Massive Rotator Cuff Tears: Proven Exercises to Ease Your Pain

In the United States approximately 17 million people struggle with rotator cuff tears. Often, pain and an inability to raise the arm overhead becomes debilitating.  Both surgery and physical therapy are effective ways to treat small and massive rotator cuff tears.  Many factors, including the size and characteristics of your tear, determine your best course of treatment.

Older tears involving multiple tendons are classified as massive.  Not all massive rotator cuff tears can be repaired with surgery. Sometimes there is not enough healthy tissue left. In these cases, you are told to live with the pain.  However, there is now evidence that certain exercises can help people with massive rotator cuff tears.  This article describes how you can get started feeling better.

Physical Therapy Decreases Pain from Massive Rotator Cuff Tears

Would you prefer to avoid the risks associated with surgery?  Or maybe you are a poor surgical candidate because of other medical conditions?  If so, there is hope for you. Research out of Vanderbilt University has outlined a rehabilitation protocol with overall success rates as high as 96%.

This physical therapy protocol is proven to decrease pain, increase strength, and improve shoulder function.   The protocol includes 12 weeks of physical therapy. The exercises focus on supine lying exercises with a gradual progression to standing upright.  In some cases, shoulder injections and anti-inflammatory medications are part of the treatment program.

Rotator Cuff Basics and Why This Program Works

Your rotator cuff is made of 4 muscles and their corresponding tendons.  Collectively, your rotator cuff keeps the ball of your shoulder joint in the socket.  Without a properly functioning rotator cuff, the ball leaves the socket.  This results in a shoulder shrug or a complete inability to raise your arm.

With a massive tear, your rotator cuff may be nonfunctional.  Attempting to strengthen your rotator cuff may provide only a little help.  Instead, you want to strengthen other muscles that will compensate for your torn rotator cuff.

We see many people with massive rotator cuff tears who can raise their arm overhead without pain.  This is because their deltoid muscle is strong enough to compensate.  The exercises outlined in his program retrain and strengthen your deltoid.  With consistent adherence to the program, expect to see gradual improvements in pain and raising your arm overhead.

Range of Motion Exercises

Your first goal is to improve your passive overhead range of motion without pain. Perform these exercises lying on your back. Start by using a cane or wand for assistance.  Then remove the assistance as you become stronger.  Gradually progress the exercises to an inclined and then upright position.

Perform 3 sets of 10 to 15 repetitions each day.  Don’t worry about holding the stretch.  Instead, perform the exercises in a smooth, slow, and controlled fashion.  If you experience pain during certain points in the range of motion, limit how far you go.

Strengthening Exercises

After you see improvements in your range of motion, incorporate deltoid and teres minor strengthening exercises.  Perform these exercises in sitting or standing.  Perform 3 sets of 15 to 20 repetitions each day.  Some discomfort is ok.  But you don’t want sharp pain when doing these exercises.

Your teres minor is the smallest of your rotator cuff muscles.  It is not involved in most massive rotator cuff tears.  Side-lying external rotation strengthens your teres minor.  Start with the weight of your arm.  After you can perform 3 sets of 15 repetitions incorporate a light 1 pound hand weight.

Final Thoughts on Exercises for Massive Rotator Cuff Tears

Progress will be slow at first.  Expect to see improvements within 3 to 6 months as long as you do the exercises consistently.  Not coincidently, this is about the same time frame it takes most people to recover from rotator cuff repair surgery.

For the best results, perform the exercises at least 5 days per week.  Perfect form is a must!  If you can’t do the exercises properly, you will experience more pain.  Let us know if you need help.  Call our office to schedule an appointment with your physical therapist.  We are here to help you move without pain.

 

Reverse Shoulder Replacement Recovery: Strengthening Exercises

The reverse shoulder replacement has a specific design that takes advantage of your large deltoid muscle.  So even if your rotator cuff is damaged, overhead movement is preserved. Strengthening exercises in physical therapy targets your deltoid muscle and the muscles attaching to your shoulder blade.  This articles shows you 5 of the most common strengthening exercises we prescribe to help with your reverse shoulder replacement recovery.

Shoulder Replacement Recovery: Returning to Sport

Many people pursue shoulder replacement surgery with expectations of returning to their favorite activities or sports.  A 2020 systematic review investigated the rate of return to sport in patients recovering from shoulder replacement surgery.  This paper included 12 different studies looking at patients after shoulder replacement surgery.   Overall, 82% of patients returned to playing their favorite sport.  Swimming showed the highest rate of return (84%), followed by fitness (77%), golf (77%), and tennis (69%).  Strengthening your shoulder is key to returning to these types of activities.

Reverse Shoulder Replacement Recovery: The Basics of Strength Training

For the best reverse shoulder replacement recovery you will need to be diligent with your strengthening exercises.  Light strengthening exercises begin 6 to 8 weeks after your surgery.  Again, the focus is on improving the strength of your deltoid muscle and the muscles that attach to your shoulder blade.  Strengthening exercise are performed once daily 3 to 5 times per week.  Initially, start with 15 repetitions per set.  Also, we recommend 2 to 3 sets of each exercise.  As you progress, increase the resistance as you lower the reps to 10 per set.

Band Forward Elevation in Supine

Lying on your back to exercise minimizes the effect of gravity.  This makes it ideal to begin exercising with light resistance while protecting your healing shoulder. To perform this exercise begin on your back holding a resistance band in your uninvolved side hand at waist level. Your involved side shoulder starts flexed 90° with your elbow straight holding the band in a thumb-up position. Place minimal tension on the band in this starting position.  Then, actively lift your arm into forward elevation to approximately 160°.  This will lengthen the band.  Pause 2 to 3 seconds at the top.  Finally, lower slowly back to the starting position.  Perform 10 to 15 repetitions for 2 to 3 sets each day.

Press-Up in Standing

Initially, perform this exercise without any weight.  As your strength improves, add 1 to 2 pounds.  Start in a standing position with your hand close to your body and elbow bent.  Perform an overhead pressing movement.  Straighten your elbow as your arm passes overhead.  Hold for 2 to 3 seconds before slowly lowering your arm back down to the starting position.  Perform 2 to 3 sets of 10 to 15 repetitions each day.   It is important to avoid “shrugging” your shoulder or arching your low back.

Prone Row

Begin lying on your stomach holding a dumbbell.  Start with your arm in an extended position.  Perform a row.  Your elbow stays close but not all the way against the side of your body.  Hold the top position for 1-2 seconds before slowly lowering the weight.  It is important to pull your shoulder blade back as you raise your elbow.  Avoid overextending and shrugging your shoulder.  Perform 2 to 3 sets of 10 to 15 repetitions each day.

Prone Horizontal Abduction

Lie face down with your arm over the side of a bed or bench.  With your thumb up and arm straight lift toward the ceiling at a 90-degree angle (the 9:00 and 3:00 positions of a clock).  This position is aligned with the muscle fibers of your middle trapezius.  Be careful to avoid shrugging your entire shoulder as you raise your arm.  Instead, think about tilting your shoulder blade backward as you raise your arm.  Pause at the top of the movement before returning to the start position in a controlled manner.  Perform 2 to 3 sets of 10 repetitions each day.

Serratus Wall Slide with Foam Roll

Begin with your forearms resting on a foam roll against the wall placed at shoulder height.  Protract the shoulder blades by pushing your upper back away from the wall.  This activates your serratus anterior muscle.  Next, “roll” your forearms up the wall in a controlled manner, making sure you don’t lose the protraction.  Return back to the starting point in a controlled manner.  Perform 2 to 3 sets of 10 repetitions each day.

Final Thoughts on Your Shoulder Replacement Recovery

Performing a gradual and progressive strength training program will optimize your reverse shoulder replacement recovery.   Everyone progresses at a different rate.  Your physical therapist will be your guide as you work towards your goals.  Most people return to their favorite sports or activities within 3 to 6 months.  This of course, assumes you have restored 85% to 90% of your shoulder strength.  If you would like help developing the best individually-tailored exercise program give us a call.

Reverse Shoulder Replacement and Early Rehabilitation

Reverse shoulder replacement is becoming an increasingly common surgery.  If you are plagued by painful shoulder arthritis along with rotator cuff disease this surgery is an option for you.  Also, some types of arm or shoulder fractures are best treated with a shoulder replacement.   After surgery, your outcome becomes largely dependent on your rehabilitation.  This article focuses on what is most important during the first month of your recovery.

Early Motion is Beneficial after Reverse Shoulder Replacement

There are two possible early complications following reverse shoulder replacement.  First, it is important to protect the shoulder from dislocating during the first month of your recovery.  Your shoulder is most at risk for dislocating when you attempt to reach behind your body.  You should avoid movements that involve reaching behind your back to dress or reaching into the backseat of your car.

Rehabilitation

The second common complication is a stiff shoulder.  Not moving your arm at all will result in shoulder stiffness.  This leads to a poor long-term outcome.  A recent study from the University of California showed excellent results when patients began range of motion exercise 1 week after surgery.  Both early exercisers and those who delayed exercise 6 weeks achieved excellent outcomes with very low complication rates.  This study suggests both immediate and delayed rehabilitation are safe and effective.

Exercises after Reverse Shoulder Replacement

This article describes 5 exercises we prescribe early after shoulder replacement.  We emphasize overhead range of motion.  For the first 6 weeks we refrain from performing exercises that involve reaching behind your back.  Some pain is acceptable during exercise.  However, pain should be minimal and dissipate soon after completing your exercises.  Most surgeons advise using a sling for the first few weeks.  You want to slowly wean yourself from using the sling to minimize your change of developing stiffness.

Table Slides

 Stand holding a towel with your hand resting on a table top or counter.  Relax your shoulder and neck muscles.  Slowly lean forwards and slightly out to the side (a 45 degree angle) while sliding your hand on the table or counter.   When a mild stretch is felt, pause and hold the position for 5 to 10 seconds.  Avoid exercising through pain.

Waiter’s Bow

Begin standing with your hands resting on a table top or counter.  Relax the shoulder and neck muscles.  Slowly step backwards while keeping your hands on the table or counter.   When a mild stretch is felt, pause and hold the position for 5 to 10 seconds.  Perform 10 repetitions.  Avoid holding your breath, bouncing, or exercising through pain.

Washcloth Press Up

Lie on your back with your knees bent.  Hold a small towel with your hands close together.  Your other arm assists lifting your involved arm straight up to the ceiling.  Straighten your elbow fully.  Then pause and hold the position for 5 to 10 seconds.  Avoid exercising through pain.   Progress this exercise by performing it in a slightly reclined position.

Self-Assisted Shoulder Flexion

Begin lying on your back with your hips and knees bent.  With your other hand grasp the wrist of your involved side.  Next, passively lift your involved arm overhead.  Maintain a straight elbow.  Pause and hold the position for 5 to 10 seconds.  As your pain decreases, progress the exercise by increasing the duration of the stretch up to 30 seconds.

Wand-Assisted Shoulder Flexion

Begin on your back holding a cane or wand in each hand.  Space your hands slightly wider than shoulder-width.  The cane or wand is grasped between your thumb and index finger with a thumb-up position.  The thumb-up position will maximize movement at your shoulder joint.  With both elbows straight, lift your arms overhead until a mild to moderate stretch is felt.  Hold this position for 5 to 10 seconds.  Then slowly lower back to the start position.  Perform 10 to 20 repetitions.

Final Thoughts on Rehabilitation after Reverse Shoulder Replacement

We have described 5 safe and effective exercises to begin soon after your reverse shoulder replacement surgery.  Start with the 2 or 3 exercises that are most comfortable for you.  Perform these exercises 2 to 3 times per day.  After a few weeks you want to be performing all 5 exercises several times per day.  After 6 to 8 weeks you will be ready to begin some gentle strengthening exercises.  Next week’s article will go into more detail about this phase of your rehabilitation.  Give us a call if you have questions or would like some help getting started.

Shoulder Stretches: 5 Stretches to Improve Reaching Behind Your Back

If you are dealing with shoulder pain you probably have a few movements that are painful or even impossible.  One of those movements is likely reaching behind your back.  During your typical day you routinely reach behind your back for personal hygiene, retrieving our wallets, putting a belt on, or for females, fastening your bra. People with many different shoulder problems experience a great deal of pain and stiffness when attempting these types of activities.  Thankfully, there are shoulder stretches that can help you.

Oftentimes, reaching behind the back is the last movement to return to normal when dealing with a shoulder problem.  There are exercises you can perform at home to speed up your recovery.  This article highlights 5 shoulder stretches you can perform to improve reaching behind your back.

Breaking Down Behind the Back Movements

Reaching behind your back involves complex movements of your spine, shoulder blade, shoulder joint, and elbow joint.  All of these areas must be mobile in order to fully reach behind your back for functional tasks.  Your thoracic spine has to extend and rotate.  Your shoulder blade needs to tilt backwards.  And, your elbow must bend.  Most importantly, your shoulder must rotate internally.  Shoulder internal rotation stiffness is the most common problem associated with limitations reaching behind your back.  However, stiffness in any of the previously mentioned areas must be addressed in order for you to function without pain.

Proof Shoulder Stretches Work

In order to reach your back pocket or perform personal hygiene your shoulder must internally rotate at least 45 degrees.  People recovering from shoulder surgery or those with a frozen shoulder typically have about 50% or less of this range of motion.  People with rotator cuff tendinitis or impingement usually have about 2/3 of the required range of motion.  A recent study published in the journal Sports Health showed people with shoulder impingement and limited internal rotation range of motion respond very well to home shoulder stretches.  Those that performed shoulder stretches daily saw more than a 50% improvement in their range of motion and pain after 4 weeks.

Pec Minor Shoulder Stretch

Your pectoralis minor muscle attaches onto your ribs and shoulder blade.  Short pec muscles will pull your shoulder forward.  In order for your hand to get behind your back, your shoulder blade must tilt back.  If it can’t you will be limited and place more stress on other structures around your shoulder.  To stretch your pec minor, lie on a foam roll long ways or with a rolled up towel between your shoulder blades.  With your elbow bent allow your arms to fall down towards the floor.  Fully exhale and relax in this position for 30 seconds.  Perform 3 to 5 stretches each day.

Thoracic Reach Backs

Your upper back has to extend and rotate when you reach behind your back.  Many people have stiffness in their upper back.  This places additional stress on your neck and shoulder.  To perform the reach back stretch, begin sitting back on your heels, with one hand behind your head and your other forearm resting on the ground in front of you.  This position minimizes movement in your low back and maximizes movement to your upper back.  From here, rotate your elbow up to the sky while exhaling.  Your other forearm remains in contact with the ground.  Return to the starting position and repeat for 10 to 20 repetitions before switching to the other side.  You can modify or progress this exercise by placing your hand behind your back instead of behind your head.

Cross Body Stretch

This shoulder stretch addresses muscles in the back of your shoulder which are prone to tightness.  This stretch is performed lying on your involved side with your hips and knees bent.  Your involved shoulder and elbow are positioned in 90 degrees of flexion.  Your hand of the uninvolved arm grasps your elbow and gently pulls it across your body.  Once a mild stretch is felt on the outside or back of your shoulder, hold for 30 seconds.  Perform this stretch 2-3 times each session.  Research from several studies suggests this stretch is the most effective for improving shoulder internal rotation range of motion.  We agree.

Sleeper Stretch

The sleeper stretch is also very effective for improving internal rotation range of motion.  For this stretch, assume the same starting position as the cross body stretch.  However, with the sleeper stretch, gently move your wrist and forearm down towards the table.  Once a mild stretch is felt on the outside or back of your shoulder, hold it for approximately 30 seconds.  The stretch is typically performed 2-3 times each session.

Hand Behind the Back Stretch

The final stretch in this series is the most uncomfortable and in many cases, the most effective.  It is important that you perform this stretch gently without significant pain.  Restoring hand behind the back movements takes time.  Consider it a marathon, not a sprint. Don’t try to regain all your mobility back at one time.  Slow and steady is best with this stretch.

Stand holding a towel or stretch-out strap.  Drape the strap over your opposite shoulder and gently pull your hand up your back.  Your body will want to lean forward.  Try to remain standing tall.   Also, avoid holding your breath.  Concentrate on each slow breath.  Hold the stretch at least 10 seconds to start.  Work up to performing each stretch for 30 seconds for 3 to 5 repetitions each day.

Want Help Getting Started Stretching Behind the Back?

These are the 5 shoulder stretches we think are best for improving range of motion reaching behind your back.  Most people can perform the first 3 shoulder stretches without considerable pain or difficulty.  The sleeper stretch and stretch behind the back will likely cause some pain.  Start easy, be consistent each day and go slow.  If you need more help give us a call.  We are here for you.  Many people do better when they perform their home shoulder stretches supplemented with manual therapy performed by your physical therapist.

Shoulder Labrum Tears: 5 Exercises Before Jumping into Surgery

Pain with or without clicking deep in your shoulder may indicate an injury to your labrum. The glenoid labrum is a layer of cartilage within the socket of your shoulder joint.  It plays an important role in stabilizing your shoulder during pushing movements, overhead reaching and sports that involve throwing.  Repetitive overhead throwing in baseball players often leads to breakdown of the labrum.  Repetitive pressing or pushing movements in the gym can also irritate your labrum.  Trauma such as falling on an outstretched arm or bracing yourself during a motor vehicle accident can injure your labrum.

Surgery is often recommended to repair a torn labrum.  However, exercise can also be a very effective treatment option.  Non-operative management includes non-steroidal anti-inflammatory drugs and steroid injections to decrease pain and inflammation.  Physical therapy and exercise also plays an important role in recovering full function of your shoulder. This article outlines a game plan for rehabilitating your injured shoulder after a labrum injury.

Glenoid labrum tear

Surgery or No Surgery for Glenoid Labrum Tears?

Both surgery and a non-surgical approach can lead to satisfactory results in 66% to 85% of people with labrum tears.  A small study published in The American Journal of Sports Medicine suggests nearly half of those with labrum tears do well with surgery.  The same may be true for those who pursue non-surgical treatment.  Regardless of treatment, it appears that 80 to 85% report satisfactory results 2 to 3 years later.  However, the level of satisfaction and return to sport in overhead athletes is closer to 66%.  This is understandable given the demands baseball pitchers and tennis players place on their shoulders.

Patients with labrum injuries should undergo 3 to 6 months of non-surgical treatment before considering surgery.  If this approach fails your doctor may recommend surgery.  Rehabilitation focuses on improving shoulder range of motion and strengthening the rotator cuff and shoulder blade muscles.  Below are videos of 2 important stretches and 3 commonly prescribed strengthening exercises you can perform in your home.

Cross Body Stretch

This stretch addresses tightness in the back of your shoulder which is often stiff in overhead athletes.  The infraspinatus, teres major, and teres minor muscles can become shortened from repetitive throwing or weight training.  This stretch is performed lying on your side with your hips and knees bent.  Your involved shoulder and elbow are positioned in 90 degrees of flexion.  Your hand of the uninvolved arm grasps your elbow and gently pulls it across the body.  You want to feel a mild stretch on the outside or back of your shoulder.  Hold this position for 30 seconds.  Perform this stretch 2 to 3 times each session.

Sleeper Stretch

The cross-body stretch is superior to the sleeper stretch for improving shoulder range of motion in young baseball players.  However, the sleeper stretch is the more popular of the two stretches.  Start in the same position as the cross-body stretch.  However, with the sleeper stretch, your wrist and forearm are gently moved down towards the table.  You want to feel a mild stretch on the outside or back of your shoulder.  Hold this position for 30 seconds.  Perform 2 to 3 stretches each session.   For most people, both the sleeper and cross-body stretch do not need to be performed.  My personal experience, and the best available evidence, suggests the cross-body stretch is the most beneficial for improving range of motion.  Choose which one works best for you.

Shoulder Flexion in Side-lying

It is important to strengthen your shoulder muscles while limiting stress on your injured labrum.  The biceps tendon attaches to your labrum.  Strong contractions of your biceps muscle can pull on the upper part of your labrum.  Therefore it is best to perform strengthening exercises which minimize biceps activity.  Perform shoulder flexion raises in a side-lying position to minimize biceps activity and reduce strain on your labrum.  Start on your side holding a light dumbbell.  Your elbow remains straight as you raise your arm slightly overhead.  Your arm remains parallel to the floor as you perform the movement.  Perform 3 sets of 10 to 20 repetitions several times per week.

External Rotation Diagonal

Stand holding a resistance band in one hand.  Anchor the band at knee to waist level.  Start with your hand positioned in front of your opposite front hip pocket.  Your elbow remains bent at a right angle throughout the exercise.  Perform the movement by flexing and rotating your arm across your body.  You will end up in a position similar to the arm cocking part of throwing.  Hold this position 1 to 2 seconds.  Reverse the movement back to the starting position.  This is a great exercise for the rotator cuff and lower trapezius muscle.  Perform 3 sets of 12 to 20 repetitions several times per week.

Prone Row to External Rotation

Position yourself on your stomach with your arm hanging over the side of your bed or a treatment table (if available).  Hold a light weight.  Usually 1 or 2 pounds is enough to begin with.  Perform a high row with your elbow in line with your shoulder.  Pause 1 to 2 seconds then rotate your hand upwards towards the ceiling.  Hold this position 1 to 2 seconds.  Reverse the movement back to the starting position.  This is another great exercise for the rotator cuff and lower trapezius muscle.  Perform 3 sets of 8 to 12 repetitions several times per week.

Tips for Getting Started

Symptoms of a labrum injury can range from a minor annoyance to debilitating.  In many people it severely limits overhead activity and the ability to carry out routine daily activities.  The right exercises can help.  For the best results, exercise 3 to 5 times per week.  Infrequent or random exercise will do you little good.  Give these 5 exercises a shot for at least 3 months and see how things go for you.  If you want more help give us a call.  Our physical therapists can help you find additional exercises right for you and supplement these with manual therapy treatments.   You don’t have to keep suffering and you have options other than surgery.

5 Yoga Poses to Decrease Your Shoulder Pain

Are you one of the nearly two-thirds of adults in the United States with shoulder pain?  You may have difficulty reaching overhead, placing your hand behind your back, or lying on your side at night.  The causes of your shoulder pain can range from a mild sprain or strain to a complete tear of the rotator cuff.   Thankfully, there is a great chance your shoulder pain will resolve with a short period of rest and the right type of exercise.  There are many forms of exercise which can be helpful for you.  Yoga is a popular choice for many people.  Yoga is a great way to strengthen some of the smaller muscles around your shoulder.  Strong shoulders are more resistant to injury and pain.

More about Yoga for Shoulder Pain

Yoga combines breathing techniques, meditation, and various body postures.  Yoga reduces stress, depression, and anxiety.  It also improves your concentration, coordination, flexibility, balance, and blood pressure.  Yoga has been proven to be particularly effective helping women recover their shoulder function following breast cancer surgery.  Many yoga postures require high activity of the shoulder stabilizing muscles.  The most critical of these muscles are the middle trapezius, lower trapezius and serratus anterior.  The following 5 exercises engage and challenge these key muscles.  All 5 can easily be performed in your home.  They are described in order of difficulty starting with the least difficult first.

Yoga for shoulder pain

With each exercise it is important to concentrate on your breath.  This will clear your mind and relax your body.   Three-part breathing is an excellent technique to start with. During the three-part breath, you first completely fill your lungs with air, as though you are breathing into your belly, rib cage, and finally upper chest. Then you exhale completely, reversing the flow.  At first you may only be able to hold each pose for 1 breath.  That is okay.  As you become stronger try holding each pose for at least 3 to 5 slow breaths.

Locust Arms Back

The locust pose is an excellent way to strengthen your middle and lower trapezius.  These muscles are important for your overhead function and posture.  Start by lying face down with your legs straight and your thighs touching together.  Point your toes with the tops resting on the floor.  Place your arms to your side with your shoulders and elbows straight.  Slightly lift your hands from the floor with your palms down.  Pull your shoulder blades back and slightly lift your chest.  Focus your gaze slightly forward and down.  Hold this posture for at least 3 to 5 slow breaths.  Concentrate on each breath.

Locust Arms Forward

To increase the level of difficulty, perform the locust pose with the arms above your head.  Lie face down with your legs straight and your thighs touching together.  Point your toes with the tops resting on the floor.  Place your arms overhead to form a “V”.  Maintain your elbows straight.  Slightly lift your hands from the floor with the thumbs point up.  Pull your shoulder blades back and slightly lift your chest.  Focus your gaze slightly forward and down.  Hold this posture for at least 3 to 5 slow breaths.  Concentrate on each breath.

Upward Dog

The upward dog pose involves weight bearing through the arms and shoulders.  This involves all the stabilizing muscles of the shoulder and upper back.  Lie face down with your hands in line with your chest.  Point your fingers forward and support your weight on your hands.  Straighten your arms.  Press the tops of your feet into the mat so that your thighs elevate off the floor.  Pull your shoulder blades back.  Focus your gaze forward.  Hold this posture for at least 3 to 5 slow breaths.  Concentrate on each breath.

Side Angle

The side angle pose integrates an overhead reach with a lower body side lunge.  Stand with your left heel aligned with the arch of your right foot.  Your left knee will bend and track over your foot.  Do not allow your knee to move past your toes.  At the same time your left elbow bends and your forearm rests on your left front thigh. The right knee remains fully straight.  Raise your right arm fully overhead, next to your ear.  Focus your gaze forward.  Hold this posture for at least 3 to 5 slow breaths.  Concentrate on each breath.  With each breath try to stretch your hand further and further towards the sky.  If you experience pain or are unable to fully raise your arm overhead you can try raising the arm out to your side.

Side Plank

The side plank places greater demand on the shoulder muscles because of its one-arm weight-bearing position.  From a push-up position, transfer all your weight onto your right hand.   Align your left shoulder on top of your right.  Reach towards the ceiling with your left arm.  Stack your feet on top of each other.   Maintain a neutral spine.  A straight line should extend from your head through your spine and down to your toes.  Focus your gaze forward.  Hold this posture for at least 3 to 5 slow breaths.   Concentrate on each breath.  With each breath try to stretch your hand further and further towards the sky.

Get Started with Yoga

The popularity of yoga is increasing. Unfortunately the number of people experiencing shoulder pain is going to continue to rise.  Keeping your shoulders strong and mobile is your best defense against future problems.  These 5 yoga poses are great to incorporate into your workouts.  I recommend performing them two days per week.   You can cycle through each pose several times.  They will probably take you no more than 30 minutes each day.  If you experience any difficulty give us a call.  We would love to help you out.

 

 

5 Easy Exercises for Shoulder Arthritis

Shoulder arthritis occurs in approximately 15% of people over the age of 65.  It is more common in women.  As with other forms of arthritis, it begins with a slow progressive loss of cartilage within the joint.  This leads to changes of the bone and joint lining.  Joint inflammation, stiffness, muscle weakness, pain, and deformities within the joint are common.  Despite popular belief, arthritis is not always a downward cycle of pain culminating in a joint replacement surgery.  Many people we work with achieve excellent results by doing the right exercises for shoulder arthritis.

Osteoarthritis

Non-Surgical Treatment of Shoulder Arthritis

Lifestyle changes, activity modification, and strategies to protect your shoulder joint are important parts of treatment.  Weight bearing activities through the shoulder should be minimized or avoided.  Examples include push-ups and heavy overhead work. In cases of acute pain, medications or injections are helpful.  However, they should be used sparingly due to their long-term adverse effects.

Exercise is beneficial because it improves health of the existing cartilage, decreases joint stiffness, improves muscle strength, decreases pain, and improves function.  To start, gentle passive exercises are done.  These are best done lying down with the assistance of a cane or wand.  Manual therapy techniques performed by a physical therapist enhances the benefits of exercise for shoulder arthritis.

As pain and range of motion improve, stretching exercises are progressed and strengthening exercises are added.  The following 5 videos show examples of exercises we have used with excellent results for many people with shoulder arthritis.

Wand-Assisted Shoulder Flexion

Begin on your back holding a cane or wand in each hand.  Space your hands slightly wider than shoulder-width.  Hold the cane or wand between your thumb and index finger with a thumb-up position.  The thumb-up position will maximize movement at your shoulder joint.  With both elbows straight, lift your arms overhead until a mild to moderate stretch is felt.  Hold this position for 5 to 10 seconds.  Then slowly lower back to the start position.  Perform 10 to 20 repetitions each day.

Wand-Assisted Shoulder External Rotation

Begin lying on your back with a small pillow or towel roll under your upper arm.  Hold a cane, golf club, or similar object in both hands.  Use the non-involved arm to passively rotate your involved arm out to the side.  Maintain your elbow at a 90-degree angle throughout the exercise.  Pause and hold the position for 5 to 10 seconds.  Perform 10 to 20 repetitions each day.  Avoid exercising through pain.

Waiter’s Bow

Begin standing with your hand resting on a table top or counter.  Relax your shoulder and neck muscles.  Slowly step backwards while keeping your hand on the table or counter.  Pause and hold the position for 5 to 10 seconds.  Perform 10 repetitions each day.  Don’t hold your breath, bounce, or exercise through pain.

Wall Chest Stretch

This purpose of this stretch is to restore normal posture and position of your shoulder.  Most people with arthritis develop rounded shoulders.  This increases joint stress within the shoulder.  To begin, stand next to the corner of a wall or door jam.  Place your hand, forearm, and elbow on the wall.  Next, take a small step forward and slightly turn your body away from the wall.  You should feel a mild to moderate stretch in the front of your shoulder or chest. Hold the stretch for 15 to 30 seconds and perform 3 to 5 repetitions daily.  If you experience pain, slightly lower your arm or decrease the intensity of the stretch.

2-Arm Band Row

The row is a great exercise to begin strengthening the muscles around the shoulder.  This exercise emphasizes the muscles that hold the shoulder blades back.  To perform this exercise, anchor a resistance band to a piece of furniture or door knob.  Grasp the ends of the band in each hand.  Next, step back so there is tension on the band.  Pull your hands and elbows back.  The most important part of the movement involves squeezing or pinching the shoulder blades together.  Perform 10 to 20 repetitions for multiple sets 3 times per week.

How to Get Started with Exercises for Shoulder Arthritis

Exercise can’t reverse or cure arthritis.  Nothing can, not even surgery.  But your pain and suffering from shoulder arthritis can be managed with the right exercise program.  Although shoulder surgery can be extremely successful, it is not an option for everyone.  If you are looking for a different approach, your physical therapist can help you.  Begin with the strategies discussed in this article.  And if you need more help and are interested in teaming up with one of our doctors of physical therapy, give us a call.

Band Rotator Cuff Exercises for Baseball: Part 2

Nearly 50% of all baseball pitchers experience shoulder or elbow pain that limits participation at some point in their careers.  The repetitive stress of overhead throwing leads to overuse injuries of the shoulder and elbow.  However, many of these overuse injuries are preventable.  Exercises targeting the rotator cuff are one such approach.  In a previous article (Part 1) we wrote about free weight exercises for the rotator cuff.  Resistance band or tubing exercises are also commonly used to assist in reducing injury risk.  This article discusses the role of band exercises for the rotator cuff as part of a warm-up or conditioning program.

Band or tubing exercises are an important part of pre-throwing warm-up routines for some baseball players.  There are several solid products designed specifically for baseball players.  I recommend any of these: J-Bands, ArmCare2Go, and Kbands.  Band or tubing programs typically include several exercises to activate muscles important in the throwing motion.  They are conveniently performed in the bullpen, dugout, and locker room or on the sidelines.  These same exercises are also important components of rehabilitation and long-term arm care conditioning programs.  The goal of these programs is to maintain high levels of strength and endurance in the shoulder muscles.  Particular attention is given to the rotator cuff and scapular stabilizers because they play a key role in reducing injury risk.

Overview of Band Rotator Cuff Exercises for Baseball Players

During the throwing motion, large forces are generated from the lower body.  Energy is then transferred through the core to the arm.  The arm’s primary function is to dissipate these forces in order to minimize stress to the shoulder and elbow.  Band exercises are a great way to prepare the upper body muscles prior to throwing.  Under these circumstances, 5-7 exercises are performed as part of a warm-up.  One set of 30 repetitions performed in a controlled fashion is recommended.

As part of a conditioning program, these same exercises can be performed for multiple sets 3 to 4 times per week.  It is important to keep in mind; arm care exercises are integrated into a total body conditioning program including the lower body and core.  The following 5 rotator cuff exercises can be integrated into a long-term conditioning program or as part of an individualized warm-up.

Band Diagonal Flexion Pattern

Stand or kneel with a band anchored to a solid base at the side.  The hand begins positioned in front of the opposite hip with the palm facing the body.  The movement of this exercise resembles drawing a sword.  The hand moves across the body and upwards.  The finish position includes rotating the arm so the thumb is pointing behind the body.  As you lower the arm back to the starting position the palm rotates back to face the body.   This exercise activates all rotator cuff muscles at moderate to high levels.  It also performed in a fashion similar to the throwing motion.  This makes it ideal to incorporate into any pre-throwing warm-up.

Band Internal Rotation @90 Degrees

Stand or kneel with your back to the band anchored to a solid base. With the shoulder elevated and the elbow bent, begin with the shoulder in external rotation similar to the arm cocking phase of throwing.  Move the shoulder into full internal rotation and then return to the starting position while maintaining the shoulder and elbow positions.   A common mistake is to gradually allow the arm to drop during the exercise.   This exercise results in high activation of the subscapularis muscle.  This rotator cuff muscle functions to stabilize the shoulder joint and accelerate the arm towards home plate.

Band External Rotation @ 90 Degrees

Stand or kneel facing a band anchored to a solid base. With the shoulder abducted and the elbow bent, begin with the shoulder in internal rotation.  Move the shoulder into full external rotation similar to the arm cocking phase of throwing.  Slowly return to the starting position while maintaining the shoulder and elbow positions.   A common mistake is to gradually allow the arm to drop during the exercise.  This exercise activates all rotator cuff muscles at moderate to very high levels.  It is performed in a position similar to the arm cocking and early acceleration phase of throwing where high stress is imparted on the shoulder and elbow.

Band Throwing Acceleration

Stand in a lunge stance holding the band or tubing with the throwing arm in a position of abduction and external rotation.  This is similar to the arm cocking phase of throwing.  Begin the exercise by moving the arm across the body similar to the acceleration phase of throwing.  Shift your body weight from the rear to the front leg as you perform the throwing motion.  Return to the starting position in controlled fashion shifting your bodyweight back to the rear leg.  This exercise results in very high activation of the subscapularis and teres minor of the rotator cuff.  The subscapularis functions to accelerate the arm towards home plate.  The teres minor acts to stabilize the shoulder and control the upper arm during the acceleration and follow-through phases of throwing.

Band Throwing Deceleration

Stand in a lunge stance holding the band or tubing with the throwing arm in a low position.  This is similar to the follow-through or ending phase of the throwing motion.  Begin the exercise by moving the arm back and up towards a position of abduction and external rotation (arm cocking position).  Shift your body weight from the front to the rear leg as you perform this motion.  Return to the starting position in controlled fashion shifting your bodyweight back to the front leg.   This exercise results in very high activation of the teres minor.  The teres minor acts to stabilize the shoulder and control the upper arm during the acceleration and follow-through phases of throwing.  This exercise emphasizes an eccentric muscle action similar to how the rotator cuff functions during throwing.

Closing Thoughts on Band Rotator Cuff Exercises for Baseball Players

Arm overuse throwing injuries for the baseball player can derail a career.  However, many of these injuries are preventable. These 5 exercises are only a small sample of band rotator cuff exercises for baseball players which can be helpful. They can be performed during any part of a pre-throwing warm-up or year-round training program. Your physical therapist can perform an individual assessment and design an exercise program based on your deficiencies and goals. The objective is to increase the baseball player’s likelihood of a long injury-free and successful career. Contact us today if you questions about which exercises are right for you.

 

6 of the Best Middle Trapezius Exercises

Your trapezius is a large broad muscle spanning your upper back.  It has attachments to the spine, shoulder blade, and collar bone.  Your trapezius is divided into 3 parts: the upper, middle, and lower portions.  As a whole, your trapezius plays an important role in overhead function.  Your middle trapezius is also responsible for retracting or pulling back the shoulder blade.  Poor function of your middle trapezius has been associated with shoulder, neck, and elbow pain.  Thankfully, there are a variety of middle trapezius exercises that will decrease your pain and improve function.

The Role of Middle Trapezius Exercises in Overhead Sports

Your middle trapezius plays an important role in in positioning and controlling movement of the arm during overhead sports.  This is especially true in sports such as baseball and swimming.  During baseball pitching, the middle trapezius is activated at very high levels to control the position of the shoulder blade as the pitcher’s arm accelerates towards home plate.  Youth pitchers with a history of shoulder pain have less strength in their middle trapezius compared to pitchers without pain.

In swimmers, weakness of the middle trapezius is associated with shoulder pain and disability.  Also, athletes with shoulder impingement exhibit poor timing of their middle trapezius muscle.  As a whole, weakness and poor timing of the middle trapezius can place excessive stress on other areas of the arm.  This predisposes the athlete to poor performance or injury.  The 6 exercises in this article are simple examples of how to train your middle trapezius.

Prone Row

Begin lying on your stomach holding a dumbbell.  Starting with your arm in an extended position, perform a row.  Your elbow stays close but not all the way against the side of your body.  Hold the top position for 1-2 seconds before slowly lowering the weight.  It is important to pull the shoulder blade back as you raise your elbow.  Avoid overextending and shrugging your shoulder.

Prone Shoulder Extension

Begin lying on your stomach with the arm holding a dumbbell.  Starting with your arm in an extended position, raise your arm up with your elbow straight.  Your elbow stays close but not all the way against the side of your body.  Hold the top position for 1-2 seconds before slowly lowering the weight.  It is important to pull your shoulder blade back as you raise your arm.  Avoid overextending and shrugging your shoulder.

Prone Horizontal Abduction in External Rotation

This is my “go-to” exercise for strengthening the middle trap.  Lie face down with your arm over the side of a table or bench.  Be sure to keep your neck in a relaxed neutral position resting on your other forearm.  With your thumb up and arm straight lift toward the ceiling at a 90-degree angle (the 9:00 and 3:00 positions of a clock).  This position is aligned with the muscle fibers of the middle trapezius.  Be careful to avoid shrugging your entire shoulder as you raise the arm.  Instead, think about tilting the shoulder blade backward as you raise your arm.  Pause at the top of the movement before returning to the start position in a controlled manner.

Prone Lower Trap Raise

This exercise strengthens all ports of the trapezius.  Lie face down with one arm over the side of a table or bench.  Be sure to keep your neck in a relaxed neutral position resting on your other forearm.  With your thumb up and arm straight lift toward the ceiling at a 45-degree angle from your head (the 10:00 and 2:00 positions of a clock).  This position is aligned with the muscle fibers of the lower trapezius.  Be careful to avoid shrugging your shoulder as you raise your arm.  Instead, think about tilting the shoulder blade backward as you raise your arm.  Pause at the top of the movement before returning to the start position in a controlled manner.

Side-Lying ER

Lie on your side holding a dumbbell with your elbow bent.  Place a towel roll in the armpit to increase activation of your rotator cuff during the exercise.  Rotate your arm upwards maintaining the elbow against the side of your body.  Hold the top position for 1-2 seconds before slowly lowering the weight.  It is important to pull your shoulder blade back as you raise your arm.  This increases activation of the middle and lower trapezius muscles.

Prone Row + ER

Lie face down with your arm over the side of a table or bench.  Be sure to keep your neck in a relaxed neutral position resting on your other forearm.  First, perform a high row with a pause at the top.  From this position externally rotate your arm upwards towards the ceiling.  Pause at the top and reverse the sequence back to the start position.  Be careful to avoid shrugging your shoulder as you raise your arm.  Instead, think about tilting the shoulder blade backward.  This exercise results in high activation of the rotator cuff, middle trapezius, and lower trapezius.

Closing Thoughts about Middle Trapezius Exercises

The middle trapezius is often neglected in rehabilitation and conditioning programs.  However, this muscle plays a very important role in overhead function and sports.  Middle trapezius exercises should be included as part of a well-rounded strengthening program.  These 6 middle trapezius exercises can be easily performed in the gym or at home.  It is not necessary to perform all 6.  Instead, select 2 or 3 which you are comfortable performing.  Start with light weights (2 to 3 lbs).  Multiple sets (2 to 3) of 10 to 20 repetitions, a few times per week is recommended.  Contact your physical therapist if you need help getting started.

Thoracic Outlet Syndrome: 5 Exercises to Help

Thoracic outlet syndrome (TOS) refers to compression of the major nerves and blood vessels in the area between the neck and shoulder.  More than 90% of cases involve compression and irritation of the nerves as they pass through the thoracic outlet.  It is less common for the blood vessels to be involved.

Common symptoms of thoracic outlet syndrome include pain in the neck, upper back, shoulder, arm, or hand.  It is also common to experience numbness, tingling, and weakness of the arm, hand, and fingers.  Symptoms are aggravated with overhead positions or activities such as throwing a baseball.  Also, repetitive tasks such as prolonged typing exacerbate symptoms of TOS.

Anatomy of the Thoracic Outlet

Thoracic outlet syndrome exercise

There are 3 components to the thoracic outlet extending from the neck to the front of the shoulder.  The 1st component is the interscalene triangle.  Nerves exit the neck and pass between the two scalene muscles.  Abnormalities of these muscles can contribute to compression or irritation of the nerves.  The 2nd component of the thoracic outlet is called the costoclavicular space.  This is the area between the collar bone and first rib.  Abnormalities of the first rib or an extra rib sometimes called a “cervical rib” can lead to irritation of the nerves or blood vessels.  The 3rd component of the thoracic outlet is the area between the pectoralis minor muscle and the rib cage.

Treatment for Thoracic Outlet Syndrome

Treatment for TOS begins with rest from any aggravating activity such as overhead sports (baseball pitching) or repetitive tasks such as keyboarding.  Referral to a physical therapist is the next step.  Physical therapy for thoracic outlet syndrome targets the 3 primary compression sites.  Manual therapy techniques and stretching exercises target the scalene muscles, first rib, and pectoral muscles.   Nerve gliding exercises are prescribed to improve the health of the irritated nerves.  Postural correction exercises are also an important component.  A slouched or flexed posture closes down the space of the thoracic outlet and increases irritation of the nerves and blood vessels.  Finally, pain-free strengthening exercises for the shoulder and upper back muscles are prescribed based on the patient’s individual needs and goals.

Scalene Muscle Stretch

Stretching the scalene muscles alleviates irritation of the nerves and blood vessels within the interscalene triangle.   Begin sitting with a strap or belt draped over the affected shoulder.  Pull down on the strap towards your opposite hip.  Side-bend the neck away from the affected side and slightly turn towards the affected side. Finally, perform a gentle chin tuck to increase the stretch in the side of the neck.  Hold this position for 30 seconds.  If you experience symptoms during the stretch, start with shorter hold times and work up to 30 seconds.

First Rib Self-Mobilization

Improving the mobility and position of the first rib alleviates irritation of the nerves and blood vessels just below it.   Begin sitting with a strap or belt draped over the affected shoulder.  Pull down on the strap towards your opposite hip.  Side-bend the neck toward the affected side.  Look down to the armpit.  This position relaxes the scalene muscles so the forces are directed to the rib.   While holding pressure with the strap, perform 10 slow and deep breaths to mobilize the rib.

Pec Minor Stretch

Improving pectoralis minor length and mobility will alleviate irritation of the nerves under this muscle.  Begin lying over a foam roll under the hips and spine.   With the elbow bent allow the arms to fall down towards the floor.  Fully exhale and relax in this position for 30 seconds.  It is important for your spine to maintain contact with the foam roll.  If you experience symptoms during the stretch, start with shorter hold times and work up to 30 seconds.

Trapezius Muscle Strengthening

To strengthen the lower trapezius muscle lie face down with one arm over the side of the table or bench.  Be sure to keep the neck in a relaxed neutral position resting on your other forearm.  With the thumb up, arm straight, elbow slightly bent, lift toward the ceiling at a 45-degree angle from your head (the 10:00 and 2:00 positions of a clock).  This position is aligned with the muscle fibers of the lower trapezius.  Be careful to avoid shrugging the entire shoulder as you raise the arm.  Instead, think about tilting the shoulder blade backward as you raise the arm.  Pause at the top of the movement before returning to the start position.

The middle trapezius is trained in a similar fashion.  To target the middle trapezius perform the movement with the arm straight out to the side.  This corresponds to the 9:00 and 3:00 positions of a clock.  Strengthening both the middle and lower trapezius will orient the shoulder blade so that irritation of the nerves in the thoracic outlet is diminished.

Closing Thoughts About Thoracic Outlet Syndrome

Thoracic outlet syndrome can be debilitating and negatively impact your quality of life.  Not everyone with TOS has to suffer.  These 5 exercises are only a small sample of the types of exercises that can help.  Meet with your physical therapist and get started on the road to recovery.  Your physical therapist will continually assess your injury and progress your exercise program based on your goals.  The objective is to decrease pain and give you your quality of life back as quickly as possible.  Contact us today if you are experiencing symptoms suggestive of TOS or if you have questions about which treatments are right for you.