Introduction
After rotator cuff surgery, an exercise rehabilitation program will aid in your recovery, help you return to daily activities, and eventually will lead to your return to recreational activities and sports.
This is a general rehabilitation program meant to be undertaken 4-6 weeks post-operation. Consult with your doctor or physical therapist to ensure you are ready for this program that provides a collection of stretches and exercises. However, not all exercises are recommended for all rotator cuff surgery patients. You should consult with your doctor or physical therapist before undergoing this program.
In order to regain full athletic ability, two criteria must be improved:
Muscular Strength
Strengthening the muscles that surround the Glenohumoral (shoulder) joint will keep the joint stable. This will also help prevent further injury to the joint and/or the muscles surrounding it.
Flexibility
Stretching the muscles that surround the joint will help improve your range of motion and help you return to regular daily activities. It will also prevent further injury.
Muscles targeted:
• Biceps Brachii
• Triceps Brachii
• Supraspinatus
• Infraspinatus
• Subscapularis
• Teres muscles (minor and major)
• Rhomboids (minor and major)
• Deltoids (Posterior, lateral, and anterior)
• Trapezius
Before we begin
Here are a few pointers before you begin your workouts:
Warmup
Before beginning this program, warm up by doing light activity such as riding a stationary bike for 5-10 minutes.
Pain
Do not ignore pain, if these stretches or exercises cause pain anywhere (especially in your shoulder), consult your doctor or physical therapist.
Stretches
1. Passive external rotation
Equipment:
Hockey stick, golf club, etc.
Direct...
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...push your hips out to relieve pressure on your lower back
2. Pull cable back to your side while pulling your shoulder back and pushing your chest slightly forward
3. Slowly lower until arm is fully extended and shoulder is pulled slightly forward
4. Repeat
5. Repeat with your other arm
6. Bent over horizontal abduction
Equipment:
Dumbbell, weight bench or other, table-like flat surface
Directions:
1. Lie flat on your stomach with your target shoulder on the edge of the bench or table
2. Slowly lift your arm out to side until completely horizontal
3. Return to starting position by slowly lowering weight
Notes:
• You can place either a towel or you hand under you chin for added comfort
• This exercise can also be performed on one knee if needed
• Lift your arm no higher than the level of your body
• Keep your palm facing down throughout the entire exercise
... It is not completely clear how it is that a tendon becomes a ligament, although Dr. Akizuki thinks that range of motion exercises help the tendon learn that it is being used as a ligament now and that it needs to adopt. Surgeons don't go back in to biopsy the repaired elbow to see how the tissue has changed, but follow-up MRIs show that the new tissue is acting as a ligament should.
Witvrouw, E., Mahieu, N., Roosen, P., & McNair, P. (2007). The role of stretching in tendon injuries. British journal of Sports Medicine , 224-226.
When stability weakens there is greater risk for injury because the muscles stop contracting and supporting the joints and ligaments as they should. This can lead to severe joint pain as well as torn ligaments. By using kinesiology tape, injuries like these can be prevented by providing extra support and limiting the strain put on joints and ligaments once the muscle becomes (2014). Effects of Kinesiology Taping on Repositioning Error of the Knee Joint after Quadriceps Muscle Fatigue. Physical Therapy Science 26(6); 921-923.
A rotator cuff is simply a group of four tendons and muscles that are located right on the shoulder and on top of the humerus bone. (Source 1) The rotator cuff is what controls the shoulder and allows it to move and be mobile. The four main muscles that consist of the tendons are the supraspinatus, infraspinatus, teres minor, and subscapularis muscles. (Source 2). Too much wear and tear on these muscles (such as too many thrown fastballs) is precisely what causes the rotator cuff to begin to tear, as well as swelling in the tendons.
Graston instrument-assisted soft tissue mobilization (GITSM) is a tool used by therapist and chiropractors to help break up the scar tissue and replace it with fibroblast allowing for faster recoveries (Black 2010). A series of heat, GISTM, then strength and flexibility training are required (Black 2010). Numerous studies have been conducted, by certified therapist qualified in GISTM, to examine the styles and recovery periods after an injury. After going through the treatment, patients are measured by their range of motion (ROM) to see if the treatments were effective or not (Black 2010). ROM can vary depending on the region of the body that is being treated, but the overall goal of GISTM is to allow a person to get back to their regular routines they had before their injury. A study conducted by Logan College of Chiropractic shows that plantar fasciitis (foot) can be treated by GISTM on the first day of treatment (Daniels and Morrell 2012). Another study by Duke University shows that GISTM can be effective for patients after surgery that had an injury in the Patellar tendon (knee) (Black 2010). After several treatments, GISTM can, also, be used to treat a compression fracture in the lumbar (back) (Papa 2012). Each study shows the method of GISTM, the patient’s recovery period along with the methods of recovery.
One of the functions of the rotator cuff muscles and the long head of the biceps, is to pull the head of the humerus down from the acromion process, to prevent impingement. Strengthening the subscapularis, infraspinatus and teres minor can help with this function. Dr. Fishman discovered a technique when doing yoga and experienced relief of his own rotator cuff pain. The technique is based on a headstand in yoga and is called the Triangular Forearm Support.
Exhale and bend your left knee over the left ankle, causing the shin to be perpendicular to the floor.
Initiate the movement by taking the hips straight back with a slight knee bend while the shins remain vertical. The upper body moves simultaneously with the hip hinge as if taking a bow. Do not allow the low back to round. Once the hands are near the kettlebell, grasp the kettlebell
This case involved a 53 year old man who sustained a significant tear of his rotator cuff while playing baseball. He underwent surgical repair and was given a referral for physical therapy. The referral was to begin passive ROM 3 times per week for 2 weeks then initiate a supervised home program of active exercise for 2 weeks, and elastic resistance exercises for internal and external rotation every other day for a month. 2 weeks after surgery, he had his first PT visit in a sports medicine clinic that was managed by an athletic trainer (ATC).”
* FEEL the stretch in the quad (hip) of your bend leg and try to
Rotator cuff tear – The muscles adjoining the shoulder joint are required for rotating the shoulder, amid other movements. The tendons of these muscles furthermore influence the structural strength of the shoulder joint. Harsh, rapid actions, for example in tennis and baseball, can result in tearing of one of these tendons. This then causes pain as well as a decline in range of motion. Surgery possibly will be necessary to repair a torn
typically remove bone spurs from the underside of the acromion; this procedure is also known as an acromioplasty (Armstrong, 2017). The next surgical procedure that surgeons use is an arthroscopic repair. An arthroscopic repair is when the surgeon inserts a small camera into the glenohumeral joint. The camera displays images on a screen in order for the surgeon to guide miniature surgical instruments through small incisions. Most surgeons prefer this method because it is not invasive and the small camera can move around to see if all the structures in the shoulder are good and do not need to be addressed. Also the arthroscopic approach spares the deltoid muscle from being detached. The final option called the mini open repair uses newer technology
• Bend you knees and plant your feet on the floor. • Extend your arms along your body on the floor. Press your palms to the floor. • Lift your hips toward the ceiling as you press your feet
Six participants had land-based exercises, and twelve participants did a combination of land-based and aquatic exercises. The study outcome was measured by the Western Ontario Rotator Cuff scores and the range of motion measure.14 The results showed that aquatic therapy improved range of motion measures at pre-surgical, three weeks, six weeks, twelve weeks, and post-surgical. 14 The Study proved land-based and aquatic physical therapy exercises after rotator cuff repair is a good therapeutic intervention. Burmaster, Eckenrode, and Stiebel did a case study on one participant with an arthroscopic rotator cuff repair. The outcomes were measured by Penn Shoulder Score, Disability Index, and the Shoulder Pain. The participant did physical therapy sessions three times a week with eight land-based sessions and ten aquatic sessions. The participant pain level at rest was at four out of ten in the initial evaluation, and with activity nine out of ten. The results showed the shoulder range of motion and strength increased over the study.15 Also, the pain at a resting level went to two
Getting the support muscles of my legs in shape is one good way to lower the risk of knee injury. Therefore, a good conditioning program is needed. Exercises are certainly one answer, but all too often people consider exercise and activity as being synonymous. A good exercise regimen will provide overall muscular improvement.