Rotator Cuff/Shoulder Rehab

[Rock]

Hey everyone.  I've been a certified trainer (ACE, ACSM) for over 10 years and have been using FitSync for about 3 years. This is my first post and I have a question on shoulder rehab exercises. 

Any thoughts out there on the old standby "Interior Shoulder Rotation" and whether there is much difference between a standing cable version vs a side lying dumbbell version.  The lateral load on the humerus seems it could be higher with the standing cable but only at higher resistance levels.   

[Steele]

You're in luck - I just happened to be poking around and saw your post appear.

Here's the deal; at lower resistance levels there's no appreciable difference in load in side lying dumbbell vs standing cable.  BUT once you increase the weight you do put a lateral/outward load on the humerus/shoulder with the cable.  Think of it - not only are you rotating the arm across the body but you also need to resist the outward pull of the cable by keeping your humerus tight to your side.   IF the shoulder is already loose you're going to loosen it and irritate it more with the lateral load.

My recommendation is first, back way way off on the weight.  YOung guns and athletes love to crank up the weight as soon as they start feeling better but tell these guys to focus on pure, perfect form every time and not to try to set a record.  Next, once you get up to 20lbs or so I would go with the side lying rotation on a SOFT bench - this stablizes the humerus against the rib cage without any lateral load like you would find with a cable.   

[Paul]

You guys just solved a big mystery for me.  I'm not a trainer but I do two sets each of interior and exterior shoulder rotation as part of every upper body workout.  I had shoulder surgery a few years ago on my left shoulder so I've been doing these for years as part of my regular routine and both shoulders have been solid ever since the surgery.

A couple months ago I couldn't understand why my left shoulder started hurting and feeling loose.  I checked all my workouts in my FitSync stats for the past 6 months and discovered that the pain started around the same time I switched from lying dumbbell interior/exterior rotations to standing cable on a free motion machine.

Since I read this post a couple weeks ago I became more conscious of how the cable version seemed to be pulling my shoulder sideways much more than the lying version when doing the interior rotation (exterior didn't make a difference).  So I went back to lying dumbbell version on both a few weeks ago and magic! - shoulder doesn't hurt anymore.   Thanks again for the tip! 

[Stephen Holt]

As stated in Travell & Simons' Myofascial Pain and Dysfunction: The Trigger Point Manual :
 

The function of the subscapularis is chiefly to help secure the head of the humerus in the glenoid fossa during arm movements, particularly abduction. It is active in medial rotation and adduction of the arm at the shoulder joint.

By lying down on your side and stabilizing the head of your humerus with an external device (the bench), you're taking away from the function of the subscapularis by putting it in a position where it no longer has to "secure the head of the humerus in the glenoid fossa" or help with "adduction of the arm at the shoulder joint."

A better choice of exercise would be the D1 Extension PNF pattern.
 - Stephen

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Stephen Holt
Named one of America's Greatest Trainers by Men's Fitness
2003 ACE Personal Trainer of the Year

[dRas]

Sounds great Stephen ... great to see you on the boards
but... what's a D1 Extension PNF pattern???

[Rock]

Thanks for the insight, Stephen.  Nice to have someone of your caliber weigh in. 

What are your thoughts on PNF for athletic populations with either no current symptoms or no history of shoulder injury?  I've typically applied the D1/D2 PNF series to non-athletes or those suffering neurological damage but maybe I've been overlooking a more beneficial conditioning program.

What would you recommend as a good general shoulder conditioning routine for athletic populations?  I have a fair number of clients (male and female but mostly male) from late 20s to early 40s who are either former college athletes or athletic individuals in good condition that could benefit from a preventive routine they could do regularly at home or the gym to supplement their other training.  I usually have these folks do cable or DB shoulder rotation and lots of stretching.  Any thoughts you could share would be appreciated.

Rock

PS - dRaz, PNF is Proprioceptive Neuromuscular Facilitation which is fancy talk for using spiral and diagonal patterns of motion to stimulate nerves and muscles.  Stephen could give us a better explanation but my understanding is PNF came out of lots of research into rehabbing those with nerve and muscle damage due to injury, stroke, etc. and is also frequently used following surgery. 

[Paul]

Hey there Stephen and welcome!

Yup, I remember PNF exercises well following shoulder surgery a while back.  I still can't pronounce proprio...whatever but they sure helped me restore my shoulder.

I'm also looking for some good shoulder exercises I can do in addition to my regular workouts to maintain strength and flexibility.  Right now I do what it sounds like Rock has his clients do; internal and external shoulder rotation and all the stretches the therapists showed me after surgery. 

My regular routine includes DB work for the front, back, and side deltoids and so far so good.  Gave up overhead presses since I'm not 25 anymore.  So anything you can suggest would be welcome.

Thanks.

Paul   

[Paul]

Forgot to post my workout - here's my regular routine twice a week.  The rest of the time I'm cycling, swimming, or doing crunches in front of the TV between sips of beer and mouthfuls of pizza 

[Nazrin Idham Bin Razali]

Hello, my friend.
I'm Nazrin nice to meet ya.
By following my experience, the Rotator Cuff problem or injury we need to tell the client or our-self refer to the doctor.
But, if the pain or problem is not serious we can do a simple rehab by doing a sport massage. to strengthen back the blood capillaries to they normal places. But you should be careful during do this rehab. You must know which muscle part was pain, what movement they feels pain and what bone you must touch and not.

Just using a fingertips and feels the muscle, we called it (Trigger Point).

Happy trying.