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Rotator Cuff Question

So I’ve got a rotator cuff problem/impingement situation in my right shoulder. I’ve had this kind of thing a couple times in years past, and on both occasions ART treatments have cured it pretty quickly. This time, the ART isn’t working, and my practitioner (who’s Level 3, i.e. an instructor) is sending me for an MRI. I haven’t had the MRI done yet, but I’m 99% sure it will show nothing, because there’s no extreme pain, as a tear would likely cause, just a nagging impingement during certain movements (such as when lowering the bar during a bench press – I haven’t benched in months because of this). I’ve been reading the forums recently about doing external rotation exercises for the rotator cuff, some of which I’ve been doing (and I’m going to be adding Cuban rotations starting tonight). My question is this, though: can merely strengthening the proper (external) rotators actually ELIMINATE the pain? How so? It seems to me that there’s clearly an adhesion there, i.e. something is rubbing against something else and causing inflamation, which needs to be gotten rid of (hence ART therapy, which should remove the built up scar tissue). Can rotator cuff exercises alone really CURE this thing? Also, should I do them even if there’s pain during part of the range of motion – should I work through the pain zone, or stop short of that range of motion (for rotator cuff exercises, that is)? Thanks for all your help.

I put a trainee on cuff work, it helped mildly. It wasnt until I had her startdoing her lunges with the weight overhead AND dong static holds in a handstand position that she turned the corner. as far as the pain, thats tough. I’d keep your ART guy in the loop. pain is not really meant to be ignored. Good luck.

Although I’m no expert on rotator cuff problems, I have had a few in the past and have read up on the subject. If your problem in an adhesion, then no, the exercises will not help to eliminate it. However, if your problem is an imbalance (which is very likely), then the exercises will help.

What happens is that one muscle group (typically the chest) gets too strong and starts to pull the joint slightly out of alignment. This causes the impingement. When you add in rotation exercises to strengthen the opposite players then the joint comes back into proper alignment and the pain goes away. If you keep up with the exercises after the pain leaves, it shouldn’t come back (unless you injure yourself in some other manner).

It took me about three or four times of getting rotator cuff problems (in both shoulders) before I incorporated cuff-specific exercises into my warm-up on a permanent basis. And surprise, the problems haven’t come back.

Bottom line: give the exercises a fair shot. (I find that rubber tubing works better than a weight, for whatever that’s worth.) I think you’ll be pleasantly surprised, and in any case it can’t hurt. Good luck.

“Can rotator cuff exercises alone really CURE this thing?” Possibly, but there might be an underlying problem, that’s why it wouldn’t hut to get an MRI (and just because it doesn’t hurt doesn’t mean that the MRI won’t see anything). “Also, should I do them even if there’s pain during part of the range of motion – should I work through the pain zone, or stop short of that range of motion (for rotator cuff exercises, that is)?” As far as pain goes, it’s really your call. If it is excruciating stop. In regard to range of motion I find that you should not let your hand drop too much (but I feel that more ROM is usually better). The other main concerns is amount of weight and overtraining. When you are having problems with your shoulder use a very light weight and go toward higher reps (15). I would also keep the number of sets low, (6-12) per week, I have found that a Monday Friday split works quite well (keep in mind these are pretty small muscles). You might also try 6-7.5 grams of EPA/DHA per day, which should have a positive effect on any inflimation that you might have. Best of luck.

Char, what rotator exercises do you do? Had the shoulder problems which ART did wonders for (I’m benching again with no pain!). Also working the rotator cuff after back and chest days. Wondering if there are some different exercises I can do for them.

Thanks to everyone for your input. I really appreciate it. Jay, with regard to those static holds in the handstand position, how long should I hold for (and how many “reps”)? I assume you mean up against a wall, as opposed to trying to do an actual free-standing handstand? Thanks. I have been doing the rotator cuff exercise where you stand with a dumbell in hour hand, like you’re holding a hammer, with elbow bent at ninety degrees, and rotate out (towards your back) and back in (towards your stomach). On the outward stroke, there is some pain/impingement as I go further out, but it’s not excrutiating, so I’ve been working through it, going to the point where my forearm is sticking straight out to my right side (in line with my body). I can do sets of 10 with a 30-pound dumbell with good form. Should I not go so far out, so as to totally avoid the pain zone, or should I keep doing the full ROM? (Again, the impingement feeling is there, but it’s not MAJOR pain). I cannot do the exercise where you lie on a bench on your side, with a dumbell hanging down in front of you and rotate the forearm upward – it just hurts too much. Also, I do plan on adding Cuban presses (was going to start last night, but work kept me from getting to the gym), although I have a feeling (from “practicing” them with no weight) that I’ll probably be working through a little pain with those as well. Is that OK? I’ve also been doing Arnold presses, as per my ART guy’s suggestion (I can do 8 or 9 reps with 75’s, 2 or 3 sets), and these cause no pain at all. I’ve been doing the fish oil (EPA/DHA) thing for a while, so that’s taken care of – maybe things would be even worse if I weren’t using it. I haven’t been icing my shoulder after workouts, but am thinking it’s probably a good idea. Am I right? Any other suggestions? Again, thanks to everyone.

What exercises did I do? Well the lay-on-the-bench exercises that Damici described. Plus I lay on the floor with a very light dumbell, with my upper arm extended 90 degrees out from my torso and my forearm 90 degrees from my upper arm, above my head. (The position like when you were wrestling as a kid and someone pinned you and then sat on your chest holding your wrists.) Rotate the dumbell from here until the forearm is vertical to the ground, then back. Also did the complement to this exercise, which is to sit on the floor with a chair beside you whose seat is at shoulder height, place your elbow on the seat with the forearm in front of you (basically, you’ve taken the “top” position from the previous exercise and just altered your torso posiiton until you’re sitting upright), then rotate the DB up a la a Cuban Press until your forearm is pointing straight up.

I did Damici’s exercises plus the ones just described for rehab, and continue to do Damici’s exercises (with a rubber tube) to prevent re-occurance.

Damici, if you want my advice it would be to (a) lay off the Arnold Presses. They aren’t working your rotator cuff, believe me. Nothing with that amount of weight is hitting the tiny RC heads that you need to strengthen. (B), I would focus on the exercise that you said was too painful to do. Do it anyway, with no weight at all if you have to. That’s where your problem is, and that’s what you have to work on. But with LIGHT WEIGHT. Finally, ©, I would wait to start the Cuban Presses until I could do the exercises described above with five pounds or so for very high reps - like 50-100 or so. If you’ve got pain just from “practicing” the movement, using even a bar may very well set your rehab back. Light weights are the way to go with RC rehab.

Hope this helps. Good luck.

I started her with holds of 30 seconds. I myself do it for 45-60 when I do the static hold. I also am doing partial reps as a goal of getting to full range reps. The external rotator work is helpful to me. I have also read on the Super training forum and elsewhere that simply moving through a full range(cable work high and low) is theraputic as well as loading the joint dynamically with one armed dumbell snatches. My shoulder is a LOT better, as well as Melody’s. The exercise you mention is good, but the external rotator work I do is in the arm wrestling position, it that makes sense, upper arm 90 degrees in front, hold a dumbell and move the dumbell around a fixed axis about your elbow. Use google and look for seated L-Flys. Maybe back off the heavy lifts for a while and work to get good mobility in the shoulder and strength throughout the range of motion. Curious, does it hurt when you do dumbell presses? Has the ART guy looked to your clavicle and the integrity of its motion? Good luck. I’d definately work with dumbells, add in full ROM exercises, and work the external rotators as well as moblilty exercises.

Thanks guys, for your replies. Char-Dawg, I’ve been taking your advice and doing that lying exercise that you said to go ahead and do, even though its too painful. I’ve been using only 2 pounds (a full “Surge” bottle) and I’m so far able to do 30 reps per side. I’ve also been doing a modified “Cuban press,” also with the Surge bottle: I stand next to a dresser that’s just about shoulder high, rest my elbow on the edge of it, with my upper arm horizontal and out at ninety degrees from my body, and rotate down until my forearm is just below parallel to the floor (forearm is hanging over edge of dresser – i.e. in the air), and back up, almost to the vertical postion. I can do about 25 of these, and they don’t hurt. I’m still doing the hammer-grip standing dumbell exercises that we talked about as well. Jay, I’m about to add the static holds that you mentioned, too. When you say you’re doing partial reps, with the goal of getting to full range reps, are you referring to doing pushups in that vertical position, as opposed to just static holds? In answer to your question, if I were to do regular seated dumbell presses (for shoulders), with any effective amount of weight, yes, that would hurt. The Arnold presses don’t hurt, though. I’m wondering if I should discontinue them, though, or keep doing them, as they’re the only real shoulder exercise I can do to maintain SOME mass and strength. I’m going to look into the “L-flys” as well. It’s too early too feel any difference or progress, of course. My shoulders still hurt a bit when I wake up in the morning from lying on whichever side I was lying on most recently. How will I know when to start eventually getting back into normal chest and shoulder exercises (and how long should my rehab likely take)? Thanks again guys.