Thursday, January 28, 2010

Understanding Pain in the Cuff

Rotator cuff injuries, such as tendonitis, bursitis and rotator cuff tears affect so many people. Lets first understand what the rotator cuff is. The rotator cuff consists of four small muscles, which form a sleeve around the shoulder, this allows us to raise our arm overhead effectively. These muscles, consisting of the supraspinatus, infraspinatus, teres minor and subscapularis, oppose the action of the deltoid and depress the head of the humerus (upper arm) during shoulder elevation to prevent impingement.
It is a known fact that the most commonly injured muscle is the supraspinatus. It is responsible for initiatingand aiding in elevation of the arm. This means that if this is torn, the individual typically experiences persistent pain in the upper lateral arm and significant difficulty raising the arm without compensatory motion from the scapula (shrug sign). The hallmark signs of a tear are nocturnal pain, loss of strength, and inability to raise the arm overhead.
However, acute tendonitis may also present with similar signs and symptoms, as pain can inhibit motion and strength. However, rest, ice, anti-inflammatory medication and therapeutic exercise normally help solve the problem quickly.
Rotator cuff tears are most common in men age 65 and older. Tears and/or injury are typically related to degeneration, instability, trauma, overuse and diminished strength/flexibility related to the aging process. However, youth are also at risk for injury if they are involved in repetitive overhead sports, like swimming, volleyball, baseball, softball, etc.
Many people can function adequately with a torn rotator cuff provided they have a low to moderate pain level. The primary reason for performing rotator cuff surgery is mainly to alleviate pain as it probably won't restore function. It is common for post surgical patients to lose some mobility as a result. Strength recovery is dictated by the size of tear, quality of the torn tissue at the time of surgery, time elapsed between injury and repair, and the surgeon's ability to recreate the proper anatomical relationship.
It could take up to 18 months following surgery to completely recover, although most people return to normal activities of daily living in 3-6 months. However, on the contrary, tendonitis usually resolves within 4-6 weeks, depending on the management of the injury.
It is important to understand the key to avoiding rotator cuff injury is performing adequate conditioning prior to stressing it with vigorous activities. Many weekend warriors try to pick up the softball, baseball, football, etc. and begin throwing repetitively and forcefully without properly having an adequate warm up.
This will lead to excessive strain on the rotator cuff and swelling which causes inflammation. The inevitable result is soreness, especially with overhead movement or reaching behind the back. The act of throwing is the most stressful motion on the shoulder as the rotator cuff is forced to decelerate the humerus during follow through at speeds up to 7000 degrees/second causing a forceful rigid action.
Without proper strength and conditioning, the shoulder easily becomes inflamed. Since the rotator cuff muscles are small, it is best to utilize lower resistance and higher repetitions to sufficiently strengthen them.
Finally, it is important to note some precautions with general exercises routinely performed in health clubs. I would recommend the following suggestions to prevent rotator cuff problems:
1. Avoid lat pull downs and military presses behind the head, as they place the shoulder in a poor biomechanical position encouraging impingement.
2. Do not lower the bar or dumbbells below parallel with incline/flat bench press for the same reason as above.
3. Refrain from using too much weight with lateral shoulder raises. This exercise increases the load on the shoulder to 90% of the body weight; therefore there is no need to use heavy weight. It is best to maintain an arc of movement slightly in front of the body with lateral raises to decrease stress on the rotator cuff, while voiding elevation above 90 degrees.
4. Specific rotator cuff exercises can be incorporated into upper body workouts. Perform 2 sets of 15-25 repetitions for each exercise. These exercises should be done no more than three times per week to avoid overtraining.
For more information on exercises to cure a rotator cuff tear visit Shoulder Arm Pain and get your FREE step by step report to cure that Frozen Shoulder.

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For more information on exercises to cure a rotator cuff tear visit Shoulder Arm Pain and get your FREE step by step report to cure that Frozen Shoulder.

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