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Rotator Cuff Rehabilitation – External Rotation Exercises.

Rotator Cuff Rehabilitation – External Rotation Exercises.

We asked Dr Alastair Tehan (Osteopath) what are some common exercises he prescribes when dealing with shoulder injuries?

He responded:

There are many exercises and it really depends on the type of shoulder injury the person has sustained, but lets say someone has sustained an injury that has created some instability of the shoulder.  The shoulder is a very complex joint that enables a very large range of motion, weakness of the shoulder muscles can often put undue stress on the shoulder capsule and ligaments.  I often find due to desk based occupations with poor posture that people are often weak in their external rotators, and I feel this may predispose them to injuries in throwing sports such as cricket.

Strengthening the external rotators of the rotator cuff can not only help rehabilitate from many shoulder injuries but may also help reduce the likelihood of many injuries in the first place.  The rotator cuff consists of four muscles;- Supraspinatus, Infraspinatus, Teres Minor, and Subscapularis muscles.  These muscles are endurance muscles and as such we often need to hold contractions, or perform repetitive actions with relatively light weights.  The risk of working with heavier weights is not only damaging to these muscles but often just sees these muscles being bypassed for larger muscles to perform an action.  With many of the rotator cuff exercises I’ll often start patients with about 3 sets of 12-15 repetitions, and build up to 5 sets of 25-30 repetitions.

Isometric Rotator Cuff activation

The towel Squeeze – Isometric Rotator Cuff Activation.

The towel squeeze:

This is an exercise I’ll often start my patients with, it requires no equipment or gym memberships and in itself can often alleviate a lot of their pain.

Often the first step is getting the patient used to an externally rotated position and then activating the rotator cuff muscles.  Placing a towel under the armpit, the patient will bend the elbow to 90 degrees and then turn the arm outwards with the palm facing forwards.

Be sure not to cheat and start to rotate your upper body, if you’re concerned this may be happening you may choose to put your back against the wall.  Once you’ve reached a comfortable externally rotated position gently drawing the elbow into you side and holding for about 10 seconds and repeat 3-6 times.

 

 

 

 

 Dumbell External Rotations Laying on side.

Dumbell External Rotations (Step 1)

 Dumbell External Rotation (Step 2)

Dumbell External Rotation (Step 2)

The Dumbell External Rotation exercise:

I’d like to stress that this exercise can also be done without purchasing equipment as I often get patient to perform it using a can of tomatoes or something to that effect.

A patient will lay on their side usually with a pillow under their head to assist with maintaining neutral alignment in their neck.  With their elbow of the top arm bent to 90 degrees they hold a weight often between 500 grams up to about 3kg.  Gently externally rotating at the shoulder and lifting the hand away from the ground.  Its really easy to feel if you are cheating with this one as when your body starts to rotate backwards you’ll feel like you want to roll onto your back.  Slowly lowering the weight again and repeating anywhere between 3-5 sets of 12 to 30 repetitions depending upon your current status.

 

 Theraband External RotationsTheraband External Rotations Start Position  Theraband External Rotations End PositionTheraband External Rotations End Position

Theraband External Rotation exercise:

1. Secure Theraband to the door at approximately your own elbow height.  If you don’t have a door anchor you may wish to tie the theraband into a knot that you can close on the other side of the door.  Warning door handles can be dangerous.

2. Place a folded towel between your elbow and your torso on the side of the shoudler you are trying to strengthen, this will act as a feedback mechanism that will avoid cheating that can occur if you abduct or draw your elbow away from your side.

3. Bending the elbow to 90 degrees and grasping the theraband, stand side on to the door so that the Theraband is travelling across your upper abdomen.

4. Being mindful of your posture gently externally rotate / turn your upper arm out, once again avoiding rotation through the torso and avoiding any excessive wrist flexion or extension, try to keep the wrist neutral.

Start with about 3 sets of 12-15 repetitions, and build up to 5 sets of 25-30 repetitions.

Using a Theraband and a door anchor is a great portable way in which to train the muscles of the rotator cuff and shoulder.  I often find I give this to people who need to travel a lot.  The beauty about Theraband is not just its portability but I find it a little better than dumbbells as it is very easy for the patient to increase or decrease the load. Patients simply hold the band with more or less tension, or even doubling it over for more resistance.  A door anchor is a worthy investment as it prevents injuries that can sometimes occur if a door handle is used and is not securely attached to the door.

At our clinic we sell 2 meters of theraband for about $10 and Door anchors are about $15.

 

** Please note whilst this article includes some general information, shoulder injuries are quite complex and a thorough diagnosis is always necessary before determining the exercises that are the best course of action.  If you have a shoulder injury and are seeking information, the best thing to do is book with one of our Osteopaths for a more tailored exercise regime.