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
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