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ROTATOR CUFF STRENGTHENING

ROTATOR CUFF - What is it?

Rotator cuff strengthening is an integral part of the treatment of every shoulder injury, otherwise the shoulder will remain weak and prone to re-injury.

The rotator cuff is the name given to a group of four muscles that act to stabilize the shoulder. Shoulder pain and the so-called frozen shoulder often involve these key shoulder muscles.



They are the
  • Subscapularis (which lies UNDER the shoulder blade), the

  • Supraspinatus (which lies ABOVE the spine of the shoulder blade), the

  • Infraspinatus (which lies UNDER the spine of the shoulder blade) and the

  • Teres Minor. To these four muscles we will add the

  • Biceps muscle for simplicity, since it also a common offender that needs strengthening.

These shoulder muscles allow you to raise your arm, turn it and move the arm into many different positions, each carefully controlled and cordinated, as in throwing a ball accurately, for example.

Unlike the hip joint though, the shoulder socket is very shallow to allow for greater range of motion of the shoulder. This makes the shoulder more vulnerable to injury, leading to shoulder pain, strains, tears and sometimes frozen shoulder.

Because the shoulder is non-weightbearing (as in the hip and knee) it is much less prone to arthritis. An exception here is the AC joint (Acromio-Clavicular). This joint that connects the collarbone to the shoulder blade is often injured in falls, and should it not be correctly managed with Rotator Cuff strengthening it becomes prone to Immobilisation arthritis.

See if you can follow the thin clavicle (collar-bone) at the top of the picture to where it joins with the shoulder blade (scapula) at the acromion. This Acromio-Clavicular (AC) joint with its ligament is key to shoulder mobility. Chiropractic adjustment of the AC is very important.

The shoulder muscles are energised by nerves emerging from the lower neck. An old neck pain injury often lies at the root of shoulder pain. Have you perhaps been involved in a car accident or an old sporting injury?



The so-called Rotator Cuff Syndrome is a complex condition involving four shoulder joints, together with their capsules and ligaments, the shoulder muscles and their tendons, their nerve supply and the Acromio-Clavicular Joint.

In these shoulder syndromes, the muscles after being strained adhere to each other and the roof of the fossa which is formed by the AC-joint.

A sports-oriented chiropractor will not only adjust your neck but focus on these peripheral sites of injury, the four shoulder joints, and a complete set of rotator cuff strengthening exercises.

Strengthening

The simplistic and safest rotator cuff strengthening exercises are the isometric exercises. A very good place to start, as Julie Andrews would say! Sound of Music ... (Sorry, a bit crazy this morning!) When you read you begin with A-B-C, when you sing ... when you strengthen your shoulder you begin with STRETCH -ISOMETRICS-DYNAMICS) These isometric exercises mean that the shoulder doesn't move! Here are six little exercises to start with. Whilst sitting in a chair, place your elbow against your side with the elbow at 90 degrees, and your hand straight in front of you. Using your other hand,

  1. grasp your wrist with the 'good' hand, and press straight across (inwards) with your injured arm. Without movement! Against resistance from the good arm.

  2. Adjusting the fingers slightly, in the same position, now pull outwards, again without movement.

  3. Now pull your elbow straight against your chest.

  4. Reaching across, grasp the elbow of the painful arm, with your 'good' hand. Now attempt to pull your painful arm away from the body, against the resistance of your good hand. Without movement. Gently, you're not going to the Olympics in Beijing!

  5. Now press your elbow backwards against the back rest of your chair.

  6. Lastly, make a fist with your sore arm, keeping the elbow at your side, and push straight forwards against the good hand. Again without movement.

Do about 5-10 reps of each, every time you take a tea break. Start slowly, particularly if these movements are painful. There's no rush.

Isometrics are more effective that dynamic exercises in the initial phase after injury when it comes to rotator cuff strengthening, but you must do it in different positions. When these six are painless, then do them with the shoulder flexed at 45 degrees, and then 90 degrees ...

Strengthening exercises with movement.

Once you can do the isometric ROTATOR CUFF STRENGTHENING exercises without pain, then progress to exercise with movement. The simplist is a simple affair with a small pulley, a cord with a handle at each end. Fix the pulley to the ceiling, and pull away, changing the position.

This excellent, simple little inexpensive shoulder stretcher you can get from a Dutch site

WEIGHT TRAINING

Once you can do that without pain, then it's time to move your ROTATOR CUFF STRENGTHENING on to light weights. Holding any tincan of around 400 g (1 lb) in your hand, start moving the arm in these same directions. Always start with stretching and do it at least twice a day.

A used bicycle tube is excellent for Rotator Cuff strengthening. Hook it over some fixed point, and start doing gentle exercises against the resistance of the tube. Inwards, outwards, forwards ... you can use your imagination, but follow a routine, gradually expanding it as you feel the shoulder getting stronger.

Warm up routine

Golfer Padraig Harrington

Whilst none of us would consider a routine like this before playing sport, if you are a professional sportsman, where fine-tuning makes a profound difference at the finish line, then you may wish to think about Padraig Harrington's preparation for a round of golf.

Padraig was missing 4-5 tournaments per year due to injury. So he hired chiropractor Dr Dale Richardson to go on tour with him. Now he misses no tournaments. This is the routine that Dr Richardson has given him:

  1. Early morning: 45 minutes of stretching, stability and core work to get warmed up.

  2. Shower

  3. Breakfast

  4. 20 minutes with Dr Richardson checking that all the joints and muscles needed by a professional golfer - every one in the body! - are working right, followed by more stretching.

  5. An hour at the range hitting shots to warm up further.

  6. 4-5 hours on the golf course.

  7. One hour with Dr Richardson getting treatment and cool-down procedures.

  8. Gym work in the evening, time and energy levels permitting.

The basic principles here: Stretching, warm-up, checking that muscles and joints are working correctly, after-sport stretching and cool-down apply whether you are going to spend the day gardening, preparing for a game of squash, or even just going for a hike.

For a professional sportsman, Harrington's words are interesting: One thing I know through experience is that I need to keep having constant attention, even when I have weeks off, because I can see even though I would be injury-free for say a couple of weeks, I can feel symptoms building up, and if I don't deal with those early signs I'm going to be in trouble on the course.

Rotator Cuff Strengthening: BREATHING

Patients often ask me how they should breathe with these exercises. I confess, it's an area I'm totally ignorant about and yet I believe it could be vitally important. "Breathing is, hands down, the most important aspect of yoga" they say at YogaTheCure. You might look to this page at Yoga Breathing for some tips on how to breathe wtih your Maignes Syndrome Exercises. YOGA BREATHING ...

Links

Having read this page, should you want to read more about shoulder anatomy, (did I hear you exclaim, "four! shoulder joints?") and see some diagrams, then for more info about Rotator cuff syndrome and the Frozen Shoulder please click here:


  • From ROTATOR CUFF STRENGTHENING to SHOULDER ANATOMY

  • Rotator cuff syndrome

  • Frozen Shoulder

  • Shoulder abduction relief sign, a pinched nerve?

  • Why should MUSHROOMS always be on the menu?

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