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Coming back from a Rotator Cuff Injury

Dear Dr. Bell, after a long injury in my rotator cuff, more than 6 months without doing any kind of workout, what is the best way to come back and to strengthen my rotator cuff? I know I should work on my rotator cuff muscles infraspinatus, supraspinatus, teres minor, subscapularis like doing internal and external rotation but still I feel some pain.

The Shoulder is the most flexible joint in the body and enables a wide Range of Motion with a great deal of strength, speed, and power. Unfortunately, it’s great Range of Motion (ROM) comes at a price. The shoulder is the joint most susceptible to injury. I highly recommend you visit your doctor to determine the precise nature of pain and injury. I would also recommend you postpone any surgery or drug treatment until you read “Anybody’s Sports Medicine Book”, the Complete Guide to Quick Recovery from Injuries, 2nd Edition, written by me and my Co-Authors Dr. Jones Garrick and Dr. Peter Radetsky. Dr. Garrick was among our nation’s top Orthopedic Surgeons before he retired.

The shoulder section alone is worth more than a thousand times what you will pay for it. If you really want to get serious about the treatment, care and prevention of many of the injuries that plague you and nearly everyone else in the world, register for the IFPA Sports Medicine Trainer  Certification and get REALLY good at helping yourself and others! I also recommend that while you are waiting for your certification to arrive, you should start performing the following 4 Shoulder Rehabilitation Exercises, twice/day.

  1. Bend over at the waist and let the arm on your injured side hang in front of you. Then start swinging it in a clockwise motion. Not too hard or too fast. Use just enough muscle to kick your arm in motion and keep it swinging lazily. At first you may only be able to bend over a little bit. That’s okay. Continue to circle clockwise, then counterclockwise, bending over farther and farther as you go, until your torso is at s right angle, parallel to the ground. The key here is: don’t do anything that hurts. If it hurts to bend too far, don’t bend too far. If it hurts to swing in a circle, don’t. You may have to make an ellipse, or an egg shape, or some other figure that feels all right. Then gradually work toward a complete circle, both clockwise and counterclockwise.
  1. Stand up straight. Pretend that you’re on one end of a double-handled saw and start sawing. Back and forth, in and out, way out and way back. As with all these exercises, the more repetitions you do, the more your range of motion will increase. You’re stretching at the same time as you’re strengthening (the exercise also puts your elbow through a complete range of motion).
  1. Let your arm fall straight down to your side. Then raise your arm up and to the side at a right angle to your body and let it back down, up and down, as though you’re slowly flapping an injured wing. These are called abduction swings. Raise your arm only to a comfortable level. Even if you can only bring it up a foot or two from your side to start with, keep at it. As you continue, you’ll become more flexible. And if it hurts too much to swing your arm up at all, start out by bending your elbow to form a chicken wing. Then flap it up as far as is comfortable. After you develop flexibility that way, gradually straighten out.
  1. Last but not least, shrug your shoulders. That’s all, just shrug your shoulders and while at the top of the shrug pull your shoulders back and your shoulder blades together as though you’re trying to squeeze a tennis ball between them.

Nothing to it, right? If you’re having a fair amount of shoulder trouble, start out by doing the exercises ten times each, twice a day—in the morning and evening. You should increase how many times a day you do these exercises as you grow stronger and more flexible. What you’re shooting toward is 50 of each exercise, three times a day. That’s 750 reps. When you start doing that many, these deceptively easy exercises turn into quite a workout. Don’t worry if you work up to about 35 and figure you must have lost count because nothing so easy could be so difficult. Only pretty good athletes can do that many reps readily. Use that number as a goal, a motivator—although getting rid of your shoulder problem should be motivation enough. A week to ten days of these exercises is probably enough.

You may find that you can go back to your activity, always taking it easy, of course, working into it a little at a time. But if you go back and find that your shoulder still bothers you, it’s time for special exercise therapy to deal with the specific muscles involved. And for this you should see a doctor or physical therapist. You have to do these more specialized exercises against resistance, in very specific positions, in order to isolate one muscle or another. They’re best taught in person. You’ll find, though, that at the very least these general exercises will tone and strengthen your shoulder. They’ll make you use everything and use it right.

To give credit where credit is due, these exercises were developed by Robert Kerlan, a Los Angeles orthopedic surgeon who for years probably took care of more baseball players than anybody else has. He used these exercises as part of a rehabilitation program for pitchers. But they’re so good, they’ll work for anybody. You can use them as a general toning procedure, a preventive regimen that you can perform anytime. Of course, these exercises can be boring, and people don’t like to do boring things, especially such simple boring things. They’d rather do boring things on a complicated machine. But at the onset no machine is going to do you any more good than these simple exercises. Save your money and start circling, sawing, and flapping. Later, to really build more muscle, weights or machines will often be necessary—something you can undertake at almost any fitness club or weight room.

Most injuries and Orthopedic Disorders can be very complex. Research has proven that many of these injuries are caused by a lack of Symmetry. All the major muscles in your body need to be developed Symmetrically. In the case of the shoulders, many of your Anterior Muscles located on the front of your torso become Hypertonic: overly strong and overly tight when compared to your Posterior muscles located on your back. If your Internal Rotator Muscles become Hypertonic while your Posterior Rotator Muscles become relatively weak and stretched, you can experience shoulder and rotator cuff injuries that can cause debilitating pain. All your muscles need to be developed in Symmetry.

Train hard, but even more importantly, Train Smart!

Good Luck,

Dr. Jim Bell