulder joint. These muscles sit around the scapula and shoulder joint. The muscles can be remembered by the acronym SITS. Supraspinatus, Infraspinatus, teres major/teres minor and subscapularis.  (see fig.)  Collectively, these muscles form a web of stability and are individually responsible for all the motions of the shoulder, our most mobile joint. The figure does not show the subscapularis which is the only rotator muscle located on the interior of the shoulder blade. It is responsible for internal rotation and adduction.  It is activated in the gym with exercises such as cable crossover and bench.  Not what I would classify as an underutilized muscle in the gym.

Dysfunction of the glenohumeral joint and more specifically the cavity separating the humerus (upper arm bone) and the scapula (shoulder blade) is the area that I will concentrate on in this article.  The most common problem I see is impingement of the shoulder joint causing inflammation or injury to the bursa and supraspinatus muscle. This is commonly an overuse injury caused by poor posture, muscular imbalances, general muscular weakness and over compensation of larger muscles of the anterior delt, pecs, upper back and cervical to thoracic spine area.

Other shoulder problems usually are a result of an injury that someone can point to as the cause of their acute pain. Impingement syndrome is usually a chronic problem that last months or even more than a year. It does not go away with rest. It must be corrected through clinical exercises and treatment plans.

By the time I see clients at TopShape Fitness Studio with shoulder issues, they can be quite severe. Clients have usually already been to physio more than once and have even had cortisone shots.  They may even have “Frozen Shoulder” (inability to move shoulder through any significant range of motion) and are in severe discomfort, dysfunction and stress.

Here is the good news. It can be fixed. In fact, a significant result can be shown within 2 weeks and full recovery in as little as 6 weeks. If you follow the plan!

Rotator Rehab Mistakes:
  1. Common mistakes made by sufferers of rotator cuff, sprains, tears, tendonitis or bursitis make are to rest and wait for symptoms to subside.  Unfortunately when clients go to their family GP and complain that it hurts to do a certain movement, the doctor may advise not to move it. If you don’t move your shoulder through its proper range of motion you will lose that range of motion. Range of motion (ROM) rehab exercises are critical. The following videos show common range of motion warm-ups.

Here are some acute phase rehab exercises:

 (pendulum warmups)

 (warmup stick stretches)

  1. Icing will stop the healing process momentarily. It feels good and it may help dull the pain but does not help in healing in any way. In fact, by stopping the inflammation process you are stopping the constant supply of blood that carries inflammatory cells to the injured area. This is critical in the healing process. You are also stopping the production of growth hormone and interrupting the lymphatic drainage process. The 1 way system that flushes swelling from the affected area. This is counterproductive. Please refer to our blog article on Icing for more information. At TopShape we haven’t used ice in rehabbing our athletes or regular clients since 2008. Since that time I have noticed a significant improvement in recoveries of various injuries.

  1. Another mistake is to take non-steroid anti-inflammatory, NSAIDs, like advil. NSAIDs not only interfere with the essential process of inflammation, it interferes with the neurological training adaptation that needs to happen when healing during clinical exercise rehab.

  1. Lift through it. Muscular imbalance plays a large roll.  An over dominance of anterior musculature, such as pecs and anterior delts and the lack of flexibility in these groups helped lead to the injury. To continue these movements in improper form is insanity. Many lifters even demonstrate incorrect form in their pull-ups, recruiting the pecs rather than the proper scapular movement. This is a main contributor to why women have such a difficult time with pull-ups. Not strength, but function.

So what’s the plan? First get a proper diagnosis. Here at the studio I do an injury movement test to confirm a doctor’s or physio’s diagnosis. Having a defined diagnosis, speeds up and helps me define an individualized treatment plan for the exact injury. This means you don’t have to do a lengthy generalized program.

After the warm-up exercises like the ones above, we perform scapular stabilization exercises.

 Here are some exercises for the more chronic and dysfunction correction warm-ups

 (scapular retraction) and 

(lying dynaband extension)

Lastly some favorite posture correcting exercises. These are general correction exercises for the majority of dysfunction I see.  If you are a regular weight lifter than some shoulder accessory work is needed in your program. Add some of these to help balance anterior and posterior chain exercise

(rotator strengthening)

(overhead scapular retractions)

 Try this program if you are suffering from shoulder dysfunction. It has helped me build functionally strong shoulders after years of dysfunction.

Mike Hayden

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