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 loss of cartilage within your joint.  This leads to changes in your bone and joint lining.  Joint inflammation, stiffness, muscle weakness, pain, and deformities within your joint occur.

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.  It is important to minimize or avoid weight-bearing activities through your shoulder.  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 the health of your existing cartilage, decreases joint stiffness, improves muscle strength, decreases pain, and improves function.  To start, gentle passive exercises are best.  These are best done lying down with the assistance of a cane or wand.  Manual therapy techniques performed by your physical therapist enhance the benefits of exercise for shoulder arthritis.

As your 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 maximizes 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 stress within your shoulder joint.

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 your shoulder.  This exercise emphasizes the muscles that hold your 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 are interested in teaming up with one of our doctors of physical therapy, call us today.

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.

 

Rotator Cuff Exercises for Better Baseball Players

If you are a baseball player, the health of your rotator cuff muscles is a crucial part of any success. Your rotator cuff is 4 small muscles connecting your shoulder blade to your upper arm. The 4 muscles are the supraspinatus, infraspinatus, teres minor, and subscapularis. Your rotator cuff’s job is to maintain the ball of your shoulder centered in the socket of your shoulder blade.

Weakness, fatigue, or injury to your rotator leads to poor movement of the ball within the socket. This leads to pain, loss of throwing velocity, poor performance, and injury. Thankfully, exercises targeting your rotator cuff lowers your injury risk and improves your performance on the field.

The Rotator Cuff During Throwing

Rotator Cuff Anatomy

There are 6 sequential phases to baseball pitching. Your rotator cuff is most active during the arm cocking through arm deceleration phases. The greatest stress to your shoulder and elbow occurs during arm cocking and deceleration. Most overuse injuries occur from repetitive stress during these phases. A strong and healthy rotator cuff is essential to withstand these stresses.

A classic study performed by the late Dr. Frank Jobe revealed the muscle activity of the rotator cuff during the different phases of pitching. The supraspinatus muscle is most active during the transition from the stride to the arm cocking phase.  As the arm raises, it centers the ball within the socket. The infraspinatus muscle is most active during the arm cocking phase as the shoulder maximally externally rotates. The teres minor’s primary role is to assist with decelerating the arm after ball release. And finally, the subscapularis is highly active as it contributes to arm acceleration.

 

Phases of Baseball Pitching

The Rotator Cuff and Injuries in Baseball

Several studies prove an association between rotator cuff weakness and injury in baseball players. A 2015 study showed baseball players with ulnar collateral ligament injuries had significantly less rotator cuff strength compared to healthy pitchers. An earlier study found high school baseball players with pre-season supraspinatus weakness were more likely to sustain arm injuries during the regular season. Research performed in Japan found rotator cuff imbalances were associated with shoulder and elbow injuries in high school pitchers. Finally, research on professional pitchers shows pre-season weakness of the supraspinatus and infraspinatus muscles are associated with in-season injuries requiring surgery.

Rotator Cuff Exercises for Baseball

For good reason, most elite baseball players perform regular rotator cuff exercises as part of thier year-round arm care program. The specific exercises performed are based on scientific research showing which exercises elicit the highest activation of the rotator cuff.

Baseball players are also creatures of habit and routine. The individual preferences of the athlete are always considered when selecting exercises. Some athletes prefer exercising with resistance bands while others prefer more traditional free weights. Perform the following 4 exercises with light dumbbells.  Between 2 to 8 pounds is enough. In part 2 of this article, we will cover some of the most beneficial resistance band exercises for the rotator cuff.

Closing Thoughts on Rotator Cuff Exercises for Baseball Players

Overuse throwing injuries for the baseball player can be debilitating and derail a career. These 4 exercises are only a small sample of rotator cuff exercises for baseball players that are helpful. They are done during any part of a 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 your likelihood of a long injury-free and successful career. Contact us today if you questions about the exercises that are right for you.

 

How to Achieve the Best Outcome after Rotator Cuff Surgery

It is estimated that nearly 1 of every 4 rotator cuff repairs will re-tear within 6 months of surgery.  Overly aggressive rehabilitation or inappropriate use of the involved arm can increase this risk.  Based on my 15-plus years of experience as a physical therapist, this is the time when patients are tempted to progress themselves too quickly.  Don’t take the chance.  If you want to achieve the best outcome from rotator cuff surgery, perform your rehabilitation under the guidance of your physical therapist.

Rotator cuff tendon healing is considered sufficient to begin gentle strengthening exercises between the 12th and 16th week after surgery.   After restoring range of motion, it is important that resistance is gradually introduced and progressed.  The purpose of this article is to highlight several key exercises which are utilized during the later phases of rehabilitation after rotator cuff surgery.  Your physical therapist will help you develop the best-individualized plan based on your surgery and long-term goals.

Strengthening Exercise after Rotator Cuff Surgery

Strengthening exercises for the rotator cuff is initiated below–chest level with exercises such as internal and external rotation.  During active-assisted arm elevation exercises, it is important that you maintain appropriate exercise form in order to minimize the risk of developing compensations.  A common compensation is to “shrug” the entire shoulder when attempting to raise the arm overhead.  When you can perform a press-up exercise overhead without compensation, you are ready to progress to performing the full-can scaption with a light dumbbell.  The level of resistance is generally kept low (1 to 2 pounds) but may be increased based on your functional demands.

External Rotation in Side-Lying

This exercise is ideal for strengthening two of the rotator cuff muscles, the infraspinatus and teres minor.  Begin lying on the side with the involved arm on top.  The elbow remains bent at 90 degrees throughout the exercise.  Rotate the arm upwards through a full range of motion while keeping the elbow tucked to the side of the body.  Hold the top position for 2 to 3 seconds before slowly lowering back to the starting position.  Typically 2 to 3 sets of 10 to 20 repetitions are performed.

Band Internal Rotation @ 0 Degrees

This exercise is ideal for strengthening the subscapularis muscle of the rotator cuff.  Begin standing with the involved arm closest to where the resistance band is anchored.  The elbow remains bent at 90 degrees throughout the exercise.  Rotate the arm inwards through a full range of motion while keeping the elbow tucked to the side of the body.  Hold the top position for 2 to 3 seconds before slowly returning back to the starting position.  Typically 2 to 3 sets of 10 to 20 repetitions are performed.

Wand-Assisted Flexion in Standing

This exercise is helpful for transitioning back to full overhead reaching activities.  Stand holding a wand or cane in both hands.  The uninvolved arm will assist in elevating the involved arm overhead.  The elbow remains straight with a thumb-up position throughout the exercise.  The thumb-up position increases rotator activation and minimizes the risk for shoulder impingement when the arm is raised.  It is important to slowly control the lowering of the arm using as much of the musculature on the involved side as possible.  Hold the top position for 2 to 3 seconds.  Typically 2 to 3 sets of 10 repetitions are performed.

 Serratus Punch

 This exercise activates the rotator cuff and shoulder blade muscles while incorporating a more functional reaching movement.  Begin with a resistance band anchored behind you.  The hand starts close to the body with the elbow bent.  A punching movement is performed with a slight upwards inclination.  Hold the top position for 2 to 3 seconds before slowly returning back to the starting position.  Typically 2 to 3 sets of 10 to 20 repetitions are performed.

Press-Up in Standing

This exercise is a progression of wand-assisted flexion in standing.  Initially, the exercise is performed without any weight.  As the strength of the rotator cuff improves, 1 to 2 pounds is added to the movement.  In a standing position, start with the hand close to the body with the elbow bent.  A pressing movement is performed overhead.  The elbow straightens as the arm passes overhead.  The top position is held for 2 to 3 seconds before slowly lowering the arm back down to the starting position. Typically 2 to 3 sets of 10 repetitions are performed.   It is important to avoid “shrugging” the shoulder or arching of the low back.

Full-Can Scaption

Once the press-up exercise can be performed properly without compensation, the full-can exercise is added to improve rotator cuff strength.  This exercise specifically targets the supraspinatus muscle which is the most commonly torn tendon of the rotator cuff.  The exercise starts from a standing position with the elbow straight and thumbs pointing up.  The arms are elevated from an angle midway between the front and side of the body.  The top position is held for 2 to 3 seconds before slowly lowering the arm back down to the starting position. Typically 2 to 3 sets of 10 repetitions are performed.   It is important to avoid “shrugging” the shoulder or arching of the low back.

Final Thoughts on Rotator Cuff Surgery Rehabilitation

Rehabilitation after rotator cuff surgery is a slow progression lasting anywhere from 3 to 6 months.  Your physical therapist will be your guide through the process.  You will be safely progressed in the most effective manner based on your own healing capabilities and long-term goalsYour physical therapist will know when to ramp things up and when to slow things down.  In the end, you will feel like a new person.   Contact your physical therapist if you have questions or are ready to get started with your rehabilitation.

Rotator Cuff Surgery Recovery: Safe and Effective Exercises

Rotator cuff repair surgery involves stitching the tendon back to the tendon or tendon back to the bone.  This requires caution for the first 3 to 6 months after surgery.  Your repair is vulnerable to re-tearing.  Overly aggressive stretching or lifting of your arm will damage the repaired tendon.  The exercises included in this article are a safe progression of the early phase range of motion exercises done during your rotator cuff surgery recovery.

Rotator Cuff Surgery Recovery is a Marathon

You must remain patient throughout the process in order to achieve the best results.  Your second phase of rehabilitation begins around 6 weeks after surgery.  However, if you had a larger tear that requires greater protection this will be delayed further.

Phase 2 exercises use less external assistance than those performed in phase 1. This leads to slightly greater activation of your rotator cuff muscles but do so in a protected fashion.  The goals of phase 2 are to restore your range of motion and prepare your shoulder muscles for gentle strengthening exercises down the road.

Incline Table Slides

This exercise is a progression of the table slide exercise performed in the early phases of rehabilitation.  Begin standing, holding a towel with your hand resting on a surface inclined about 45 degrees.  Relax your shoulder and neck muscles.  Slide your hand up the incline.   At the top, hold for 2 to 3 seconds.  Perform 10 to 15 repetitions for 2 to 3 sets.

Wall Slides

This exercise is a progression of the incline table slide.  Here you transition towards raising your arm overhead.  Begin standing, holding a towel with your elbow bent.  Relax your shoulder and neck muscles.  Slide your hand up the wall.  At the top, hold for 2 to 3 seconds.  Lower your arm under control.  Slowly slide back down the wall.  Initially, your uninvolved hand can be used to assist the movement.  As pain decreases and strength improve, perform the exercise unassisted.

Active Press-Up in Supine

Lie on your back with your knees bent.  Your arm begins to your side with your elbow bent.  Actively lift your arm straight up to the ceiling.  This is like a bench pressing movement. When your elbow reaches full extension, pause and hold the position for 2 to 3 seconds.  Perform 10 to 15 repetitions for 2 to 3 sets.  This exercise can be safely progressed by performing it in a slightly reclined position and eventually in standing.

Wand-Assisted Flexion in Supine

Lie on your back holding a cane, wand, or similar straight object.  Space your hands slightly wider than shoulder-width.  Grasp the cane or wand between your thumb and index finger.  Assume 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.

Resistance Band Elevation in Supine

Performing exercises lying on your back minimizes the effect of gravity.  This makes it ideal to begin exercising with light resistance while protecting your healing rotator cuff repair.

To perform band elevation, begin on your back.  Hold a resistance band in your hand at waist level.  Start your shoulder flexed at 90°.  Straighten your elbow holding the band in a thumb-up position. Put minimal tension on the band in the starting position.

Actively lift your arm to approximately 160°, thereby lengthening the band.   Pause 2 to 3 seconds at the top, then lower slowly back to the starting position.  Perform 10 to 15 repetitions for 2 to 3 sets.

Closing Thoughts on Rotator Cuff Surgery Recovery

From the 6 to 12-week point after your rotator cuff surgery, you will feel much less pain.  Beware!  This can provide a false sense of security.  Your repaired tendon is still at only approximately 25% to 50% normal strength during this time period.

Exercise must still be applied cautiously.  Your physical therapist and surgeon will communicate with each other to determine the optimal rate of progression for you.  If you remain patient and consistent with your exercises you will be happy with the end result.

If you are looking for more help, call our office to schedule an appointment.  Our doctors of physical therapy have been helping people in Southern Ocean County move without pain for more than 15 years.

 

Rotator Cuff Surgery: What to Expect in Physical Therapy

Rotator cuff tears occur in nearly 30% of people over the age of 60.  Some rotator cuff tears can be treated conservatively with physical therapy.  However, many will require arthroscopic surgery to repair the torn tendons.  Nearly 500,000 rotator cuff repair surgeries are performed each year in the United States.  Postoperative physical therapy is crucial if you want to achieve a successful long-term outcome following surgery.

Early Physical Therapy After Rotator Cuff Repair

Re-tearing of the surgically repaired rotator cuff tendon is common following surgery.  Most re-tears occur within the first 3 to 6 months following surgery.  Another potential complication is stiffness or loss of motion in the shoulder.  Appropriate exercise prescribed by your physical therapist will minimize your risk of re-tearing the repair and help reduce stiffness.

rotator cuff tear exercises

Some surgeons recommend a 6-week period of strict immobilization in a sling without any physical therapy.  Other surgeons allow protected motion and passive exercise within 2 weeks following surgery.  Research suggests most patients can  safely begin physical therapy early after surgery. This minimizes stiffness of the shoulder and loss of muscle in the rotator cuff.  However, patients with larger tears may benefit from delaying physical therapy for 4 to 6 weeks to protect the healing repair.

Protection and Early Motion

After surgery, your shoulder will be immobilized in a sling for the first 4 to 6 weeks.  During this period, you may perform very low load exercises initiated by your physical therapist.   These exercises require low activation of the rotator cuff muscles.  This approach protects your healing repair, reduces stiffness, reduces pain, and minimizes muscle loss.  Some of the following 7 exercises may be prescribed based on the size of your tear, surgeon preference, and other individual factors.

Forward Bow

Begin standing with your hands 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.   When a mild stretch is felt, pause and hold the position for 5 to 10 seconds.  Avoid exercising through pain.

Table Slides

Stand holding a towel with your hand of the involved arm 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.

Ball-Assisted Scapular Protraction

Begin standing with your hand resting on an exercise ball on a table top or counter.  Relax your shoulder and neck muscles.  Slowly roll the ball forward and slightly to the side (a 45 degree angle).   When a mild stretch is felt, pause and hold the position for 5 to 10 seconds.  Avoid exercising through pain.

Wall-Assisted External Rotation

Stand facing the corner of a wall.  Place a small towel roll under your arm.  Bend your elbow and rest your hand on the corner of the wall.  Slowly step and turn your body away from the wall.  Maintain your elbow tucked to the side and hand on the wall.  Pause and hold the position for 5 to 10 seconds.  Avoid exercising through pain and avoid overstretching the shoulder into external rotation.

Cane-Assisted 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 with both hands.  Use your other arm to passively rotate your involved arm out to the side.  Maintain the elbow of your involved arm at a 90-degree angle throughout the exercise.  Pause and hold the position for 5 to 10 seconds.  Avoid exercising through pain and avoid overstretching the shoulder into external rotation.

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.  When your elbow reaches full extension, 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.

Supine Self-Assisted 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 pain begins to diminish, progress the exercise by increasing the duration of the stretch up to 30 seconds.

Rotator Cuff Rehabilitation: Closing Thoughts

Rehabilitation following rotator cuff surgery begins with n introduction of protected range of motion exercises.  During the first few weeks of rehab, you will perform exercises similar to those in this article.  At approximately 6 weeks after surgery, the focus shifts to restoring active range of motion exercises without resistance or weights.  Progressive strengthening exercise begins at postoperative week 12.  Future articles will address these phases of rehabilitation.  If you want to learn more about rehabilitation and recovery from rotator cuff surgery, contact your physical therapist today.

 

Shoulder Impingement: Stretching and Strengthening Exercises

Shoulder impingement involves compression of the rotator cuff tendons between the top of the shoulder blade (acromion process) and upper aspect of the arm bone (humerus).  Other structures involved include the biceps tendon and bursa (a fluid-filled sac between 2 bones).  Shoulder impingement accounts for approximately 1/3 of all shoulder pain.  Pain is usually worst when reaching with an outstretched arm or lifting overhead.

Impingement Syndrome

During normal activities of daily living, your rotator cuff becomes compressed and stretched.  This typically does not result in any pain.  However, several factors can contribute to excessive compression of your rotator cuff and pain.  Thankfully, the majority of these factors are modifiable through exercise.  In fact, research shows exercise is at least equally effective or better than medications, injections, and surgery for most painful shoulder problems.

Exercise addresses many of the modifiable risk factors that contribute to shoulder impingement.  Stretching exercises increase the available space between the shoulder blade and humerus. This can alleviate compression of the rotator cuff, bursa, and biceps tendon.  Strengthening exercises  that target the rotator cuff and shoulder blade muscles also increase the available space.  Exercising with an appropriate load strengthens the tendons which further reduces pain.  There is no one-size-fits-all exercise approach for shoulder impingement.  The following exercises are only examples which may be included in an individualized rehabilitation program.

Stretching Exercises for Shoulder Impingement

Stretching the shoulder is an important part of any shoulder rehabilitation program.  In particular, exercises targeting mobility of your pectoralis minor muscle, thoracic spine, and posterior shoulder are important.  Increasing the length of your pectoralis minor pulls the shoulder blade back, improves posture, and increases the available space for your rotator cuff.  Improving extension of your thoracic spine improves posture and overhead shoulder mobility. Stretching the back of your shoulder helps reposition your upper arm bone allowing greater space for any compressed soft tissues.  For the best results perform stretching exercises daily.

Rotator Cuff Exercises for Shoulder Impingement

The primary job of your rotator cuff is to center the ball of your arm bone (humerus) in the socket of your shoulder blade.  Any weakness of your rotator cuff causes the ball to migrate upwards into the bone above it leading to impingement.  Once your  shoulder becomes painful, your rotator cuff muscles shut down leading to a vicious cycle of pain and weakness. It is imperative that your rotator cuff is strengthened in order to restore proper shoulder function. There are 4 muscles of the rotator cuff.  They are the supraspinatus, infraspinatus, teres minor, and subscapularis.  These muscles function together and are all strengthened during rehabilitation.

Performing the following 3 exercises will improve the strength of your entire rotator cuff.  Strengthening exercises are performed 3-4 times per week.  Start with a weight that allows you to perform 12 to 15 repetitions for 3 sets.  Over the course of several weeks, progress the weight so you are performing closer to 8 to 10 repetitions for each set.  A sense of fatigue and some pain is acceptable and in most cases beneficial for recovery.  On a 0 to 10 scale, keep the pain levels at a 5/10 or less.

Shoulder Blade Exercises for Impingement

Your trapezius and serratus anterior muscles function together to rotate your shoulder blade upwards.  They also tilt your shoulder blade backward as your arm is raised.  This is essential for overhead function.  If your shoulder blade does not appropriately tilt backwards or rotate upwards,  aryourm bone will jam into your acromion.  This results in impingement of your rotator cuff.   Follow the same guidelines described above for rotator cuff strengthening exercises (i.e., sets, repetitions, etc).

Closing Thoughts

Shoulder impingement is a common disorder in athletes, weekend warriors, and sedentary adults.   Exercise is the first line of treatment and in most cases, very successful.  Your shoulder complex is composed of several joints and many small but intricate muscles.  Therefore, recovery is often slow at first.  However, if you stick to your exercise program expect a full recovery in 3 to 4 months.  For faster results, it is best to work with your physical therapist so your exercise program is targeted to your individual needs.  Give us a call if you would like some help.