Rotator Cuff mega-CONFUSION

RE: Rotator Cuff mega-CONFUSION (billem)

Wed, 21 Jun 2006 18:09:06 GMT

I think we're coming from two different angles. My situation sounds quite different to yours. I started swimming and working out with weights as a result of my injury. I found that these activities helped to alleviate the aches I had, especially the pulling motions of deadlift and pullups. (When I started I couldn't even do one pullup). Often, not always, the heavy aches would go away for several hours at a time after working out. My goal is to have no more aches so I've never really done bench press with such a goal you've suggested but I do something similar: weighted pushups and dips; they don't help as much as the pulling exercises though.

I'll just ask one question because some of my others got buried in my last post. What I'm really interested to know is, with regard to the rehab exercises, particularly the rotations, do you use the same resistance and rep/set scheme you started with from the very beginning?

RE: Rotator Cuff mega-CONFUSION (Lynx100)

Wed, 21 Jun 2006 05:22:55 GMT

Billem, i agree with you theory that weights are better than bands BUT only at the latter stages of rehab. I benefited immensely from band work and only started dumbells later on.

One thing that i frown at with all physios when they devise a rehab program for rotator cuffs is when they include work for the shoulder when it is in an unstable position early on in the rehab program- i.e. when you arm is abducted or 'away' from the body or raised etc.

The shoulder joint is the most mobile in the human body and its fantastic but it also comes with its downside. While its mobility and range of motion is great, those same characteristics make it the most unstable joint and the most susceptible to injury.

As for my injury, i avoided all overhead activity or any activity that involved taking my shoulder joint away from my body for a significant period of time- skullcrushers, military press (obviously), lat raises, bench press, dips etc.

I kept majority of my muscle mass my doing squats, deadlifts, pulleys for arm work etc... all while maintaing my shoulder joint in a relatively stable position. Deadlifts were uncomfortable at first, but as my band work increased and i increased the resistance, i was able to deadlift pain-free (mind you, not very heavy weight, but enough to keep my muscle interested in retaining most of their size)

Because the rotator cuffs are such small intricate muscles but are responsible for the stability of arguably the most important joint in the body, when they get injured, they really have to be protected.

I had an arthroscopy because the MRIs werent conclusive to whether it was JUST a supraspin tear or something else too - turns out it was only a supraspin.

As for the arm held out with the thumbs pointed down, your right, that does cause impingement but that again, depends on where the tear is in the supraspin. Tendon tears or tear of the muscle belly close to the tendon insertion are more susceptible to this. Saying this, i had a tear close to the tendon, and i did these exercises regularly with no weight, not even theraband. Even the healtiest of shoulders can get damaged easily if this is done improperly and with too much weight.

I think you should also remember, that the key to Rehabbing a injured muscle lies not in how you do the exercies, how well and how much weight/resistence you use... the key lies in REST.

Sure therell be some muscle loss, and significant loss of strength but when rehabbing a shoulder, your end goal isnt to have a shoulder that you can go back to benching 225lbs with... its to have a shoulder thats functional. That should be end goal and the attitude to have.

Once you have a functioning shoulder, then you can slowly resume additional acitivities, e.g. weights, and most of the time, you recover quite well if you have that attitude.

RE: Rotator Cuff mega-CONFUSION (billem)

Wed, 21 Jun 2006 04:26:11 GMT

I'm 31 and injured it about 2 years ago. It's bursal side, how about yours?

I think I've learnt my lesson and can tell how much soreness is enough to stop an exercise or activity. So having an injury of this magnitude is probably a good thing to prevent something worse in the future. As for healing, maybe we're just strengthening around the injury to take more and more stress off it and onto other parts, to allow it to rest that bit more to recover. I wonder: if the pain/ache dissipates to nothing, does that mean the tear has closed up? Or is it possible for the two ends to be too far apart to ever meet up again? Interesting.

I feel that working with free weights is actually more beneficial for rehab overall than bands. You don't have to stabilise a band, you just pull it, but with a dumbbell, besides pulling it, you have to control in 3D, which involves so many more surrounding muscles. The trick is to align your body so you can use gravity on the dumbbell in BOTH directions of the arc when doing rotations. Look at this image of rotations performed and note the man is "pulling" the weight even when he is lowering it: http://www.myogenic.de/gfx/cpress.jpg
To "push" the weight he'd need to be upside down or at least on a decline. Something you might know about, otherwise to think about.

On these 2 types of rotations (dumbbell pull and push) I normally use 2.5kg, sometimes heavier, particularly for partials. What kind of weight are you using? Besides this I do shoulder rolls and big straight-arm circles like butterfly swimmers. Otherwise general weight training. How about you?

Have you ever had anything invasive done? How about anti-inflamms?

I looked at your stickied thread on rehab exercises...
IMO:
1) I don't understand all of them. More videos/images would help.
2) The exercises shown in the images are good. I did these as a beginner but the true external rotations are the real deal, especially with free weights. This is what I call an "external rotation", maybe you can give me the correct term: http://www.exrx.net/AnimatedEx/Infraspinatus/DBUprightShoulderExtRot.gif

3) You wrote: "The supraspinatus is strengthened by holding out your arm straight in front of the body, with the thumbs pointed toward the floor.": I believe this causes impingement with the thumbs pointed down and is to be avoided. But pointed horizontally or upwards is fine.

I've tried pendulum swings and don't feel comfortable... feels like my arm is going out of it's socket... dunno what else comes to mind...

I'll try to read them more closely again to better understand them and comment later. I'll write back soon.

RE: Rotator Cuff mega-CONFUSION (Lynx100)

Tue, 20 Jun 2006 04:22:25 GMT

Billem.. good to hear from you again.

Glad you got the MRI. A partial thickness tear of the supraspinatus - EXACTLY the same as the one i had. It really knocks you around, especially early on in the injury. I couldnt sleep properly.

How long has it been now since you injured it?? Oh, and how old are you by the way?

I think the important thing to realise is that band work is fantastic for it and shouldnt be stopped BUT at the same time, dont overdo it. People think that because its a 'rehab exercise', doing it will heal the injury so they do it more often than they should.

Mine has come good with time but still niggles every now and then when i push too hard with my weights.

They key thing to realise is that it WILL come good with time. Patience and persistence is the key with rehab. It seems like a ****to do and can seem to take forever and you can feel like youre not getting better, but i can assure you that you are.

Maybe you should change your rehab routine slightly. Check out the thread that is STICKY'D at the top of the injury forum - rehab exercises for rotator cuff.

Have you tried all them? While they are not all for supraspinatus, another key mistake is that you should only rehab that muscle that is injured. This is not always true, ESPECIALLY with rotator cuffs. It will be worthwhile strengthening all of them, not JUST supraspinatus.

Have a look at that thread and let me know your thougts.

RE: Rotator Cuff mega-CONFUSION (billem)

Tue, 20 Jun 2006 03:51:09 GMT

I've found you and I'm back! Hi Lynx100 :)

The news on my condition is a bit mixed. Here's an update.

I underwent an MRI a few months ago and it did reveal a partial thickness tear of the supraspinatus (something the ultrasound did not find). I've been going through physiotherapy since but the dull ache is only marginally lessened. Though I think it's only in the last month that I've been doing the rehab exercises effectively (correctly and sufficiently).
I'm REALLY hoping to escape without surgery or a corticoid injection by progressively (how far to go?) strengthening my Rotator Cuff through rotations.

It's very frustrating because I have full range of motion except for that one small plane of movement that causes a sharp pain, as I explained before. As usual, the dull ache persists. It comes and goes throughout the day. As before, stress can bring it on, but so can activity (general or vigorous). But some exercises especially pullups and dips on the rings usually make it go away. So nothing seems to have changed overall. :( The doctors don't know why and want to inject the steriod, hoping it's inflammation that can be settled, but no thanks to the corticoid. Apparently many people have such tears with no pain or such aches.

I still feel indecisive as to what to do: to stop every form of exercise except for the cuff rotations or not. I can't tell if an exercise is doing me harm because none give me pain, so I can only go by that dull/numb ache which is intermittent and a bad indicator. I also get referred aches (I've coined it this from the term "referred pain") So e.g. instead of the shoulder, the ache might be referred to the tricep or the side of the biceps or elbow area. The aches go away when I sleep or am completely relaxed.

Any ideas?! I'd like to learn about rehab exercises I'm unaware of. I do external rotations with the force acting in both directions (using bands or dumbbells against gravity), laterals... maybe there's something more indirect that might help in the long run?

Can scar tissue cause aches like this?

RE: You think you're confused, I know I am!!! (chrisfry)

Fri, 09 Sep 2005 20:05:06 GMT

Ok, here's the scoop!!! Tendonitius in my shoulder. Thats it! Went to the dr. today. The usual hurry up and get there and wait!!! Get in to see him, wait some more. Moves my arm around, hand on the shoulder, feels it pop loudly!! "Was that the pop you were refferring to?" YUP!! Ok, thats all I need to know. Bercitus(sp). Which is tendonitus of the shoulder. WHEW!!!! What a load off my mind!!! I'm glad I didn't have a fractured collar bone or a RC injury!!!

I'm on anit-inflams, and shoulder exercises for the next 2 weeks. Check up is then.

Thanks guys!!

Chris~

RE: You think you're confused, I know I am!!! (Lynx100)

Thu, 08 Sep 2005 03:24:24 GMT

X-rays cannot diagnose rotator cuff tears. MRI's and ultrasound are the investigationss of choices for any muscular, tendonous, ligamentous injuries.

RE: You think you're confused, I know I am!!! (chrisfry)

Wed, 07 Sep 2005 21:33:37 GMT

X-Rays wont show anything related to rotator cuff?? But the ultrasound or MRI will??? I'm calling my fam. dr. in the morning to see if I can see him, and if I cannot, I'll ask them for a recommendation of an ortho....

Thanks!

Chris~

RE: You think you're confused, I know I am!!! (Lynx100)

Tue, 06 Sep 2005 22:39:06 GMT

Go see your ortho if you can. If you cant see your ortho soon, then go to your family doctor.

Either way, you will probably get an ultrasound or MRI if its suspected to be rotator cuff tear.

You think you're confused, I know I am!!! (chrisfry)

Tue, 06 Sep 2005 16:44:33 GMT

Sorry to bring this post back to life here, but last week I noticed that my left shoulder was irritating me. I knew that the RC is back there, from baseball, and hearing about injuries. I thought that it may have been a sore muscle, but not today!!! I couldn't even move my left arm at all today. The entire pain is in my shoulder joint. Not sure if it is RC or a spur, or what the case is..... All I know is that it FREAKING HURTS!!!!!

A bit more background on this.... Late last week, I would go and move it around, b/c it was stiff, understandable, as I was not using it as much as I used to. It would pop/grind on every rotation I was giving it. So, last night it started to hurt a bit more, and I had tried to block out the pain. I'm pretty good at that! :) But when my alarm clock went off this morning, I nearly screamed when I used my left arm to shut my alarm off. I suffered all throughout work today. I thought I was going to drop everything I lifted today.

Yeas back, maybe 3, I used to work out 3-4x/week. I was getting myself into some pretty good shape. But nice weather come around, and lost all interest there. I had other things on my mind. I forgot to mention that the pain is spreading in towards my collar bone... Now I think I'm worried!!!

Should I see my family dr. or an ortho???

Confused fully!!!

Chris~

RE: Rotator Cuff mega-CONFUSION (billem)

Sun, 26 Jun 2005 06:24:34 GMT

We've established from the X-Rays that there is no skeletal deformity, so why an Ortho? I thought an ortho principally dealt with skeletal deformities.

Ignore that last paragraph .... I just realised there was more to orthopedics than plain old bones :)

RE: Rotator Cuff mega-CONFUSION (Lynx100)

Sat, 25 Jun 2005 00:47:07 GMT

Right. Thats a different story.

Ultrasound is very much user-dependent. Which means, that you can only interpret an ultrasound depending on how much experience you have in diagnosing that particular injury.

For shoulder injuries, MRI is the best diagnostic test we have at the moment. However, this being the case, it is also expensive if you dotn have private health insurance.

If the pain persists and it starts to bother you, go see an Ortho with your Xray and Ultrasound reports and he/she will refer you to get an MRI.

RE: Rotator Cuff mega-CONFUSION (billem)

Fri, 24 Jun 2005 04:53:28 GMT

I made a mistake where I said I had a MRI. I actually had an UltraSound, where they put a gel on your arm and scan over it as you watch the output in real-time.

RE: Rotator Cuff mega-CONFUSION (Lynx100)

Fri, 24 Jun 2005 03:42:05 GMT

Thats good to hear. If this reduced space is normal then alls well and good.

However, that said, should this space between the acromion and humerus decrease even further(can happen with inflammation from repeated overhead/overuse of the shoulder) then that reduced space can mean an impingement.

Impingement can cause differnet types of inflammatory reactions in the shoulder - bursitis, tendinitis and also arthritis. The first 2, bursitis and tendinitis, are common cause of shoulder pain in young people such as yourself. Impingement syndrome also weakens the rotator cuff and makes it more susceptible to injury hence its important that you do your RC exercises regularly. They dont take long and once you know all the exercises, you can perform them whenever you have some free time on your hands ( i did mine whenever i was watching TV).

However if both the MRI and X-Ray came back clear, then i cant imagine that it be too serious, unless someone missed something when reading these films but thats not very likely.

I guess then it comes to do the same things as all other injuries. Rest, rehabilitate and avoid things that aggravate it.

RE: Rotator Cuff mega-CONFUSION (billem)

Thu, 23 Jun 2005 23:48:23 GMT

I got the X-rays back today. There's no bone spur and everything is 100% in the shoulder. There "appears" to be a slight reduction in space between the acromion and humeral head, which is supposedly completely normal, anyway.

I'll keep at the RC rehab exercises. I'm happy to hear any other ideas you have, Lynx.