Suzie Says...Rehab Shoulder Injuries - The Basics
In this blog I will be focusing on one of the most common shoulder problem, rotator cuff injury.
Rotator cuff injury can mean a few different things including tendonitis, tendinopathy, impingement, and tears. It is a major cause of shoulder pain, which can make riding a motorcycle challenging, uncomfortable, or almost impossible.
The 'rotator cuff' is made up of four small muscles (see picture below) and is key in stabilising your shoulder and allowing you to move it. It's often a neglected muscle group with many gym-goers focusing on exercises that work the large 'superficial' muscles like the deltoids, trapezius, lats etc. Luckily, you do not need to go to the gym to keep your rotator cuff healthy.
Approximately 50% of new episodes of shoulder pain resolve in eight to twelve weeks, but upto 40% persist for longer than one year with rates of recurrence being moderate to high, so prevention is better than cure. Don’t put off sorting it out or seeing a physio: acute injuries have much better chance of being sorted than ones that have been left for weeks, months or years.
Simple exercises for your rotator cuff (for avoidance and recovery from low level injury)
Exercises for the rotator cuff should NOT be painful. It is not no pain no gain. If 0 is no pain and 10 is worst pain imaginable, do not go over a 3. Perform exercises carefully, especially post injury. If your pain was 1-2 prior to exercises and goes up to a 3 during exercise, this should settle quickly once you have finished (i.e. after 20-30 minutes of resting).
If pain is very high prior to exercise, you need to settle the pain. For this you can consult a pharmacist about appropriate analgesia and also use ice on the painful area. As usual, make sure ice is covered, ideally in a damp cloth, and apply it to the area for 10 minutes, checking your skin regularly. Remove it for 10 minutes and re-apply for 10 minutes. Alternatively apply the ice for 15-20 minutes without removing it, again checking the skin regularly. Only apply ice a maximum of once every 2 hours (2 x 10 mins or 1 x 15-20 mins as discussed above).
Do ALL exercises on BOTH sides if possible.
Pendulums (mainly used after acute injury)
Lean over with your unaffected arm supporting you on a table or something suitable, let your affected arm hang down relaxed.
First - Slowly let your arm swing forwards and backwards.
Second - Slowly let your arm swing side to side
Third - Slowly let your arm swing in a clockwise circle
Finally - Slowly let your arm swing in a anti-clockwise circle.
Do each movement 30 times if not painful, 2-3 times a day.
Assisted movements (mainly used after acute injury)
Flexion - Use your unaffected arm to lift your bad arm up in front of you - here I am demonstrating an effected right shoulder.
Abduction - Hold a pole (wide grip) with arms straight down. Use your unaffected arm to push your affected arm out to the side - here I am demonstrating an effected right shoulder.
External Rotation - Bend your elbows to 90° and hold a pole. Place a small rolled up towel or similar between your side and elbow as shown in the picture. Use your unaffected arm to rotate your affected arm out to the side (keeping elbow by your side) - here I am demonstrating an effected right shoulder.
Repeat the above 5-10 times each if not painful, 2-3 times a day.
Side-lying external rotations
Lie on your side, affected arm uppermost. Place a small rolled up towel or similar between your side and elbow (see picture). With your elbow bent to 90°, take your hand slowly from your belly and rotate your arm, keeping your elbow in contact with your side, so your hand points towards the ceiling and then slowly lower. Do not rotate your body (lean back etc), the movement should only be coming from your shoulder - here I am demonstrating an effected right shoulder.
Use a small weight/water bottle to hold in your hand if this exercises is too easy if not painful.
Repeat 8-12 reps, 3 sets, once a day if not painful.
Internal/External rotation and Abduction on wall
Internal Rotation - Stand in a door frame or something suitable, elbow bent. Place the palm of your hand/inside of your fist on a door frame/wall/solid object and gently push inwards. Hold 5 seconds. Relax. Here I am demonstrating an effected left shoulder. Repeat 8-12 reps x3 of each, once a day if not painful.
External Rotation - Stand in a door frame or something suitable, elbow bent. Place the back of your hand/outside of your fist on the door frame/wall/solid object and gently push outwards. Hold 5 seconds. Relax. Here I am demonstrating an effected right shoulder. Repeat 8-12 reps x3 of each, once a day if not painful.
Abduction - Stand sideways next to a wall, elbow bent. Place your forearm on the wall/solid surface and gently push outwards. Hold 5 seconds. Relax. Here I am demonstrating an effected right shoulder. Repeat 8-12 reps x3 of each, once a day if not painful.
Repeat 8-12 reps x3 of each, once a day if not painful.
Stand next to a wall edge or door frame. Take your arm out to the side at about 70-90 degrees and bend your elbow. Place your arm against the wall. Next, rotate your body away from your arm until you get a gentle stretch in the front of your shoulder and / or in your pec (chest) area. This should not be painful. If it is, adjust the position of your arm on the wall. DO NOT take the stretch into pain. Hold this for 30 seconds then gently release. Repeat 3-4 stretches, 3-4 times a day if not painful.. Here I am demonstrating an effected right shoulder.
Horizontal adduction stretch
Take your arm directly across your body so that your arm is in line with the level of your shoulders (or there about). Use your other arm to help. You should feel a gentle stretch in the back of your shoulder, but not pain. DO NOT take the stretch into pain. Hold this for 30 seconds then gently release. Repeat 3-4 stretches, 3-4 times a day. Here I am demonstrating an effected right shoulder.
NOTE: Only do what is pain free and build up slowly. For all ‘Theraband’ exercises, start with the easiest and slowly progress. For the Theraband branded exercises bands, yellow is the easiest, then red, green, blue and finally black. Personally I have never used black for any upper limb rehabilitation as it's very strong. If the bands are too easy, get to a physiotherapist for some higher level, functional exercise. In the above photos I have used a green band however this is not a branded Theraband exercise band, and is similar to the strength of a red Theraband.
For a video of all these exercises and more please click HERE.
If you have had a shoulder injury and you don't know what the injury is or it is causing a lot of pain (especially if it's persistent), it's always best to get an assessment because different injuries require different exercises.
If you have hurt your shoulder and you are struggling to lift it up without assisting it (especially a few days after it's settled) you MUST get an assessment to check you have not completely torn your rotator cuff (e.g. one of the tendons like the supraspinatus).
Luime JJ, Koes BW, Hendriksen IJ, Burdorf A, Verhagen AP, Miedema HS, Verhaar JA. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scandinavian journal of rheumatology. 2004 Mar 1;33(2):73-81
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