Rotator Cuff

[WarpedMind]

What clubbell exercises are good/safe for RC? Which should I avoid? I was told that you should never use more than 5 lbs. to rehab RC, so I guess I should expect to actually rehab it using clubbells... but I would like to swing away without having to worry about damaging them further. I noticed that circles make my shoulders uncomfortable.

[Scott Sonnon]

Tom, did you read the RC Rehab program in the early issues of CST Mag?

[WarpedMind]

I may have missed that one... I'll go look for it. Thanks!

[ldurand]

Coach, I went to the archives and found the first and second Shoulder Impingement/Rotator Cuff articles, but couldn't find the 3rd one, which is about preventive/rehab(?) exercises for these issues.

Can you point me in the right direction? I'm making slow but steady progress in healing my bicep tendonitis, and the impingement syndrome you described also sounds like me, so I would like to know those exercises. I'll be ready for them soon.
Thank you! -Linda

[Scott Sonnon]

Linda,
I'll dig out the article and just republish it here for you and Tom.

[Scott Sonnon]

Circular Strength Training Conservative Rotator Cuff Impingement Preventative Exercise Program
What are Cumulative Trauma Disorders?
Without sufficient recovery periods, forceful, repetitive, or sustained static activities occurring over time may cause Cumulative Trauma Disorders, which affect soft tissue of both musculoskeletal and peripheral nervous systems. Any sport or job using the arms can be associated with Cumulative Trauma Disorders. The most commonly described and diagnosed disorders are Carpal Tunnel Syndrome, Epicondylitis (also known as "Tennis Elbow"), and Rotator Cuff Impingement. Clubbell Training for Circular Strength and the Zdorovye Natural Health System may be conservative injury prevention for those at risk and may be important rehabilitative tools.
How does cumulative trauma affect the shoulder?
The shoulder is the most mobile joint in the human body, but unfortunately, great mobility comes at the expense of stability. It is a complex arrangement of structures working together to provide the movement necessary for daily life, work and athletics. Bones and soft tissue (ligaments, tendons, and muscles) produce shoulder movement and keep the joint in place while it moves through extreme ranges of motion. Certain work or sports activities can put great demands upon the shoulder, and injury can occur when you exceed and/or overload these movement limits.
Shoulder injuries are common in both young and old, conditioned and deconditioned. There are numerous causes of shoulder pain in these groups. Two of the most common occur in the narrow space between the bones of the shoulder. Irritation in this area may lead to a pinching condition called impingement syndrome. It can also lead to damage of the tendons known as a rotator cuff tear. These two problems can exist separately or together. It is likely that rotator cuff tears result from the impingement and age related changes within the rotator cuff tendons.
What is Rotator Cuff Impingement?

RC Impingement occurs when the tendons of the rotator cuff and the subacromial bursa are pinched in the narrow space beneath the acromion. This causes inflammation and swelling in the tendons and bursa. The pinching worsens when you raise the arm away from the side of the body and upward. Impingement may develop over time as a result of a minor injury, or as a result of repetitive motions that lead to inflammation in the bursa. Impingement is classified in three grades:
• Grade I - inflammation of the bursa and tendons
• Grade II - progressive thickening and scarring of the bursa
• Grade III - rotator cuff degeneration and tears are evident
What are the symptoms of RC Impingement?
Most often you feel pain, weakness and loss of range of motion. You experience often sharp, but intermittent pain in early stages, which increases to a more constant ache as impingement progresses. Although pain is usually present after impingement onsets, the injury causing event may be minor or you may not even remember it as painful. You often feel the pain exacerbated by motion above the “Safety Zone” (movement above the arms held parallel to the floor). You may feel an increase of pain at night because your mind rests and becomes aware of the pain and because inflammation and swelling increase at night. This may disturb your rest if you sleep on the affected shoulder.
In the early stages of impingement, you may abate the pain by exercising the shoulder. However, you should know that unless rehabilitative, this accumulates greater stress. Eventually, pain continues even during exercise, which usually means that your impingement has progressed due to ignoring the symptoms and exacerbating the condition. In other words, you should begin rehabilitation as soon as you begin to feel pain.
How do I test myself to see if I suffer RC impingement?
The key feature of the self examination is an assessment for signs of impingement.
1. Single Arm Snow Angels: Remember this game from childhood to move the arms up and down from at your sides while laying in snow? Do similarly standing with one arm at a time slowly. Experiencing pain once the shoulder becomes parallel with the ground (perpendicular with your torso) and above the “Safety Zone” may indicate impingement.
2. Fish Story: Ever hear someone tell a fishing story describing the size of their catch? With your elbows at your side and your forearms parallel to the floor, imagine starting with a small sized fish and move your forearms outward to increase the “size” of the fish-story. Pain in this rotation may indicate impingement.
3. Tray Carry: With your upper arms parallel with the floor and your forearms perpendicular to your upper arms, rotate your hands backward as if carrying two trays of food. Pain moving the forearms backward may indicate impingement.
4. Back Scratch: Ever have an itch to low on your back to reach over your shoulder causing you to insert your hand at waist level and climb upward with your thumb to scratch the itch? Do this now with both arms. Discomfort or pain in this range of motion for either arm may indicate impingement.
What is the difference with a rotator cuff tear?

Continual irritation to the bursa and rotator cuff tendons can lead to deterioration and tearing of the rotator cuff tendons. The tendon of the supraspinatus muscle is the most commonly involved tendon among the rotator cuff muscles. This muscle forms the top of the cuff and lies in the narrow space beneath the acromion. It is subject to the most pinching of all the rotator cuff muscles.

Rotator cuff tears can be the result of a traumatic injury or deterioration over time. Symptoms may manifest, but in many cases, you may experience no symptoms at all. For young active people, full thickness rotator cuff tears are fairly uncommon. When they do occur, they are usually the result of a high-energy injury to the rotator cuff associated with throwing or overhead sporting activities. In older people, rotator cuff tears tend to be the result of wear and tear over time. Several scientific studies have shown that up to 2/3 of the population at age 70 have rotator cuff tears; many of these people had no symptoms. Begin your preventative shoulder strengthening program now.
How are impingement and RC tears addressed?

Impingement and rotator cuff tears can be treated conservatively (non-operatively) or surgically.

Addressing both injuries usually begins with a conservative preventative and rehabilitative program. More than 2/3 of impingement patients can expect significant improvement in their symptoms with a physical therapy program alone. These results are lower in older individuals and in those with large bone spurs.

When trauma causes a tear in younger people, surgery is often the first choice of treatment. Individuals with this type of injury recover best if surgery is done early, so consult your physician. Generally, this pertains to those individuals under the age of fifty with tears less than four weeks old.

Circular Strength Training Conservative Rotator Cuff Impingement Preventative Exercise Program

CST Conservative RCI Rehab Program is for rotator cuff impingement, not rotator cuff tears. A vast majority of individuals improve with conservative measures alone, but always consult your physician before beginning any exercise program.
The goals of this program include that you may:
1. strengthen the rotator cuff tendons.
2. stretch and regain lost motion caused by pain and inflammation.
3. better position the humerus under the acromion, thus reducing compression of the bursa.
The program has two phases over the course of 3 months:
• PHASE I: Zdorovye Dynamic Mobility Exercises: continue for 6 weeks. At 6 weeks, most people have regained full motion and will continue to regain strength with Lightweight Clubbell Program. One session per day, do the following routine for 6 weeks. You can do this more than one time a day as a pain relieving exercise as well. Perform exercises smoothly and slowly!
o 6 Degrees of Freedom Circle
 Inside Circle: On the inside (across your body) right or left side, do slow and smooth rotations drawing a circle with locked elbow, wrist and fingers, 5 clockwise and then counter clockwise 5 repetitions. Then switch arms and repeat.
 Outside Circle: On the outside (away your body) right or left side, do slow and smooth rotations drawing a circle with locked elbow, wrist and fingers, 5 clockwise and then counter clockwise 5 repetitions. Then switch arms and repeat.
 Top Circle: Above head level (as if drawing in the sky), do slow and smooth rotations drawing a circle with locked elbow, wrist and fingers, 5 clockwise and then counter clockwise 5 repetitions. Then switch arms and repeat.
 Bottom Circle: At waist level (as if drawing on the ground) without bending at the spine/waist, do slow and smooth rotations drawing a circle with locked elbow, wrist and fingers, 5 clockwise and then counter clockwise 5 repetitions. Then switch arms and repeat.
 Front Circle: Across your body in front of you, without bending at the spine/waist, do slow and smooth rotations drawing a circle with locked elbow, wrist and fingers, 5 clockwise and then counter clockwise 5 repetitions. Then switch arms and repeat.
 Back Circle: Behind your body without bending at the spine/waist, do slow and smooth rotations drawing a circle with locked elbow, wrist and fingers, 5 clockwise and then counter clockwise 5 repetitions. Then switch arms and repeat.

o 6 Degrees of Freedom Infinity
 Right/Left Infinity: Perform an Inside Circle clockwise followed fluidly by a Outside Circle counterclockwise for 5 repetitions. Reverse directions and repeat for 5 repetitions. Switch arms and repeat.
 Top/Bottom Infinity: Perform a Top Circle clockwise followed fluidly by a Bottom Circle counterclockwise for 5 repetitions. Reverse directions and repeat for 5 repetitions. Switch arms and repeat.
 Front/Back Infinity: Perform a Front Circle clockwise followed fluidly by a Back Circle counterclockwise for 5 repetitions. Reverse directions and repeat for 5 repetitions. Switch arms and repeat.

o 6 Degrees of Freedom Screw
 With your arms stretched straight outward to either side, roll one shoulder forward and the other backward, as if someone were wringing your arms and shoulders like a washcloth full of water. Keep your arms perfectly parallel to the floor throughout the entire exercise; only your shoulders should move. Exhale as your shoulder rolls forward, and slightly bend at the waist and allow your torso to twist slightly with the shoulder roll. Now reverse the motion so that the forward shoulder rolls backward and the backward shoulder rolls forward. Repeat 10 times in each direction.

o 6 Degrees of Freedom Wave
 Shoulder to Wrist Wave:
 Lift your shoulder upward (to your ear).
 Next, lift your elbow upward so your upper arm becomes parallel with the ground.
 Then, lift wrist upward so your forearm also becomes parallel with your upper arm.
 Finally, extend your hand and fingers forward again parallel. When you extend your hand, let your shoulder rest downward (remember, you initially lifted it to your ear.)
 Perform three times with both arms.
 Then begin again removing any pause between steps so this becomes fluid movement; done smoothly your fingertips should “flick” at the end of the whip you cast with your arm. Perform 10 total times per arm. (Initial three reps can be omitted once you learn the movement.)
 Wrist to Shoulder Wave:
 Begin with your arm held straight out in front of you parallel to the ground and your shoulder lifted (to your ear).
 Bend your wrist so your hand points downward while your arm remains parallel to the ground.
 Next, bend your elbow downward so your forearm points to the ground while your upper arm remains parallel with the ground. Also, bend your wrist again in the opposite direction so that your hand becomes parallel with the ground again, perpendicular to your forearm.
 Then, roll shoulder down again (away from your ear)
 Finally, lock out your elbow straight again, so that your entire arm becomes parallel with the ground, but this time with your shoulder down.
 Perform three times with per arm.
 Then begin again removing any pause between steps so this becomes fluid movement. Perform 10 total times per arm. (Initial three reps can be omitted once you learn the movement.)
• PHASE II: Lightweight Clubbell Program:
o At the beginning of Week 7, some people may begin to add resistance to the range of motions. If you are not prepared for resistance, continue with Phase I. Get permission from your physician and therapist before continuing to Phase II.
o Begin with a pair of clubbells which you perceive to you as lightweight. In other words, on a scale of 1 to 10 with 1 being extremely light and easy and 10 being extremely heavy and difficult, choose the weight between 1 and 3. For most people, this will be 5LBS Clubbells.
o Then, from Week 7 to Week 12, do the following program 2 times per week. Continue with Phase I exercises for the remainder of days in the week.
o Week 7 and 8 do 1 repetition per exercise (per arm)
o Week 9 do 2 repetitions per exercise (per arm)
o Week 10 do 3 repetitions per exercise (per arm)
o Week 11 do 4 repetitions per exercise (per arm)
o Week 12 do 5 repetitions per exercise (per arm)
o 6 Degrees of Freedom Circle
 Inside Circle: X (see week number above) repetitions slowly and smoothly with each arm. At any time you feel pain stop and continue the exercise without the weight. Take a 30 second break.
 Outside Circle: X (see week number above) repetitions slowly and smoothly with each arm. At any time you feel pain stop and continue the exercise without the weight. Take a 30 second break.
 Top Circle: X (see week number above) repetitions slowly and smoothly with each arm. At any time you feel pain stop and continue the exercise without the weight. Take a 30 second break.
 Bottom Circle: X (see week number above) repetitions slowly and smoothly with each arm. At any time you feel pain stop and continue the exercise without the weight. Take a 30 second break.
 Front Circle: X (see week number above) repetitions slowly and smoothly with each arm. At any time you feel pain stop and continue the exercise without the weight. Take a 30 second break.
 Back Circle: X (see week number above) repetitions slowly and smoothly with each arm. At any time you feel pain stop and continue the exercise without the weight. Take a 2 minute break.

o 6 Degrees of Freedom Infinity
 Right/Left Infinity: X (see week number above) repetitions slowly and smoothly with each arm. At any time you feel pain stop and continue the exercise without the weight. Take a 1 minute break.
 Top/Bottom Infinity: X (see week number above) repetitions slowly and smoothly with each arm. At any time you feel pain stop and continue the exercise without the weight. Take a 1 minute break.
 Front/Back Infinity: X (see week number above) repetitions slowly and smoothly with each arm. At any time you feel pain stop and continue the exercise without the weight.

[cobb]

Please be sure to read through the above excellent article - it's absolutely full of good information!

Let me also throw in that despite our natural tendency to want to rehab an injured area - you cannot ignore the rest of the body. As Scott talks about at length in his Z Health rehab courses, very often, pain occurs at a "shock absorber" area of the body - in other words, at a major joint. However, also very often, the root cause of the pain lies elsewhere.

As a basic rule of thumb, if you have an upper extremity or shoulder injury, you should pay particular attention to your opposite side foot, ankle and knee. Because of the complex relationship of force transmission, storage and release of elastic energy and the contralateral motions of our normal gait, disturbances of lower extremity joint mobility create a large # of shoulder injuries, or pre-dispose them to injury.

This is a critical topic and one that we will hopefully be exploring in the future at Coach Sonnon's CST mag and ZHealth publications.

One of my favorite quotes comes from Dr. Karel Lewit, one of the world's most significant musculoskeletal specialist. He often said, "He who treats the site of pain, is lost." Very accurate and very true.

Good luck and keep us informed of your progress.

Dr. C

[ldurand]

Thank you Coach and Dr. Eric--great advice and information.
And Tom, good health to your shoulders, my shoulders and everybody else's too!
-Linda

[crubio]

Dr Cobb,

Twice in the last month I have first hand experience the cross body shock-absorption where as the injury occured elsewhere but the pain was refered in the lumbar.

Both times i used to warrior wellness program described above to fix the problem.

To warpedmind may I suggest you acquire the "warrior wellness trilogy" and start doing it, every day. The tapes are very user friendly, you can even follow along, very easy to do and very good to rehab injured joints/ligaments.

After you have done it every day for a while, then you can start slowly easing in to clubbells, and I belive you will avoid reinjuring the area.

HTH
Chris