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Lauren Muney at age 40:
Wellness coach and featured in
"Fit Over 40: Role Models for Excellence"

Rotator Cuff: the little muscles with the big problems
by Lauren Muney

I have been getting many emails from "Fit Over 40" readers asking how to help rehab a rotator cuff injury, since one of the authors mentioned how I "cured" his shoulder problem. I have learned a few "post-rehab" techniques which slowly build the muscles back to close to if not as good as before the stress or injury. I'll try to use all the resources and information I can muster, but first...

DISCLAIMER:
I am not a physical therapist nor am I a rehab specialist. These professionals have undergone advanced training in biomechanics, anatomy, physiology, and a grueling education for the letters after their name, "PT" (physical therapist). What I write SHOULD NOT REPLACE being attended by your doctor, sports medicine professional, physical therapist, massage therapist, osteopath, or chiropractic specialist.

I am simply a personal trainer with an interest in biomechanics, but I listen very carefully and try to apply what I hear from all sources, testing methods for the truth.

------------------------------------

That being said, here is what I have found which helps rehab rotator cuff in general... note that the rotator cuff is four (4) muscles, and any one (or several) could be injured. I have successfully assisted my own injuries as well as others', some who claim that these methods saved them from surgery.

What I offer is that you please follow this advice and exercises to the letter... and BE PATIENT. It may take several weeks or months but you may regain full and pain-free movement.

The rotator cuff group consists of four muscles, subscapularis, teres minor, infraspinatus and supraspinatus, which are positioned around the shoulder joint. These muscles are small, but their function is very important. Specifically, they act to keep the shoulder joint stable during movements of the arm by, in layman's terms, keeping the 'ball' in the 'socket'.

IMPORTANT NOTE: I am giving you these exercises in case your problem is muscular. These will not help anyone who has worn away the harder cartilage or torn some of the tendons or ligaments. The whole shoulder socket is very dangerous and really does need attention from a professional if you have been suffering chronically ("for a while") or acutely ("very intense recent pain").

One of the best websites I found in simply explaining these exercises is TheraBand Academy. Theraband makes some excellent elastic fitness bands. I have used some of their photographs and manipulated them to explain with one glance. Visit their pages to see what they can offer.

The main exercises I recommend to people are the internal rotation and the external rotation. There are other exercises which will hit every shoulder head, but these will start you on your way.

EQUIPMENT:
Both are performed with an elastic exercise/fitness band, which you can purchase at any sports store or department-store sports department. These come in many strengths; I recommend you use buy the multi-pack which have several strengths, and begin with the lightest strength. In a while, you can move to the medium strength. Note: don't use the heavy-duty strength for any rehab exercises. The heavyweight band should be saved for resistance training only. (I have a travel set of bands which fit in their own bag. Here is a whole page of retailers who sell the same thing)

EXTERNAL ROTATION:

Tie a fitness band at waist height to a doorknob, stairs, or even a bedpost. Put a rolled-up towel under the arm to keep it away from the body -- and allow blood to flow freely.

(Do NOT use dumbbells! The angle is wrong and therefore gravity will try to pull your arms down, not sideways. This will hurt you even more! USE A BAND.)

Stand sideways with the arm at the side and the forearm parallel to the floor, pull back on the rubber band only at the elbow (not the entire arm)-- UNTIL FATIGUE. Don't go more than "fatigue". Don't count reps. How will you know what "fatigue" feels like? You'll know!

Switch arms and do the other arm the same way. If you are only injured on one shoulder, doing both arms will do two things: it will help the poor arm mimic the good arm, and it will attempt to keep them even. (The good arm will be able to exercise longer than the bad arm; use your best judgment).

INTERNAL ROTATION:

Then turn 90 degrees facing away from the door; still holding the rubber band, push the arm out in front of the body with the forearm parallel to the floor UNTIL FATIGUE. You will be using the same rolled-up towel technique... and once again, you will be using only the arm at the elbow, and not swinging the upper arm at all.

Again, do not use dumbbells.

For most people, internal rotation is easier than external rotation - there seems to be less injuries in this rotator. Again, do not go beyond fatigue. (Theraband images from Theraband Academy)

SHOULDER/MILITARY PRESSES

Next, if you aren't too weary, use VERY light weights (3-5lbs OR a sack of sugar!) and do military/shoulder presses.... you can actually use a band for these also, but I used light weights... even a soup can!

BIG NOTE:
Don't face your palms outward (like in this video!) when doing these presses - they will hurt your shoulders. FACE YOUR PALMS INWARDS TOWARDS EACH OTHER. This will protect your rotators but allow them to do the pushing which they need to rehab.

Only do these with VERY light weights -- remember that you are doing them to rehab from injury and NOT to "work out", and ONLY do them UNTIL FATIGUE. (Image from EXRX.net)

EXERCISE FREQUENCY:
Bet you are wondering why I suggest that you do these exercises only "to fatigue":

When one exercises properly, the muscles makes micro-tears in the fibers. The body doesn't want torn muscles because there is a muscle weakness when there are tears (you may feel this as "soreness") - so the biochemical processes in the muscle actually create new, strong fibers.

These fibers actually are creating "new" muscle... it's also the process by which you get "bigger" muscles... continual tearing-down and renewal of new fibers makes stronger, larger muscles... and that's how we repair muscles in physical-therapy rehabs as well as build lean muscle tissue for becoming sleek and fit. By doing these exercises, your muscles are breaking down so they can build back up STRONGER. (but do not push them! They do not like to be pushed! Use light bands and light weights only to fatigue)

By exercising these muscles only to "fatigue", your muscles know at the point they need to stop. Sometimes it's only 6 reps; sometimes it may be 13 or 20. Just go to "fatigue" (I can't stress this enough), and then rest those muscles. make sure that you do not do other exercises which will also work these muscles, such as bench press or heavy bicep work. REMEMBER YOU ARE REHABBING. You have more time in your life to get back to real training.

You can do these exercises every other day. If you stay with the rehab program, you will be able to feel yourself getting stronger.

MORE EXERCISES?
There are more exercises you can do, but start with these. Here are a couple of other exercise links with more directions for movement, so once you are in less pain you can try the gamut of exercises... just remember the towel under your arm for rotations... and ONLY TO FATIGUE.

• EXRX Page of Muscle Weakness: includes shoulder
• Joint Healing: Shoulder
• Yoga rotator cuff stretch
• Gymnasts show stretching shoulders with band

Remember to be gentle and REST afterwards. If there is pain, remember ICE for the first day, then switch off HEAT & ICE.

POST-REHAB
PRE-TRAINING:
The last thing I want to mention is to always warm up your shoulders before training... of course I am talking about when you get back to training! Do NOT swing your arms or shoulders (in the old way athletes used to). After a warm-up gentle cardio of 5-10 minutes, do some empty-handed military presses and some lateral raises, and then do them with a light weight. You can, again, do very light exercises every day to keep your shoulders in tune, but be very careful with your shoulders, and do not weight-train your shoulders and chest on days right next to each other: the shoulder inserts into the chest - you will be overworking your delts and therefore your rotators, too.

Good luck!

For more ideas on fitness, health, or "alternative" methods for your lifestyle, contact Lauren for coaching solutions!

ENJOY!