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ROTATOR CUFF RELIEF Flipbook PDF
Copyright ' You Can Be Fit, Inc. www.rotatorcuffrelief.com [email protected] 4 INTRODUCTION • Did you know that
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ROTATOR CUFF RELIEF The Ultimate Guide to Rotator Cuff Performance and Injury Prevention
Copyright Primal Pictures, Ltd. www.primalpictures.com
Steven M. Horwitz, D.C., C.C.S.P., C.S.C.S. www.rotatorcuffrelief.com
Rotator Cuff Relief The Ultimate Guide to Rotator Cuff Performance and Injury Prevention Copyright © 2006 You Can Be Fit, Inc. All rights reserved. No part of this book shall be reproduced, stored in a retrieval system, or transmitted by any means – electronic, mechanical, photocopying, recording, or otherwise – without written permission form the publisher. No patent liability is assumed with respect to the use of the information contained herein. Although every precaution has been taken in preparation of this book, the publisher and author assume no responsibility for errors or omissions. Neither is any liability assumed for damages resulting from the use of information contained herein. You Can Be Fit, Inc. is the publisher of this book. The information presented on the pages of this book is intended as an educational resource and is not intended as a substitute for proper medical and/or training advice. Consult your physician or health car professional before performing any of the exercises described on these pages or any exercise technique or regimen, particularly if your are pregnant or nursing, or if your are elderly or have chronic or recurring medical conditions. Discontinue any exercise that causes you pain or discomfort and consult a medical expert. If you use the information in this book, or on any website to which this book is linked, you do so at your own risk. No program can prevent every injury, but this type of program is effective in significantly reducing that risk.
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ROTATOR CUFF RELIEF The Solution to Rotator Cuff Fitness and Injury Prevention
Table of Contents • Introduction • Rotator Cuff Anatomy and Injury • Posture • Relationship Between the Rotator Cuff, Core, Legs • The Throwing Motion • Understanding Shoulder Movements and Terminology • Rotator Cuff Relief: Program Pretest • Rotator Cuff Relief: Program Description • Rotator Cuff Relief: Program Instructions • Exercise Group 1 • Exercise Group 2 • Exercise Group 3 • Exercise Group 4 • Additional Exercises • Stretching Methods • Shoulder, Neck, and Forearm Stretches •
About the Author, About Primal Pictures
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INTRODUCTION • • • •
•
Did you know that many commonly prescribed rotator cuff exercises are dangerous? Do you want to learn why so many people actually get tendonitis from working out and how you can prevent these injuries? Do you know how to combine strength and flexibility exercises? Are you already injured and tired of missing training sessions because of shoulder pain? Are you unsure how to modify your training accordingly? Did you know that you need more than just “shoulder” exercises to prevent shoulder injuries?
THIS PROGRAM WILL: • • • • •
Teach you a science-based progression of exercises that will prevent and alleviate current shoulder pain Teach you proper exercise technique Teach you to avoid the most common weightlifting errors that cause rotator cuff problems Eliminate your fear of training because of prior rotator cuff injury Increase shoulder strength as well as throwing, striking, and hitting power
WHO IS THIS PROGRAM FOR? This program is for any athlete, from children who are starting to play in a sports league to athletes in all sports. All athletes can use this program as a warm-up as well as for injury prevention and increased performance.
WHY THIS PROGRAM IS DIFFERENT Most health care professionals do not understand shoulder function as it relates to sports. One program from a famous orthopedic group recommends performing the same 10 upper extremity exercises in the same rep and set sequence with no diversification. No shoulder flexibility, core, or leg exercises are recommended. A balance of strength and flexibility of all the muscles around the shoulder is essential for injury prevention. In addition, proper shoulder function is linked to the movements of the lower extremity, the pelvis, and the trunk.
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This program includes dozens of different strength and flexibility exercises for the shoulder, core, and legs that are performed in small groups with changing set and repetition sequences.
THE ROTATOR CUFF INJURY PROBLEM Approximately 13.7 million people visited a doctor's office in 2003 for a shoulder problem, including 3.7 million visits for shoulder and upper arm sprains and strains. http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=121&topcategory=
Rotator cuff injuries in sports are usually a result of either direct trauma or microtrauma from repetitive movements. This damage to the joint structures can significantly affect shoulder function and often force athletes to decrease their activity levels and change their life styles permanently. Not all rotator cuff injuries are sports related. Many problems occur because of poor posture that can lead to muscle imbalance, weakness, lack of mobility, pain and eventually tendonitis and tears of the rotator cuff. Rotator cuff tears are an extremely common and important injury of the shoulder that can significantly affect an athlete's activity level and quality of life. For competitive or recreational athletes involved in baseball, tennis, volleyball, golf, swimming or weightlifting, shoulder disorders--especially rotator cuff injuries--can be debilitating. Rotator cuff injuries may require surgery and many months of rehabilitation before the athlete can return to a competitive level. A note to parents of youth baseball players: “Baseball is one of the most popular sports in the United States. Unfortunately, a large number of injuries couple this participation, particularly in young developing pitchers where repetitive stresses applied at the shoulder and elbow can perpetuate significant joint debilitation. Equally disconcerting is that these injuries are often the catalyst for significant long-term joint degradation, career ending surgeries, and restriction in routine upper limb function.” (http://www.kines.umich.edu/research/chmr/ibl.html)
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ROTATOR CUFF ANATOMY
The shoulder is a ball and socket joint. The arm bone (humerus) ends in a ball shaped surface (humeral head) that fits into a very shallow socket (glenoid). This socket is part of the shoulder blade (scapula). This shallow socket allows the shoulder joint tremendous range of motion, making it the most flexible joint in the human body. The price for this tremendous mobility is a potential lack of stability. The function of the shoulder joint is to link the upper extremity (arm, forearm, wrist and hand) to the trunk and to provide mobility and stability of movement to the upper extremity. The rotator cuff (not “cup”) is a group of four muscles that rotate the humerus and hold the shoulder in place by keeping the humeral head in the proper position inside the glenoid socket. These four muscles, the size of four fingers, maintain the proper spacing in the joint so there is enough clearance between the ball and socket (humeral head and glenoid). If the proper anatomical amount of clearance ceases to exist, rubbing or impingement occur and subsequently damages the rotator cuff muscles. The four muscles that comprise the rotator cuff are: supraspinatus, infraspinatus, teres minor, and subscapularis. We call them the SITS muscles.
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Left Shoulder - View from the rear Left Shoulder - View from the front Copyright Primal Pictures, Ltd www.primalpictures.com
The rotator cuff is used during daily repetitive motions such as scratching behind your head or back, painting, waxing a car, putting on a coat, reaching, and lifting overhead. In the athletic context, the rotator cuff plays an extensive role in such athletic activities as throwing a ball, serving a tennis ball, hitting a golf ball, spiking a volleyball, swimming, throwing a discus, putting the shot, and controlling your opponent in wrestling. Should any of the four muscles be weak or out of balance; inflammation, impingement, and even tearing can occur.
ROTATOR CUFF INJURY Rotator cuff injuries are usually the result of a combination of poor technique, repetitive overhead activity, and/or muscular imbalance. Sports such as baseball, softball, volleyball, tennis, golf, swimming, shot put, discus, javelin, weightlifting, and lacrosse each can give rise to subtle and unique technique faults that eventually cause an imbalance within the shoulder unit. No injury prevention program can be complete without proper technique coaching and performance of sports specific skills. Any overhead activity involving the repetitious motion of moving the arm from below shoulder level to above shoulder level has the potential to damage the rotator cuff. If the rotator cuff and
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surrounding muscles are not strong, flexible, and properly balanced, a cycle of impaired function and injury occurs. Frequently, the front and back of the shoulder and trunk are not balanced because athletes focus on developing the “beach muscles,” i.e. the chest and arms. An imbalance occurs because athlete performs an overabundance of bench presses and curls (chest and arms – the triceps are typically neglected) without performing the necessary stretching for those areas. Strengthening of the muscles surrounding the shoulder blades is also neglected so they become weak relative to the chest. This front to back imbalance predisposes the shoulder to an impingement injury because it places the ball (head of the humerus) too close to the socket (glenoid). Injury to the rotator cuff comes in the form of muscle strain and tendonitis. When the muscles, tendons, and ligaments of the rotator cuff become injured it is actually due to a tear within one of the three. Likewise, pulls and strains (sprains are ligament tears) in any other area of the body are tears of the muscle. Think of each muscle fiber as a single strand of rope. Did one strand of rope tear or did the entire rope tear?
What most people call a pull or strain is a tear of some of the muscle fibers, but not all, that make up the muscle. Strains are classified into three grades. Grade I is a mild tear in the muscle(s) that hinders range of motion with mild to moderate pain. Grade II is a moderate tear with a significant loss of range of motion with moderate to severe pain. Grade III is a severe or complete tear that severely limits range of motion and usually causes great pain.
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Rotator Cuff Tear Supraspinatus Muscle Right Shoulder- View from the front
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Tendonitis is an inflammation and fraying of the tendon (area that attaches muscle to the bone). Inflammation and fraying often occur prior to a tear and make a tear much more likely. When the muscle(s) tears, the first response in the body is inflammation. Inflammation is a protective reaction of the body to injury. Inflammation is typically characterized by pain, swelling, redness, and heat. Most people will feel the pain; however, there is great variability in the amount of swelling, redness, and heat one will experience. After the initial injury, a process called the inflammatory process begins. The function of the inflammatory process is to localize the area of injury, clear away the damaged tissue (cellular debris), and allow the body to resist further injury. Part of this process includes the production of tough, dense tissue in the injured area called scar tissue or adhesions. There are four problems with scar tissue: 1) It is weaker than the original muscle tissue, 2) It is less elastic (flexible) than the original muscle tissue, 3) It forms in all different directions, not just along the lines of the original muscle which contributes to the loss in elasticity, and 4) Many small nerve endings grow into the area. These changes make the injured area very painful when it is moved too far or too strenuously.
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This scar tissue must be removed in order for full function, strength, and flexibility to return to the shoulder joint. Scar tissue will not disappear without effective therapy. Removal of the scar tissue can be accomplished by two highly effective techniques: Active Release Technique (www.activerelease.com)
and Graston Technique (www.grastontechnique.com).
These techniques break up or knead away (similar to kneading away the lumps in bread dough) the scar tissue and provide the proper healing environment for the damaged tissue. This cannot be accomplished with anti-inflammatory medicines like ibuprofen (Advil, Motrin, Nuprin), naproxen (Aleve), Celebrex or Vioxx or by cortisone shots. These medications can help with the initial inflammation and pain, but they may disrupt and prevent proper healing of the muscle tissue. Problematic side effects such as gastro-intestinal bleeding and jaundice may also accompany anti-inflammatory drug use.
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GROUP 1 ROUTINE A 1 – Side-Lying External Rotation
Lie on your side with the top elbow bent to 90º and a towel between the elbow and side. Hold the dumbbell with your wrist straight and rotate your arm as high as you can comfortably. 2 - Side-Lying Internal Rotation
Lie on your side with the bottom elbow bent to 90º. Hold the dumbbell with your wrist straight and rotate your arm as high as you can comfortably. 3 - Shoulder Blade Squeeze
Lie facedown on a mat with a folded towel under your chest if desired. The shoulders and elbows should be positioned at 90 degrees. Contract your abs and buttocks. Squeeze the shoulder blades together without picking the arms off the ground. While keeping the shoulder blades together and the elbows at 90º lift the elbows and hands (thumbs up) towards the ceiling. Be sure to maintain the
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90/90 position and keep the shoulder blades squeezed together. 4- Side Raise in Scapular Plane Scapular Plane
Raise the arms in the scapular plane with the thumbs up and the elbows fully extended in the scapular plane. Raise until your arms are parallel to the floor.
CORE: Curl Up Lie on your back, tongue on roof of mouth behind front teeth, palms down under small of back. Keep one leg straight and one leg bent to 90°. Contract abs and glutes before starting curl up –feel your back push down on your hands. Raise head, neck, shoulders, breastbone, and rib cage as a unit (make believe your head is bolted to your neck like Frankenstein and that it cannot move forward or backward). Elbows remain on floor. If your neck hurts, you must strengthen it by performing isometric neck exercises.
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LEGS: Door Squat Grasp a doorknob (make sure it is secure) with both hands. Keep your feet about 6”-8” from the edge of the door, feet shoulder width apart, and arms straight (no bend in elbow). Lower down to a comfortable depth and rise up.
Static Stretching: At the end of the routine or anytime later in the day. Foam Roller
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About the author: The Consumers’ Research Council of America named Dr. Horwitz to the 2006 edition of “Guide to America’s Top Chiropractors”. Dr. Horwitz is a certified Chiropractic Sports Physician, Strength and Conditioning Specialist and a USA Weightlifting Club Coach. He is also a certified ART® and Graston Technique practitioner. Dr. Horwitz was selected by the United States Olympic Committee as the sole chiropractor for the 1996 United States Olympic Team and has traveled internationally with U.S.A. Track and Field. In 1996, Maryland Governor Parris Glendening appointed Dr. Horwitz to the Maryland Council on Physical Fitness and from 2002 to 2004 Dr. Horwitz served as the council’s Chairman. In 2004, he was selected as the Maryland State Director for the National Strength and Conditioning Association. He is a recipient of the Maryland Chiropractic Association's Outstanding Achievement Award and Washingtonian magazine has chosen him as one of the area's top sports medicine doctors. Dr. Horwitz is the author of the books YOU CAN BE FIT! and Golf Fitness Made Easy! (www.golffitnessmadeeasy.com). An athlete himself, Dr. Horwitz won his height class in the 1986 AAU Collegiate Mr. America bodybuilding contest. In 2000 he won the 198lb. masters division of the 100% RAW Powerlifting meet and deadlifted over triple his bodyweight. He can be contacted at: 12200 Tech Road, Suite 104 Silver Spring, MD 20904 301-622-9000 [email protected]
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