A PROGRESSIVE APPROACH TO HEALTH

Information Pack ~ Rotator Cuff Rehab Progressive Chiropractic Information Packs are designed to help you better understand your body

Rotator Cuff Rehabilitation

‘your chiropractor is highly trained in assessing your biomechanics…’

The shoudler

space. The tendons of the cuff, and

The shoulder joint is the most mobile joint of

associated bursa (friction reducing

the human body. It’s shallow ball and socket

membranes) slide back and forth within the

configuration affords it an impressive range of

tightly fitted archway of bone and ligament

motion, which allows us to reach behind our

called the coracoacromial arch. During

backs, over our heads across our chest and

certain movements, the archway becomes

out to the side. However, this great range of

smaller and compresses the tendons and

motion comes at a cost. Stability.

bursa. Repetitive use of the arm makes the

Unlike the deep ball and socket joint of the relatively stable hip joint, the shoulder’s

tendons and bursa prone to injury and inflammation.

stability comes not from a snug bony fit but

Bursitis: Occurs when the bursa becomes

from the high tensile force of the rotator cuff,

inflamed and painful due to compression

which pulls the head of the humerus into the

under the coracoacromial arch.

shoulder joint.

Tendonitis: Occurs when a rotator cuff tendon

The rotator cuff is comprised of four muscles

becomes inflamed, swollen and tender. If

and their tendons that attach from the

allowed to persist, tendonitis can progress to

shoulder blade (scapular) to the bone of the

more complicated and chronic problems.

upper arm (humerus). These work together to stabilise and move the shoulder joint.

You chiropractor is highly trained in assessing your biomechanics and will

The rotator cuff operates in a very tight 2

be able to identify problem areas.

Rotator Cuff Rehabilitation What is it and how did I get it? Simple Overuse tendonitis. Certain shoulder movements used during activities like throwing, overhead lifting, tennis, volleyball, golfing or sustained poor posture may cause irritation, inflammation, and even fraying of the tendon.This may cause pain and weakness in the joint.

The rotator cuff works to stabilize the shoulder joint

Calcific Tendonitis. If allowed to persist over a long period, this inflammation can sometimes result in a build up of calcium deposits within the tendons. This leads to pain, weakness and loss of motion in the shoulder. Roator Cuff Tear. Severe tendonitis that persists on a chronic level as well as severe injuries can cause partial or complete tearing of the rotator cuff tendons. This can result in more intense pain, weakness and loss of function. Contributing Factors • • • •

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Overuse. Poor scapular stability. Poor Posture. Strenuous training.

Previous Injury. Poor swimming/throwing/ technique. Treatment Rest. Avoid activities that aggravate you shoulder. Your chiropractor may advise a sling to immobilise the shoulder. Ice. Apply an ice pack – over a towel, at least twice a day for 15 minutes. Also apply ice after any activity that aggravates your shoulder Physical Therapy. While it is true that some shoulder pain will go away by itself over a few days, it is important to have your shoulder assessed by a Chiropractor, Physiotherapist or Osteopath since untreated shoulder problems can develop into complicate issues. Physical therapy, including exercises and stretching, has been shown to speed recovery and help to prevent recurrence. Surgery & Medication. It may be appropriate relieve pain and inflammation with anti-inflammatory or analgesic medication while your body’s natural healing process goes on. Injection of Corticosteroids may also be recommended. Surgery may be required if the situation is chronic or there is a tear in the rotator cuff. • •

Rotator Cuff Rehabilitation Exercise and Rehabilitation Getting control of pain and inflammation is only a small part of your recovery. You will be prescribed exercises and stretches that will speed healing, improve function and minimize risk of recurrence. It is vital that you use the suggested exercises for your full recovery.

Poor control of the ST joint is amongst the leading causes of chronic shoulder problems

Important concepts before you begin. The shoulder girdle is comprised of the shoulder joint (glenohumeral joint) and a pseudo joint which exists between the shoulder blade and the rib cage called the scapulothoracic joint (ST joint). At the glenohumeral joint movements such as flexion, extension abduction adduction, internal and external rotation and combinations of these occur. These motions are supported and augmented by movements in the second joint of the shoulder, the scapulothoracic joint. Poor control of this joint is amongst the leading causes of chronic shoulder problems. The scapulothoracic joint allows

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movements of protraction, retraction, elevation and depression and is the foundation for all shoulder movements. Poor stabilisation and control of the ST joint ultimately leads to overloading of the rotator cuff. It is important to keep this in mind when rehabilitating the shoulder girdle. Think, proximal stability for distal mobility. General Principles of Rehabilitation Early rehabilitation should aim to improve the endurance and strength of the scapular stabilizing muscles. Low weight, high repetition exercises promote muscle hypertrophy and improve fatigue resistance. Once more normal scapular mechanics have been restored, higher weights with lower repetitions may be used to promote power. • Rotator cuff strengthening can begin once a stable scapular base has been restored • Once endurance and strength have improved, exercises that promote effective energy transfer through the kinetic chain should be added.

Movements of the Glenohumeral Joint

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Movements of the Scapulothoracic Joint

Exercises are the key to making a full and lasting recovery.

Normalize the muscles

Stretching – again, starting

gently, stretch the shoulder in all directions pay particular attention to the tight muscles in the area such as the pecs, and upper traps. A good way to do this is to slide your hand up a wall. Use a towel to help your hand 6

slide. Use three different positions. First with your hand straight out in front of you, then with your arm at 45° then with your arm out to your side 90°.

Sleeper Stretch Lying on your side with your shoulder directly underneath you. Lift your arm to 90˚ flexion and hold your elbow in 90˚ flexion. Using your other hand, put pressure on your forearm in order to internally rotate the shoulder. Don’t let your elbow slide down. Keep 90˚ flexion. You should feel the stretch arcross the back of the shoulder.

PHASE 1

Range of Motion exercises – Start with a broom handle. Grasp it with both hands, palms facing your body. Use the good shoulder/arm to move the other arm passively. Move thru all ranges – • Flexion – up in front • Extension – out behind Adduction – across the front below the neckline. • Abuction – out to the side • Rotation – with elbow bent by your side.

Principles: Avoid Exercises that cause pain. Use ice following these exercises to allieviate pain and inflammation

Triggerpoint releases – using your own fingers, a broom handle or an assistant, apply firm and constant pressure to triggerpoints in the shoulder girdle until pain subsides.

Range of Motion

Exercises are the key to making a full and lasting recovery.

Scapular Clocks

Fencing

Lying on your side Elevate and protract the shoulder then slowly and deliberately, retract and depress the shoulder ‘back and down’. When standing, you can use your other hand to mark the place you want your scapular to ‘set’ to. This is not simply pinching your shoulder blades together at the back.

Extend your arm out at about 45˚ from your midline. Put your hand on the wall so that your fingers are pointing up. (12 o’clock)

Standing tall with your shoulder blade ‘set’(down and back). Lift your arm up to shoulder height with your finger pointing. Draw a small circle clockwise then anti clockwise keep your elbow and wrist rigid. The movement should come from the shoulder.

Repeat with fingers at 9 and 3 o’clock. Repeat with finger at 7 and 5 o’clock REPS – 15 SETS – 3 Twice a day

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Repeat this movement at 3, 6 and 9 o’clock. Repeat the whole series with the arm out to the side 45˚ and 90˚. REPS – 15 each side SETS – 3 Twice a day

PHASE 1

REPS – 15 each side SETS – 3 Twice a day

Move your shoulder blade forward (protraction) then draw it back deep into your back. (Retraction and depression.)

Principles: Avoid Exercises that cause pain Use ice following these exercises to allieviate pain and inflammation

Scapular Setting

Exercises are the key to making a full and lasting recovery.

Concentric Exercises

Cable Face Pull

Isometric exercises are where your arm and shoulder do not move. A constant pressure is applied in a given position. You can use your good arm to apply the resistance and you can use a broom handle as your range increases.

Progress to concentric exercises if you are able to Concentric exercises involve the shoulder and arm moving through a range of motion.

Use the split rope on a cable machine set at face height. Standing tall with scapular ‘set’ pull the rope ends towards your face. Keep your elbows high. As your hands approach your face, externally rotate your shoulders to get the extra distance

Reps 5 Sets 3 Twice a day

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You can also do this exercise lying on your side using a water bottle as a weight that you can gradually add water to as your strength increases. Reps - 15 Sets – 3 Twice a day

PHASE 2

Start with your arm by your side and elbow flexed to 90˚. Push out against your hand or a wall for 10 seconds. Then push in for 10 seconds.

Use elastic resistance band with a small rolled up towel under your armpit. Focus on external rotation.

Principles: Avoid Exercises that cause pain Use ice following these exercises to allieviate pain and

Isometric exercises

Blackburn Series Otherwise known as the BACK-BURN series. These should be done in a series, holding each position for up to 5 seconds. Position 1: “T” shape palms down Position 2: “T” shape thumbs up Position 3: “Y” shape palms down Position 4: “Y” shape thumbs up Position 5: “W” shape thumbs up Position 6 Hands down, shoulders lifted Reps: 10 Cycles Twice a day.

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Wall Angels • • •

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Stand against a wall. Gently flatten your lower back against the wall by rolling your pelvis under. Keeping your back and head against the wall raise your arms up to shoulder height with elbows bent. Inhale and raise your arms up, keeping them pressed against the wall. Exhale lower them down to shoulder height again.

REPS – 15 SETS – 3 Twice a day

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Progressive Chiropractic 346 Bourke St SURRY HILLS, 2010 tel +61 2 8354 0353 web progressivechiro.com.au

A PROGRESSIVE APPROACH TO HEALTH