Rotator Cuff Therapy
Rotator cuff therapy is a huge subject. Elsewhere on the site I have talked about physical therapists, recovery after rotator cuff repair surgery and rotator cuff remedial schedules.
There are large sections devoted to exercises for injured rotator cuff muscles and the treatment for rotator cuff tear symptoms.
In this section however I want to focus on rotator cuff therapy in general. Hopefully by now we all know that the rotator cuff is a set of four muscles needed to aid shoulder movement and stability.
But what is meant by therapy? Well thankfully sometimes in life the most obvious answer is the correct one.
Therapy, in its simplest form just means treatment. Therefore therapy is an attempt to remedy or "treat" a previously diagnosed condition.
Secondly there are so many different conditions that affect the rotator cuff such as impingement, calcification, tendonitis as well as tears. Thirdly you have to take into account the scale of the problem is it a small tear a large tear. Is it acute or is it a chronic condition.
Bearing all that in mind I am certain you will agree that rotator cuff therapy is not going to be easily defined. To an extent I suppose I have personalised it a little to make the whole thing easier for me to manage. I have generally used the term rotator cuff therapy to capture the rotator cuff remedial or rotator cuff rehabilitation phase.
I consider rotator cuff repair surgery for example to be a completely separate issue. Yes it remains therapy, as it is certainly a form of treatment, but for my purposes it must remain detached.
I suppose when I talk about rotator cuff therapy I really mean exercises for injured rotator cuff muscles and general exercise treatment for rotator cuff tear symptoms. That is what I want to cover here in a sort of general overview or reminder.
Rotator cuff therapy - the basics
What can you expect from rotator cuff therapy? Well, you should expect a progressive program of exercises based upon your condition and level of healing.
Just as importantly it must be a bespoke program, not a generic one i.e. it must be tailored to you as an individual.
Undertaking an aerobic exercise plan will improve all round fitness, increase blood flow and oxygen supply to the affected area and speed up the healing process.
Rotator cuff therapy - the early stagesIn the very early stages, exercise is so important, but it must be aided and as pain free as possible. If something hurts too much stop - it is that simple. Start with Isometric, or passive / assisted exercises. This is to allow the rotator cuff muscles to move without being under any strain.
Remember isometric exercises are those where the muscle is working but not having to contract. Remember all muscles work by contracting. Exercises that can be done both isometrically and passively for example could include both internal and external rotation. Let's see if I can explain.
Start by standing with the elbow tucked in at your side, now bend your arm from the elbow and raise you hand so it is pointing out directly in front of you.
This is the starting point for two exercises that are very similar but hopefully you will see and understand the difference. In both all situations bringing the arm in towards your stomach is internal rotation and moving it away is external rotation.
Isometric - From this position we need something like an open door, but a door that is held securely i.e. will not move at all. Place either the inside (palm of the hand) or the outside (back of the hand) of the forearm against the door.
Now push against the door. Neither the door nor the rotator cuff muscles actually move, they are not being stretched, but they are working and therefore getting safety first exercise.
Passive motion - Same basic exercise and exactly the same starting position i.e. elbow in and forearm out in front. This time have someone else support your arm at the elbow and the hand.
Allow them to slowly rotate the arm either externally or internally but not both at the same time. Do not allow any motion beyond pain free range. In this instance the muscles are moving but not working so we achieve increased range of movement in a risk free manner.
The middle bitNot a hugely interesting title I know but it was deliberately chosen. It is boring is it not? Well, yes it is and the problem is that the "middle bit" of your rotator cuff therapy can also be boring.
It is a slow process, you are past the early assisted motion, you are out the sling, people are less interested in your operation - you are on your own my friend - well not really; there is always me after all!
The middle bit consists of slowly increasing the number of exercises you do. Increasing the number of repetitions (i.e. 8 - 10 - 12) and sets (i.e. 1x8, 2x8, 3x8), please remember to leave time between each set generally a minute or two. At the same time build up the resistance. In other words make the muscles work harder.
Try resistance bands; doing exactly the same exercises as described above, but with a resistance band, slowly and gently increases the strength and durability of the muscles. Elastic based exercises for injured rotator cuff muscles are universally accepted as a vital part of any rotator cuff therapy.
You may also be ready to add some weights. Nothing too heavy, just simple hand held weights will increase the work the muscles are doing. Again using the exercise above you can see how we are progressing through a program that is getting steadily tougher. Do not forget however, that all the time, you are getting steadily stronger.
The last section is strengthening. This includes not only the rotator cuff muscles but also the muscles that surround the shoulder. The shoulder works most successfully when there is a balance between all of the separate components.
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