Rotator Cuff Exercises
actual exercies are at the bottom of the page.
Before you start
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 weight.
Look at the pictures with each exercise so you can use the correct position. Warm up before adding weights. To warm up, stretch your arms and shoulders, and do pendulum exercises. To do pendulum exercises, bend from the waist, letting your arms hang down. Keep your arm and shoulder muscles relaxed, and move your arms slowly back and forth. Perform each exercise slowly: Lift your arm to a slow count of 3 and lower your arm to a slow count of 6.
Keep repeating each of the following exercises until your arm is tired. Use a light enough weight that you don't get tired until you've done the exercise about 20 to 30 times. Increase the weight a little each week (but never so much that the weight causes pain). Start with 2 ounces the first week. Move up to 4 ounces the second week, 8 ounces the next week and so on.
Each time you finish doing all 4 exercises, put an ice pack on your shoulder for 20 minutes. It's best to use a plastic bag with ice cubes in it or a bag of frozen peas, not gel packs. If you do all 4 exercises 3 to 5 times a week, your rotator cuff muscles will become stronger, and you'll get back normal strength in your shoulder.
Start by lying on your stomach on a table or a bed. Put your left arm out at shoulder level with your elbow bent to 90° and your hand down. Keep your elbow bent, and slowly raise your left hand. Stop when your hand is level with your shoulder. Lower the hand slowly. Repeat the exercise until your arm is tired. Then do the exercise with your right arm.
Lie on your right side with a rolled-up towel under your right armpit. Stretch your right arm above your head. Keep your left arm at your side with your elbow bent to 90° and the forearm resting against your chest, palm down. Roll your left shoulder out, raising the left forearm until it's level with your shoulder. (Hint: This is like the backhand swing in tennis.) Lower the arm slowly. Repeat the exercise until your arm is tired. Then do the exercise with your right arm.
Lie on your right side. Keep your left arm along the upper side of your body. Bend your right elbow to 90°. Keep the right forearm resting on the table. Now roll your right shoulder in, raising your right forearm up to your chest. (Hint: This is like the forehand swing in tennis.) Lower the forearm slowly. Repeat the exercise until your arm is tired. Then do the exercise with your left arm.
In a standing position, start with your right arm halfway between the front and side of your body, thumb down. (You may need to raise your left arm for balance.) Raise your right arm until almost level (about a 45° angle). (Hint: This is like emptying a can.) Don't lift beyond the point of pain. Slowly lower your arm. Repeat the exercise until your arm is tired. Then do the exercise with your left arm.
here is even more information on the rotator cuff
Rotator Cuff Strengthening Exercises
C. W. Schurman, MS, CSCS 1/19/04
Do you feel as though your shoulders "give out" during your upper body workouts? Do you wonder if perhaps including some rotator cuff strengthening exercises might help? Below we discuss how to perform three rotator cuff exercises and two shoulder stretches that may help you see improvement in performance in the rest of your upper body workouts.
WHAT IS THE ROTATOR CUFF?
The rotator cuff is a group of four relatively small muscles (the Supraspinatus, Infraspinatus, Teres Minor and Subscapularis, or “SITS” for an easy way to remember them all) that help keep the ball-and-socket joint intact. Rotator cuff muscles get strained from 1) sudden impact (a fall or high-velocity movement such as throwing when a person is not used to that particular activity), 2) overuse, particularly in sports such as swimming, baseball or tennis, 3) training with too much weight in the primary movements such as bench pressing or overhead pressing without proper recovery time, and 4) doing too much of certain types of movements without balancing them out with opposing movements (i.e. not enough pulling and too much pushing.)
Because the rotator cuff muscles are so small, when strengthening them, it is important not to train with too heavy a weight. Initially a 3 or 5-pound dumbbell may suffice for most women, and an 8 to 12 pound dumbbell for men. When performing rotator cuff exercises, keep the movement slow and controlled, and be sure to train in the pain-free range of motion. Keep your wrists neutral rather than flicking the wrist to add range. You can also use therabands or exercise tubing, although remember that in doing so, the end range of motion will be overloaded far more than the start, and in this case handheld weights (be it soupcans, 2-liter bottles or dumbbells) or cables are preferable to bands.
When in doubt before beginning any of these exercises, see a sports medicine doctor, or get a referral to a specialist like a physical therapist who can help assess whether what you need truly IS rotator cuff strengthening, or if there is another entirely different muscle group to target instead.
EXTERNAL ROTATOR EXERCISES
External Rotator on Knee: To perform this exercise sit on a bench with foot propped on seat so that when you rest your elbow on the knee, the upper arm remains parallel to the floor. Start with your hand in the air, perpendicular to the floor, and slowly rotate your upper arm in an arc toward the midline of your body (keeping a right angle to the elbow) until your forearm is just above parallel to the floor. Exhale and arc the arm back up to vertical, repeat for 12-15 repetitions and then perform on the other arm, 1-3 sets each. If you anticipate that one arm is weaker than the other, complete the exercise with your weak arm first and only do the same number of reps on the strong arm as you can complete with good form on the first.
Propped External Rotator: For this exercise, sit on a bench with a barbell behind you so that your upper arm is parallel to the floor. Rest your elbow on the barbell and just as for the Knee exercise above, slowly lower the dumbbell until the upper arm is parallel to the floor and focus on contracting the small muscles in the back of the shoulder to lift the weight back to vertical. Be careful not to use so heavy a load that the weight pulls your hand too far down! Exhale on the lift and complete 12-15 repetitions, 1-3 sets each on both arms.
Side-Lying External Rotator: The final strengthening exercise to try for the external rotators is to lie on your side (on the floor or on a wide bench) with a towel or sweatshirt propped underneath your elbow to help keep it away from your hip and allow you to keep your arm at a right angle. Keep the elbow in that 90 degree position and exhale as you slowly raise the hand up toward the ceiling, stopping just shy of vertical to keep constant tension on the rotators rather than shifting the effort to the larger deltoid muscles. Slowly lower the weight back down toward your abdomen and repeat. If you feel yourself shifting your body back or taking a rest briefly at the top of the movement, lower the weight until you have a weight you can complete for 12-15 repetitions under constant tension, 1-3 sets on each arm.
STRETCHING
As part of a balanced routine that includes fairly even numbers of sets of pulling and pushing exercises for the large muscles in the chest, shoulders and back, be sure to include some stretching following your strength and rehabilitation work. The following two stretches might be perfect ones to add to your routine. Hold each for 30 seconds, and again, be cautious of pushing too hard into the stretch – the goal here should be to release tension in worked muscles, NOT cause any pain!
Door Jamb Chest Stretch: We recommend this stretch for climbers, computer programmers, bench press fanatics, or any other people who typically have forward-shoulder posture or sedentary sitting jobs. You need no equipment other than a door jamb, tree, or corner of a building. Extend your arm out from the torso at a right angle, and bend your elbow 90 degrees. Place your forearm against a wall (or do both at the same time, in a door jamb) and lean forward. You can even stagger your stance with one foot forward, if it feels more comfortable. Hold the stretch on each side for about 20-30 seconds. For optimal benefit, place this static stretch at the end of your workout before taking it to its limits.
Hug a Tree Stretch: This stretch feels heavenly after rotator cuff work and stretches the lats, obliques, arms, lower back and shoulders. It is a good one for most climbers, desk workers, and any other people who carry a lot of stress in the upper neck and back. Find a sturdy vertical surface (pictured, a squat rack, but a tree or coat rack might also do nicely) and grasp both hands around it, with feet about a foot away. Allow yourself to bend at the hips, butt back, until arms are straight, and allow your head to relax between the elbows. If you are also tight in the hamstrings you might feel a good stretch in the back of the legs.
If any of the strength or stretching exercises cause further aggravation to your shoulders, 1) lower the weight, 2) limit the range of motion to whatever you can complete pain free, 3) try the movement without any weight to see if the movement itself is causing the problem, 4) have someone familiar with the exercise check your form, and 5) see your doctor if, after 2-3 weeks, it does not improve somewhat with ice, rest, anti-inflammatories, stretching and strengthening.
and some more info
Frozen Shoulder and Rotator Cuff Injury
A Guide for the Treatment and
Prevention of Shoulder Injuries!
Have you ever been working out at the gym, pushing a heavy weight and heard a popping sound in your shoulder. Or what about skiing down the slopes, and landing shoulder first in the snow at the bottom. Or maybe just having a friendly game of tennis, when all of a sudden there's a sharp pain in your shoulder.
These are all signs of the same thing; a shoulder injury. Whether you want to call it a frozen shoulder, a rotator cuff tear or tendinitis shoulder, it's really all the same. A tear or strain in the rotator cuff muscles and tendons.
The shoulder joint is a truly remarkable creation. It's quite a complex formation of bones, muscles and tendons and provides a great range of motion for your arm. The only downside to this extensive range of motion is a lack of stability, which can make the shoulder joint vulnerable to injury.
Lets have a quick look at the shoulder joint in a little more detail. The shoulder is made up of three bones, and the tendons of four muscles. (Remember, tendons attach muscle to bone.) The bones are called the "Scapula," the "Humerus" and the "Clavicle." Or, in layman's terms, the shoulder blade, the upper arm bone and the collarbone, respectively.
The four muscles which make up the shoulder joint are called, the "Supraspinatus," the "Infraspinatus," the "Teres Minor" and the "Subscapularis." It is the tendons of these muscles, which connect to the bones, that help to move your arm.
In the picture to the right, three of the four muscles are visible, the supraspinatus, the infraspinatus and the teres minor. These are the muscles which are viewed from the rear, or posterior. The subscapularis is not visible because it can only be viewed from the front, or anterior and this particular view only shows the muscles from the rear, is if looking at someone's back. Anyway, enough of the technical stuff.
Causes
There are two major causes of most shoulder injuries. The first being degeneration, or general wear and tear. Unfortunately, the shoulder is a tendinous area that receives very little blood supply. The tendons of the rotator cuff muscles receive very little oxygen and nutrients from blood supply, and as a result are especially vulnerable to degeneration with aging. This is why shoulder problems in the elderly are common. This lack of blood supply is also the reason why a shoulder injury can take quite a lot of time to heal.
The second cause of most shoulder injuries is due to excessive force, or simply putting too much strain on the tendons of the shoulder muscles. This usually occurs when you try to lift something that is too heavy or when a force is applied to the arm while it's in an unusual or awkward position.
Symptoms
There are two common symptoms of a shoulder injury, pain and weakness. Pain is not always felt when a shoulder injury occurs, however most people who do feel pain, report that it's a very vague pain which can be hard to pinpoint.
Weakness, on the other hand, seems to be the most reliable symptom of a shoulder injury. Common complaints include an inability to raise your arm above your head or to extend your arm directly to the side or in front. In most cases, the larger the tear or damage to the tendons, the harder it is to move your arm and the injured area.
Treatment
The earlier a shoulder injury is treated, the better. The first 48 to 72 hours are crucial to a complete and speedy recovery. The first and most important course of action is the R.I.C.E.R. regime. Rest, Ice, Compression, Elevation and Referral. For the time-being, I'm not going to go into the specifics of the R.I.C.E.R. regime. It's a very important topic and I've decided to dedicate the entire next months issue to it.
After the initial injury has been treated with the R.I.C.E.R. regime, (for at least 48 to 72 hours) it's time to move onto the next stage of treatment. As mentioned before, the shoulder joint receives very little blood supply. So, what can you do to increase blood flow, and oxygen and nutrients to the injured area?
Firstly, heat! Heat is extremely good for increasing blood flow to a particular area. Heat lamps are the most effective way to increase blood flow, while heat based creams are probably a distant second choice.
Secondly, massage! Massage is one of the best ways to increase blood flow to an injured area, and of course the oxygen and nutrients that go with it. The other benefit of massage is that it helps to reduce the amount of scar tissue which is associated with all muscle and tendon, strains and tears. (I'll also discuss scar tissue in next months issue along with the R.I.C.E.R. regime.)
Lastly, don't stop moving. Some doctors will often tell patients to keep the injured area still, and this is not always the best advice. Gentle movement will help to keep the blood flowing to the injured area. Of course, if pain is present, limit the amount of moving you do, but don't stop moving all together.
Prevention
Mark my words, "Prevention is much better than Cure." Anything you can do to prevent an injury from occurring is worth it. The prevention of shoulder injuries comes down the conditioning of the shoulder muscles and tendons, which ultimately involves both stretching and strengthening of the shoulder joint.
Also, don't forget the common injury prevention techniques like, warming up properly and using a bit of old-fashioned common-sense. However, for the most part, stretching and strengthening are going to be your best defence against shoulder problems. Even if you don't have a shoulder problem now, the following stretching and strengthening exercises could save you from a major headache in the future.
Firstly, below you'll find two good stretches for the shoulder area. The first is quite a basic stretch, while the second is a more advanced stretch, specifically for the rotator cuff muscles and tendons. Please be careful, if you haven't been stretching your shoulder joint, the second stretch will put quite a lot of stress on the rotator cuff tendons. Warm-up first, then gently and slowly is the best way to proceed.
In the stretch to the left, simply stand upright and clasp you hands behind your back. Keep your arms straight and slowly lift your hands upwards. Hold this stretch for about 15 to 20 seconds, then repeat it 3 to 4 times.
In the stretch to the right, stand with your arm out and your forearm pointing upwards at 90 degrees. Place a broom stick or pole in your hand and let it fall behind your elbow. With your other hand, pull the bottom of the stick forward. Be especially careful with this stretch, it will put a large strain on the rotator cuff muscles and tendons. As above hold this stretch for about 15 to 20 seconds, then repeat it 3 to 4 times.
The shoulder has the greatest range of motion of any joint in the body. It is our shoulders that allow us to put our hands where they need to be for work, play, and all of our daily activities. To manage this, the shoulder has to have the right balance of strength, flexibility, and stability. Loss of this balance can lead to pain and injury. Maintaining this balance through exercises aimed at stretching and strengthening can help avoid shoulder problems.
Rotator Cuff Injuries
The shoulder joint is surrounded by four muscles and their tendons. These are collectively referred to as the rotator cuff. The rotator cuff is surrounded by an empty sac, or bursa, which helps the tendons slide. The rotator cuff is susceptible to many problems which can cause weakness, tenderness and pain. These problems include overuse tendinitis, which can be caused by certain activities.
Overhead sports such as throwing, swimming, or tennis, can lead to tendinitis. If the space between the rotator cuff and the bone above it is narrowed, the rotator cuff tendons and the overlying bursa can get squeezed. This will lead to bursitis and tendinitis. This is called impingement. Occasionally a calcium deposit may form in the rotator cuff and cause acute inflammation of the tendon and bursa. We call this calcific tendinitis. The rotator cuff tendons are also susceptible to the process of aging. As we get older, the rotator cuff tendons degenerate and weaken. A rotator cuff tear can occur due to this degeneration alone, or when the weakened tendons are stressed during activities or accidents. Most rotator cuff problems can be treated with rest, medication and gentle exercises, but pain which persists more than two weeks should be evaluated by a physician
The shoulder joint can be affected by many forms of arthritis. Osteoarthritis, rheumatoid arthritis, and traumatic arthritis are the most common types affecting the shoulder. Shoulder replacement (or shoulder arthroplasty) can be performed in many patients who have pain which has not responded to other treatments. Though less common than hip or knee replacements, shoulder arthroplasty has been performed since the 1950's with good success. The results of replacement surgery depend greatly on the type of arthritis, the quality of the bone, and the condition of the muscles around the shoulder. The primary goal of replacement surgery is pain relief. Shoulder arthroplasty is generally effective in relieving pain. The secondary goal of replacement surgery is improvement in range of motion and function. The extent of improvement varies greatly depending on the severity of the preoperative condition, the preoperative range of motion, and the postoperative rehabilitation. A shoulder replacement consists of two major parts, a humeral component, which replaces the bone at the end of the upper arm, and a glenoid component, which replaces the shoulder blade socket. The humeral component is made of metal, and the glenoid component of plastic. In some circumstances, such as severe fractures, only the humeral component is used. This is referred to as a hemiarthroplasty.
Common Shoulder Injuries Among Athletes
The shoulder is at risk for injury in many sports. The rotator cuff (see above) can be injured through overuse or through trauma. Rotator cuff tendinitis is common in overhead sports such as baseball, tennis, volleyball, and swimming. Rotator cuff tears can occur if the tendons are overloaded in weight lifting or football. There are ligaments which hold the shoulder bone in its socket. The shoulder has a very large range of motion, and needs some flexibility of the ligaments to allow for that range. But if the ligaments become stretched or torn, this can lead to instability. A mild amount of instability will allow the shoulder to slip part way out of socket, called a subluxation. When the shoulder comes completely out of its socket this is called a dislocation. Subluxation or dislocation can occur with nearly all sport activities. The ligaments of the shoulder are attached to the socket at the labrum. Tearing of the labrum sometimes occurs with instability. Another part of the shoulder commonly injured is the acromioclavicular or AC joint. The clavicle or collarbone meets the shoulder at the acromion where a small joint is found. This joint can be injured to varying degrees in a fall onto the outside part of the shoulder. Injury to the AC joint is called an AC separation. AC separations occur in contact sports and are frequently seen in skiing and biking falls. Clavicle fractures are common injuries seen frequently in sports where speed or contact are involved.
Shoulder Exercises
These exercises are aimed at strengthening the rotator cuff. Increasing cuff strength can decrease symptoms and effects of instability, impingement and tendinitis, as well as prevent some injuries.
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