Rotator Cuff Injury: My Rehab Journey and Recommendations.
I sustained a dislocated shoulder last season playing rugby at the
Ulster Schools U19 Rugby trial. This is the second time I have dislocated my right
shoulder. A dislocated shoulder is when the humerus dislocates or “pops” out of
the shoulder joint due to a high impact (such as rugby tackle in my case).
I have made the decision to quit rugby due to this injury as it would probably
reoccur in a contact sport, that’s why I have changed sport and taken up
Powerlifting. The rehabilitation exercises for a dislocated shoulder are called
“Rotator Cuff” exercises. This is because during a shoulder dislocation, the
“Rotator Cuff” is normally torn when the humeral head of the humerus dislocates
from the shoulder joint. As it dislocates, it tears the Rotator Cuff tendons
along the supraspinatus muscle. This is known as a Rotator Cuff tear.
The rotator cuff is made up of four muscles. These four muscles are the supraspinatus, subscapularis, infraspinatus, and teres minor. The muscles form a cuff around the shoulder joint (hence the term “Rotator Cuff”) and attach to the upper portion of the arm called the humerus.
Shown above is the view of the rotator cuff from behind (taken from Strength Training Anatomy 3rd
Edition)
Fortunately my dislocation was anterior (humerus is dislocated forward).
This did not create a large tear, but it caused me problems such as a looser
shoulder joint, instability and not comfortable in certain planes of motion
when moving my arm. To reduce the instability of the joint and reduce pain when
moving my arm I have a number of exercises (which I still use) to prevent this.
For all rotator cuff exercises it is done with a 2-4kg dumbbell, 2-4kg cables
or using light resistance bands with high reps and high sets.
I personally prefer to use cables as they provide a constant resistance
and I feel I get a better workout from using them. However some exercises
utilising dumbbells are required. The components of fitness that will be worked
are Muscular Endurance and Proprioception. I will also be working on reducing
shoulder instability.
Muscular Endurance: “is the
ability of muscle or group of muscles to sustain repeated contractions against
a resistance for an extended period of time”. http://sportsmedicine.about.com/od/glossary/g/MuscleEndur_def.htm
Shoulder Instability: “Shoulder
instability means hat the shoulder joint is too loose and is able to slide
around too much in the socket”.
http://www.orthogate.org/patient-education/shoulder/shoulder-instability.html
Proprioception: “Proprioception is
the sense of the orientation of one's limbs in space. This is distinct from the
sense of balance, which derives from the fluids in the inner ear, and is called equilibrioception. Proprioception is
what police officers test when they pull someone over and suspect drunkenness.
Without proprioception, we'd need to consciously watch our feet to make sure
that we stay upright while walking” http://www.wisegeek.com/what-is-proprioception.htm
Stretching the Rotator Cuff
Muscle:
Before doing the rotator cuff exercises you need to stretch the
muscle/muscles being worked. This is shown below from the picture taken from Strength Training Anatomy 3rd
Edition. On the picture it has a step by step guide to stretch out the
Rotator Cuff Muscles.
Rotator
Cuff Exercises
1/ Lying Down external rotation:
This is can be done with a 2-4kg dumbbell/ 2-4kg cable/light resistance
tubing on both arms. Have a small pillow or cloth between your elbow and your
side. This can be done without the pillow or cloth - it is personal preference
to make it more comfortable. The purpose of this exercise is to move your arm
from across your stomach to as far as your range of motion goes without being
sore. The arm moves away from the body (external rotation) or abducts away from
the body. This just targets the rotator cuff muscle. During a rep the concentric
phase is 1 second and eccentric phase is 3 seconds. This is to develop muscular
endurance.
Standing External Rotation
This is
the same exercise but standing up and instead of using dumbbells it can be
performed with using some tubing or cables. Same weight, reps and sets are
still applied. This can be done without the pillow or cloth its personal
preference to make it more comfortable. I use this before a lot of my workouts
as it really warms up the rotator cuff and shoulder joint.
2/ Standing Internal Rotation
This is
can be done with a 2-4kg dumbbell/ 2-4kg cable/light resistance tubing on both
arms. It is purely personal choice whatever or not you use a small pillow or
cloth between your elbow and your side. The purpose of this exercise is to move
your arm from an abducted position to across your stomach (it’s the opposite of
the external rotation exercise). The arm moves towards the body (internal
rotation) or adducts towards the body. This just targets the rotator cuff
muscle. During a rep the concentric phase is 1 second and eccentric phase is 3
seconds. This is to develop muscular endurance. I incorporate this exercise
before my main workout as it is to warm up my shoulder joint and rotator cuff.
3/ Standing Shoulder Raises:
This is done with a 2-4kg dumbbell on both arms. The purpose of this
exercise is to move your arms from your waist to shoulder height somewhere
between arms straight and horizontal level. The arm moves away from the body
(external rotation) or abducts away from the body. This just targets the
rotator cuff muscle. During a rep the concentric phase is 1 second and
eccentric phase is 3 seconds. This is to develop muscular endurance. I change
my grip as it works the muscles in a different way one rotator cuff session
using a overhand grip, another using a side grip.
Overhand and side grips
Side Grip
Overhand Grip
Dumbbell moves through a curved plane as shown from the pictures above.
4/ Standing External Lateral
Movement
This is done with a 2-4kg cable on both arms. The purpose of this
exercise is to move your arms from in front of you to parallel with your
shoulder (horizontal level). The arm moves away from the body (external
rotation) or abducts away from the body. This just targets the rotator cuff
muscle. During a rep the concentric phase is 1 second and eccentric phase is 3
seconds. This is to develop muscular endurance.
5/ Standing Internal Lateral Movement
This is done with a 2-4kg cable on both arms. This is the opposite of
the exercise above (Standing External Lateral Movement). The purpose of this
exercise is to move your arm from a parallel position with your shoulder
(horizontal level) to your arm being directly in front of you. The arm moves
towards the body (internal rotation) or adduction towards the body. This just
targets the rotator cuff muscle. During a rep the concentric phase is 1 second
and eccentric phase is 3 seconds. Again this exercise is to develop muscular
endurance.
6/ Standing Rotator Cuff Stability Ball
Exercise
This
exercise is used to increase stability of the shoulder joint and develop
muscular endurance of the Rotator Cuff. Whilst standing have your arm stretched
out full straight in front at shoulder height. The ball is level with you
touching the wall. Your hand is on the ball and has control of the ball. Some
of the movements performed are going up, down, left, right and diagonally from
both sides. This is done by moving your arm into these positions but your body
remains static and upright. Your arm which is touching the ball is the only
moving part. This increases stability of the shoulder joint. Another form of
this exercise is spelling out the alphabet then spelling it backwards.
7/ Standing Rotator Cuff Stability Ball Bounce Exercise
This exercise is used to increase stability of the shoulder joint and develop muscular endurance of the Rotator Cuff. Whilst standing have your arm stretched out full straight in front at shoulder height. The ball is level with you touching the wall. Your hand is on the ball and has control of the ball. This exercise is very similar to the last one the only difference is the amount of movement is reduced. Instead of moving your arm to move the ball across the wall, the only part that moves is the hand on the ball. The hand will lightly bounce the ball into the wall and repeat this until fatigue. The ball is touching the wall at all times and should be at shoulder height. This is done for 3 sets until fatigue is felt on both arms.
8/ Lying Down Side Raises
This exercise is on a bench or on table with your stomach on the table.
You can have a small pillow or cloth for your head or not, whichever you find
more comfortable. This can be done without the pillow or cloth its personal
preference to make it more comfortable. The purpose of this exercise is to move
your arms away from the bench to shoulder height to the side. The arm moves
away from the body (abducts away from the body). This just targets the rotator
cuff muscle. During a rep the concentric phase is 1 second and eccentric phase
is 3 seconds. This is to develop muscular endurance. I change my grip as it
works the muscles in a different way so one rotator cuff session using an
overhand grip then using a side grip.
9/ Lying Down Front Raise
This exercise is very much like the Lying Down Side Raise except you are
moving your arm forward instead of sideways.
Again, this exercise is on a bench or on table with your stomach on the table. A pillow or cloth for your head is optional. Have a small pillow or cloth for your head. The purpose of this exercise is to move your arms away from the bench to shoulder height straight in front of you. The arm moves away from the body (abducts away from the body). This just targets the rotator cuff muscle. During a rep the concentric phase is 1 second and eccentric phase is 3 seconds. This is to develop muscular endurance. I change my grip as it works the muscles in a different way so in one rotator cuff session, I use an overhand grip, then change to using a side grip.
10/ Standing External Rotation (Elbow Out)
This can be done with a resistance band, dumbbell or a cable. With a resistance band or a cable you can move the anchor up and down to challenge the rotator cuff to work at different angles. I personally use a cable as I feel I can get a better workout. To start the exercise your elbow is bent over using an overhand grip at shoulder height. You then pull your elbow up but keeping your arm at shoulder height as shown in the pictures. This just targets the rotator cuff muscle. During a rep the concentric phase is 1 second and eccentric phase is 3 seconds. This is to develop muscular endurance.
11/ Proprioception Movement Training
This type of training involved me
picking a point in a room e.g. the corner. I would then move my arm to that
corner (pointing at it) with my eyes open looking at that corner. This would be
repeated a few times raising my arm up and down. Then to begin Proprioception
training I would close my eyes and try and mimic the previous movement. I would
move my arm to the corner (with my eyes closed) and once I thought I was at the
corner I would open my eyes to see if I was. This is to develop my sense
of the orientation of my arm in space. I would repeat this (with my eyes
closed) ten times and repeat it but picking different points in a room.
12/ Lying Down Dumbbell Presses
This exercise has a great training effect on the rotator cuff from a different angle. It allows you to use heavier weights to build up the rotator cuff strength and develop the muscles surrounding it (deltoids and pectorals). The arms are close to the body and move straight up and down from a lying down position. During a rep the concentric phase is 1 second and eccentric phase is 3 seconds. This exercise can be used to develop both muscular strength and muscular endurance and is one of my favourite exercises for the rotator cuff. This picture was taken from Strength Training Anatomy 3rd Edition and from my own reading in Men’s Health: 101 Best exercises.
Example of My Personal Rotator Cuff Workout
There are 5 exercises in a
workout and it changes every week to prevent boredom and to prevent the body
from adapting to it. After doing my
usual warm up I will proceed to do:
Currently I am not having any
shoulder problem due to the sustained amount of shoulder training I have done
with these rehab exercises and weight training for developing muscular
strength, hypertrophy and power. However to develop muscular strength, I will
reduce the reps and increase the weight as shown below.
To improve your bench press in Powerlifting, focusing on rotator cuff exercises can dramatically increase the amount you can bench. All of the exercises I had used for shoulder rehabilitations I will continue to use in my development plan for injury prevention and to achieve a bigger bench press. However I will increase the weight slightly and lower the reps steadily to develop muscular strength for the bench press.
I have been doing the above exercises since 2010 (when I had my first dislocated shoulder) and I haven't had any shoulder issues to this date (touch wood).
I hope you found the information useful in your own training.
Thanks for reading
Andrew Richardson, Founder of Strength is Never a Weakness Blog
I have a BSc (Hons) in Applied Sport Science and a Merit in my MSc in Sport and Exercise Science and I passed my PGCE at Teesside University.
Now I will be commencing my PhD into "Investigating Sedentary Lifestyles of the Tees Valley" this October 2019.
I am employed by Teesside University Sport and WellBeing Department as a PT/Fitness Instructor.
My long term goal is to become a Sport Science and/or Sport and Exercise Lecturer. I am also keen to contribute to academia via continued research in a quest for new knowledge.
My most recent publications:
My passion is for Sport Science which has led to additional interests incorporating Sports Psychology, Body Dysmorphia, AAS, Doping and Strength and Conditioning.
Within these respective fields, I have a passion for Strength Training, Fitness Testing, Periodisation and Tapering.
I write for numerous websites across the UK and Ireland including my own blog Strength is Never a Weakness.
I had my own business for providing training plans for teams and athletes.
I was one of the Irish National Coaches for Powerlifting, and have attained two 3rd places at the first World University Championships,
in Belarus in July 2016.Feel free to email me or call me as I am always looking for the next challenge.
Contact details below;
Facebook: Andrew Richardson (search for)
Facebook Page: @StrengthisNeveraWeakness
Twitter: @arichie17
Instagram: @arichiepowerlifting
Snapchat: @andypowerlifter
Email: a.s.richardson@tees.ac.uk
Linkedin: https://www.linkedin.com/in/andrew-richardson-b0039278
Research Gate: https://www.researchgate.net/profile/Andrew_Richardson7
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