Working the rotator cuff

[Reverend Tap]

I was just wondering if anybody had any information on strengthening/tightening the rotator cuff. For some reason, my RC muscles have always been quite weak compared to the other muscles in the area, and I have the blessing/curse of having loose joints all over my body; this has led, on a few occasions, to serious problems, as it's quite easy for my shoulders to pop out of joint (to the extent that I can do so at will, painlessly). That led to a long and painful period of recovery back when I was a gymnast, after my right shoulder (the worse of the two) suddenly locked out of place during a one-armed handstand. I've been given a number of exercises to try over the years, but while many undoubtedly helped strengthen my shoulders overall, none of them really seem to do much in terms of actually tightening them up so they won't pop out anymore.

What prompts me to ask now, is that I've been doing staff training of late, and while it's been rocking my shoulders, I'm also curious to know if that training itself will help with the process or if I need to keep looking for outside exercises to do that.

[Oso]

there are a bunch but the one that comes to mind is laying on your side w/ a dumbell (light...5-15 maybe depending on your overall) in the upper arm and while keeping the elbow to the body lift the dumbell from the floor to just past the line of hte shoulder...your palm will be down while holding the dumbell.

there's a good PT roaming the boards...Chris Jurak...or tai gik yawn or whatever he's calling himself these days...he'll probably have lots to say.

[taai gihk yahn]

there are a bunch but the one that comes to mind is laying on your side w/ a dumbell (light...5-15 maybe depending on your overall) in the upper arm and while keeping the elbow to the body lift the dumbell from the floor to just past the line of hte shoulder...your palm will be down while holding the dumbell.

that's a good general way to strengthen shoulder external rotators (supraspinatus, infraspinatus, teres minor - or is it major? i can never remember, LOL)

there's a good PT roaming the boards...Chris Jurak...or tai gik yawn or whatever he's calling himself these days...

you really can't say I'm "good" - I never actually treated you!

he'll probably have lots to say.

pleas, PLEASE, don't feed Hardwork any straight lines, ok?

anyway, I do have some comments about some of the "problems" with RTC that come at it from a somewhat different angle, but don't have time tonight to get into that - but when I do, I'll post something, because it is worthwhile in general, given the problems a lot of folks have there, and the "mistakes" that are often made trying to rehab / maintain it...

[Oso]

See, RT, I told you


CJ: no, you didn't treat me but you do seem to come with the correct as far as this stuff goes and your advice to me personally has always been solid.

[Reverend Tap]

Heh. Cool. Thanks Oso, and thanks in advance TGY.

[SIFU RON]

GO TO

familydoctor.org

enter rotator cuff exercises into search

you will find some helpful information here. Be very careful, consult a good Doctor , get some physical therapy, and above all don't abuse your body and get worst.

[Mr Punch]

My take, as a not Chris-type person (and this is solely to give Chris something to work from you understand, as in saying, "Whaaaat the F***?!" ), but as someone who is receiving PT for torn neck muscles (not rotator cuff, but the PT is giving me some advice on how to prevent that too, esp as it's my shoulders went through overcompensation for the neck).

Scapula push-ups: slowly, make sure you keep straight arms. I do them with a yoga breathing feel too it: make sure when you're in the down position that you're really relaxedly breathing in to your abdomen and expanding your chest - this is to relax the muscles in your chest (you may be like me: tight chest muscles through a lot of PC work and overcompensatory work on my back muscles, which in turn pulls the back/neck/shoulder muscles forward too loosely, or so I'm told). Some sites recommend dive bombers (hindu push-ups) but I agree with the sites that say that these are death to rotator cuffs.

Pole arm stretches: If the scapula push-ups are too much for you, try these. They're pretty much the same but without your bodyweight. By pole, I don't mean the sexy kind, I mean a rolled yoga mat or something similar, maybe 6-8 inches thick, and relatively firm. Lie face-up on it making sure your coccyx is touching and your head too (I need two yoga mats to do this when I'm not at rehab!). Breathe deeply ten times or so to relax your spine into the mat (there may be a natural curve in your lower back which keeps a space where your spine doesn't touch - that's OK but if you can relax so this goes too, that's good too), and expand and relax your chest (again, this is important for working your upper back in balance). Stretch your arms up at 90 deg to the floor. Keep them straight, and raise and lower your arms from the shoulders (so your shoulders are dropping below the mat level and then rising up again).

Pole arm rotations: Lie as above. Breathe as above. Rest your arms at about 30 deg to your body. Slowly rotate your lower arms in a big circle slightly under your body. The circle is about nine inches (well, for me - I'm 6'1"!). It's important to keep your shoulders relaxed while you do this, and bend your elbows. This one helps the chest muscles relax, while gently working the muscles on the outer side of your shoulder blades (lats) and the small shoulder muscles between the shoulder blades.

OK, rip em apart Chris!

[Mr Punch]

Chris, what the hell does taai gihk yahn mean, and why did you choose something so impossible to spell?!

[Oso]

dude, you know it means Tai Chi Chuan in some dialect or the other...or, Chris just made it up: Jurakanese!

[taai gihk yahn]

CJ: no, you didn't treat me but you do seem to come with the correct as far as this stuff goes and your advice to me personally has always been solid.

thanks - glad to hear that it has been of use to you;

Heh. Cool. Thanks Oso, and thanks in advance TGY.

no sweat;

My take, as a not Chris-type person (and this is solely to give Chris something to work from you understand, as in saying, "Whaaaat the F***?!" ), but as someone who is receiving PT for torn neck muscles (not rotator cuff, but the PT is giving me some advice on how to prevent that too, esp as it's my shoulders went through overcompensation for the neck)....
OK, rip em apart Chris!

TBH, I actually had a difficult time visualizing exactly what you were trying to describe - but my sense was that in concept they seemed like good things from a theoretical perspective; do you have any visual examples? I am curious to understand them in more detail, always open to new ideas;

Chris, what the hell does taai gihk yahn mean, and why did you choose something so impossible to spell?!

dude, you know it means Tai Chi Chuan in some dialect or the other...or, Chris just made it up: Jurakanese!

LOL - it's the Yale system for Cantonese transliteration - the spelling is based on whether it's a high, middle or low tone; it's actually very logical and easy once you know it (unlike pinyin )


ok - RTC - this is the nutshell version, cause I'm running crazy today trying to get everything together for a ski trip with the fam;

most important thing to consider: the part of the RTC that usually gets injured are the external rotators of the shoulder joint (most common is supraspinatus, especially near the tendon; infraspin. can also take a beating, teres minor less so); why? first, to understand this motion hold your arms straight out to the side with your palms facing backwards, and then bend your elbows 90˚ so that your fingers are pointing down; from here, rotated your shoulders so that you end up with your palms facing forwards, fingers pointing straight up (as if you were opening a window); the motion you just did was concentric external rotation using supra/infra/teres min.; no big deal; now, if you do that motion in reverse (closing the window, or sort of like throwing a ball like a little girl - you guys should have no problem with that concept ) you will be using those muscles eccentrically, meaning that they contract to resist elongation of their fibers;

in general, eccentric contractions are more stressful on the muscle fibers - basically what I believe are called "negatives" in weight training; the problem with RTC is made worse by two things 1) the ER's are typically used eccentrically as decelerators; meaning that they work to control the movement of the arm during things like throwing a ball or to some extent punching (more so in the air, more so a hook than a straight arm, but that could vary); as such, they are dealing with significant torque forces but the lever arm is not always great, because the scapula often ends up being the point of support, as opposed to using the whole body (which I will explain why below); 2) the muscles that "oppose" ER's are things like teres major, subscapularis, latissimus and pecs to some degree: these muscles are all flexors / shoulder internal rotators and by their intrinsic nature tend to be much stronger than ER's, which are basically extensors, in a sense (flexors tend to have more tone than extensors in general in the body); furthermore, subscap. and lats in particular tend to be hyperfacilitated, subscap to the point of being a major "problem" muscle when it comes to neck, shoulder and back pain (I have had some patients who have had long-term significant pain where treating subscap alone has improved things by over 50% - it's pretty cool to see that!); take-home message is that the muscles causing the acceleration forces that ER's have to decelerate are intrinsicaly "stronger" to begin with; and also, even when "at rest" you have in many cases a postural imbalance where the resting position of the shoulder joint is keeping ER's on some stretch, which will cause a relatively increased amount of inhibition compared to hyper-facilitated pecs, subscap, etc. - so ER's can be "unphappy" even when not being used;
now, another big problem, in terms of scapular mechanics: if the scapula is "floating" off the spine, meaning not effectively harnessed to it (being attached only via soft tissue / muscle), the ability to get a good connection to the rest of the body decreases, so the mechanical advantage for ER's is diminished; the primary muscle that makes the connection in terms of "anchoring" the scapula to the spine is the lower trapezius; "the what?" you ask? yeah, I know - the most overlooked muscle in the body, just about - everyone things traps are the ones on the top of the shoulders that make you look big and strong - well, these are upper traps; and honestly, I don't know of a single person with weakness here - these are the ones that lift your shoulder straight up to your ears - and yet people trian them like no tomorrow when they in fact contribute significantly to muscle imbalance in terms of biomechanically effeicient posture, are always (almost) hyperfacilitated, are implicated in things like headaches, back pain, etc.;
so lower traps are in most people, inhibited (because they are opposed by upper traps, which are "on" all the time); meaning that, their roll of anchoring the bottom of the scapula to the spine is not happening nearly as efficiently as it could be; to engage lower traps, you basically try to pull the bottom of your shoulder blades down and in - like in the direction of an inverted triangle towards your butt; you may have a hard time doing this alone, because most people have significantly deceased kinesthetic awareness of these guys; another way to engage them is to lie on your stomach, put your arms out in front of you like Superman, and then try to lift them straight up in the air (together or one at a time); not as easy as you'd think...

ok, so, to wrap up - if LT's are inhibited, then scapula will tip forwards more so, decreasing the lever arm of ER's and not allowing for efficient transfer of forces from the feet through the kinetic chain up the spine to the shoulder; this will annoy RTC to no end;

solution for RTC dysfunction: defacilitate subscap / latissimus / upper traps / pecs (via GENTLE stretching, or more efficiently, with positional release or neuromuscular techniques administered on one's own or by a good therapist); de-inhibit lower traps via isolated "strengthening" and functional postural re-ed; train improved boy mechanics for ER's during deceleration type activities (plyo is the key here)

ok, that's it for now, gotta run (I will take f/u questions, of course)

[Mr Punch]

Da mn, thought I'd explained those pretty well... I'll try and get some vid up at some point maybe... ish... kind of malarkey.

[SteveLau]

Reverend Tap,

I had a right shoulder injury years ago. And a left shoulder injury which I have reinjured within the last two years. The injury is the similar enough though the cause could be different. The injured site is the front end of the shoulder for both sides, and that is where it hurts at large range of motion. Lately, the recovery is quite good, but it does not seem to complete in any foreseeable future. I have tried this and that stretching, strengthening, and even massage treatment. However, complete recovery is no where near.

A week ago, I tried another stretch. Hold our arm with elbow flexed to 90 degrees, and upper arm horizontal against a wall. Turn our body away from the arm, thus stretching the upper and front shoulder muscles. Doing just a session makes noticeable difference. I have been doing it daily for a week already. Now I can reach my hand to my upper back though there is still some tightness (for both sides). Before, I could not do so at all.

Other rehabilitation treatments might be necessary too for complete recovery. And IMHO, I think finding the right stretching exercise is the key.



Regards,

KC
Hong Kong

[Reverend Tap]

Thanks for the advice everyone.

One thing I'd like to stress is that, although I have injured my shoulders, the injuries are long since healed and dealt with (they happened a few years back); it's the base issue that caused the injuries (weak muscles/loose tendons in the RC), and that is still an issue, that I'm looking to remedy. At this point, I have no range of motion problems, no pain, nothing like that; my shoulders are just far too willing to (painlessly) pop in and out of joint if I have my arms over my head.

[chaiwai]

The rotator cuff muscles are the one's that rotate your upper arm. The problem is that for every person that says to do those exercises, there is one that says that basic exercises, (rows, pull ups, dips, push ups) strengthen the rotator cuff just as much. Who do you believe?

[Reverend Tap]

The rotator cuff muscles are the one's that rotate your upper arm. The problem is that for every person that says to do those exercises, there is one that says that basic exercises, (rows, pull ups, dips, push ups) strengthen the rotator cuff just as much. Who do you believe?

Considering my injuries due to weak rotator cuffs came at the height of my "career" as a gymnast, when lots of pull ups, dips, push ups, and such were just part of my daily life, I don't think it's accurate that those exercises strengthen them just as much.