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shoulder rehab

Shoulder pain

Rotator Cuff Rehab: Strengthening exercises

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Rotator cuff injuries are one of the most common injuries and one of the most feared, but they don’t need to be. With the right rotator cuff rehab exercises, your shoulder can be pain-free and strong again in no time.

There is a huge amount of research coming through that is showing that we have become far too reliant on surgery which often comes with its own risks and can lead to scar tissue and frozen shoulder. Current best practice recommends about 12 weeks of conservative rehab before looking into surgery if not improving. Recent studies have shown:

  • Subacromial impingement and bursitis: Exercise is as effective as surgery AND reduces the need for surgery in 80%
  • Rotator Cuff partial tear: Exercise is as effective as surgery
  • Full Thickness Rotator cuff tears: Exercise reduces the need for surgery by 75%

Rotator cuff rehab physio

That’s some fairly awesome stats from multiple studies and shows that with the right rehab exercises, there is a good chance your shoulder pain will resolve without the risk of surgery, so let’s get into it!

 

Following on from our stage 1 post on early Rotator Cuff Rehab, this is all you need to know to lay a strong base for your shoulder stabilizers.

Stage 2 Rotator Cuff Rehab: Building strength

This stage starts when you can lift your arm up in front of you over shoulder height at least. If you can’t do that, step back to stage 1 or consult your health professional

1. External rotations

  • Lie on your side with your elbow at 90° and holding a small weight – starting with about .5kg can be a good start
  • Then lift the weight, rotating with your shoulder as shown – making sure your elbow stays touching your side the entire time and then lower down
  • Repeat for 3 sets of 10 and increase or decrease weight as needed to fatigue the muscle without pain

Rotator cuff rehab external rotationRotator cuff rehab external rotation

 

2. Overhead rotational press

  • Always start with your knuckles forward and in front of your shoulder and then press up while rotating so that your knuckles are backwards
  • Do 3 sets of 12, starting with a weight that is pain-free (such as a can of beans) and build up from there

Overhead rotational pressOverhead rotational press

3. Lawn mowers

  • Start with your hand in front of your opposite pocket. Leading with your elbow, bring your arm across your body and up to the opposite corner as shown.
  • Start with a weight that is pain-free such as .5kg and build up from there with, performing 3 sets of 12 with an aim of the shoulder being fatigued at the end.

Disco dancer shoulder rehab exerciseDisco dancer shoulder rehab exercise

4. One arm push-up

  • Place your hand on the wall at chest/nipple height. Do a push-up to the wall, keeping back straight and shoulders level.
  • Only go as far as you can control and adjust the distance of your feet from the wall so that it is challenging but not painful.
  • Do 3 sets of 10

One arm push-up shoulder exercise

Tip: If the exercise is sore to do, try and use something lighter (or move closer to the wall for #4) and if you can’t do it without pain, don’t do that one for a couple of weeks – just start with the exercises that you can do. Remember rotator cuff rehab typically takes around 12 weeks on average so patience is key

Get into routine of doing the exercises 5 days a week, combined with other exercise such as walking or biking regularly


Health, Shoulder pain, Upper limb

Shoulder dislocations – Don’t brush it off – Prevent Re-injury Now

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Have you had a shoulder dislocation physioshoulder dislocation playing contact sport? If you are young and want to keep playing sport – you are at massive risk of re-injury.

There is growing evidence that if a young athlete dislocates his shoulder and plays a physically demanding contact sport – They should have surgery. This is because the shoulder becomes unstable following this and the chances of further dislocations are incredibly high.

In a study by Slaa et al, it was found that:

  • Over-all recurrence rate of 24%
  • There is a huge 64% recurrence rate in patients under 20 years of age

Also a literature review found an average recurrence rate of 67%, with much less chance of re-injury if the patient is older than 40 years of age.

The most important findings in these studies are that you have very high chance of sustaining further dislocations if you are an athlete (82% – simonet and Cofield) and/or are a young person.

 

shoulder labral tearA large part of this is because damage has occurred to the labrum – This is the tissue that helps make the shoulder socket larger and suck the ball of the shoulder joint in. If the labrum is torn (which it often is in shoulder dislocation) this causes a break in the negative pressure in the joint – it has lost the suction – meaning it is easier to “pop out” again.

 

Thedislocated shoulder, do you need surgery? shoulder joint has a tiny socket to start with!

Think of shoulder joint like a golf ball sitting on a tee – The ball of the shoulder is much larger than the socket (the tee), so to make the socket larger, the labrum comes off the socket to add more stability.

 

So if you have dislocated your shoulder, are young and/or want to continue playing a contact sport…

  • Go have your shoulder assessed by your Physio
  • Get referred to an orthopedic specialist if they deem it necessary
  • Rehab your shoulder well and get your rotator cuff as strong and stable as you can.

Do it right the first time.

 

Yours in good in health,

Shaun

 


neck pain, Shoulder pain, Upper limb

Scapula stabilising exercises – Beat shoulder pain for good.

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winging scapula shoulder bladeWhy does your shoulder pain not get better or keep coming back??  Scapula stability and control is often overlooked yet it is absolutely necessary for good shoulder function. Here we will increase shoulder girdle strength, stability and control to get rid of and minimise the chances of:

  • Rotator cuff impingement
  • Shoulder tendinopathy
  • Subacromial Bursitis
  • Neck pain and Headaches
  • And much more

Scapula Dyskinesia is a very very common response to shoulder pain and leads to ongoing, prolonged and frustrating shoulder pain. This is basically abnormal movement of your shoulder-blade. For more detail: Skapula dyskineia

Normal shoulder movement, strength, control and performance is fully dependent on the scapula – and not just movement but it’s stability as well. The scapula is the base that your arm works off and if you don’t have a stable base, you will be much more likely to have shoulder and neck pain – It would be like trying to walk in an earthquake!

Normally when you lift your arm, your shoulder blade rotates upwards as seen in the picture below. If your shoulder-blade doesn’t rotate – your shoulder gets jammed against it, leading to pain and tightness.

So given that Scapula Dyskinesia occurs in 68-100% of shoulder injuries, this is something that needs to be addressed in EVERY PERSON WITH SHOULDER PAIN. So below is your exercise regime to address this yourself at home or the gym.

1. Push-up Plus: skapual, serratus anterior strengthening exercises, physiotherapy, shoulder pain

keeping your body and arms straight, push your shoulders forward(body upwards and then control your shoulders back to the starting position).

Too easy? do a push up and add the press at the top of each push-up (this is the plus!)

2×12 reps (to start with!)and start on your knees if you need to.

 

2. Shoulder external rotation: shoulder ER

Remember to always keep your elbow into your side and at 90degress.

You can also do theses in side lying with a 1-2kg dumbell in your upper hand.

2 x 12reps, increase the stretch to progress.

 

 

3. Chariot Pull: chdariot pull

Keeping your arms straight and shoulder back and down, take your arms back untill they are level with your body.

2 x 12reps, increase the stretch to progress.

 

 

 

 

4. Thoracic Mobility: I have included this as if you have a stiff spine, your shoulder chariot pull, shoulder strengtheningblades are always going to be in a bad position, so it is important to address this so that you don’t get stuck at 95%!

Using either a full or preferably 1.2 foam roller (high density!) lie on it, placed below your shoulder blades as shown, bridge up and extend your arms overhead and then elbows down to your sides.

Tip: Keep your head up and chin tucked in.

spend 1-2minutes working on your spine.

Do these exercises two times daily (Ideally!) for 6 weeks for awesome shoulder stability and a pain-free shoulder.

http://bjsm.bmj.com/content/47/14/877.long

http://www.ncbi.nlm.nih.gov/pubmed/12670140

Also see:

Mobilise yourself

Beating neck pain and headaches

Please share and let me know how you get on.

 


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