3 Keys to Rehab a Rotator Cuff Tear & AVOID Surgery [UNIQUE EXERCISES]

if you've got a rotator cuff tear then you need to watch this video because you're going to learn from our resident shoulder guru dr erin boynton who spent seven years as the head orthopedic surgeon of the toronto blue jays is the current medical director of the national bank open wta tennis tournament and in this video she's gonna describe the most commonly missed issue that once you fix it can help you to avoid surgery and then break down the three keys to help you to rehab your torn rotator cuff and fix it and prevent those injuries from happening for the long term [Music] hey i'm eric wong and i'm a kinesiologist and the founder of precision movement i'm dr erin boynton orthopedic surgeon and chief medical officer for precision movement and if you want to learn more about us you can visit our website at www.precisionmovement.coach to learn about us and our mission to help active people get back to you and keep doing the things they love so doc with all of your experience working with shoulders you know working with the jays working with the wta the tennis tournament and being a and i have a tennis player and elite tennis player yourself why don't you start off by explaining to people what the rotator cuff is and what its primary function is because i think a lot of people still think that the rotator cuff simply exists just to do movements like this internal external rotation for sure uh well the rotator cuff is a group of four muscles that surround the shoulder the glenohumeral joint which is a ball and a saucer and they're they are responsible for internal and external rotation of the shoulder for sure but their main main job is to keep the glenocumeral joint properly properly aligned throughout all ranges of motion and it's what you and i refer to as joint centration so a good example of this is the rotator cuff is active when you do an overhead press so even though there's no rotation going on internal external rotation it needs to function and be active throughout that full range of motion to make sure the head of that humerus the upper arm bone maintains its alignment as you're pressing up overhead exactly so doc you often talk about how imaging doesn't and having a diagnosis doesn't necessarily tell you the whole story of somebody who has a rotator cuff tear or shoulder pain so why don't you talk about that a little bit more so people understand that if they have a diagnosis it's not the be-all end-all for sure um so when we when we think about rotator cuff pathology the most important thing to understand is it's a progression so we have a tendon which attaches the muscle to bone and the initial pathology or wear and tear that we see is something that is called tendinosis tendinosis can progress to a partial thickness tear and eventually to a full thickness tear so it's important that we understand how rotator cuff tears progress over our lifetime the vast majority of rotator cuff tears are age related degenerative tears and they actually start very early in our lifetime depending on how active we are if we were to do an mri of somebody's shoulder we may actually see age-related changes in their 20s and 30s if they've been particularly active and that is known as tendinosis if we then examine your shoulder at a later stage with an mri we may see a partial tear and eventually that partial tear can become a full thickness tear so it's kind of like how a hole in your pants can slowly develop over time with wear and tear it gets progressively larger with time and this is one thing that i found really interesting when you look at the research there's lots of studies that show pathology in the rotator cuff but people aren't even aware of it so i think this happens because it happens so slowly over time and that we adapt we compensate and change our activities so we don't actually create pain in the rotator cuff and this is one reason it's so important to correlate the symptoms that you're experiencing with what is actually found on an mri just because you have pathology on an mri doesn't mean you need to have an operation but it definitely is an indication that you need to change something about how you're moving and i first learned about this actually after i started working with the jays my waiting list for surgery got crazy it was over two years and so somebody would come to see me with a sore shoulder and an mri proven rotator cuff tear and i'm like okay you've done your you've done your physio you've had your cortisone injection you're still having symptoms that are interfering with the quality of your life i guess we need to do an operation and patients would say yeah let's do it and they're ready to do it the next day but unfortunately my surgery list was two years down the road and they said what the heck am i going to do for two years so i started to get them to work on exercises to change how they were loading their rotator cuff and to my amazement seventy percent of the people got better and didn't want surgery so i really got thinking that we had to fix why the rotator cuff became damaged in the first place before we even considered surgery and that's what we're going to go through today dr b is going to break down the three keys that she learned are really critical to having a healthy functional rotator cuff so doc you're a surgeon so why don't you tell people when do you think if they have a rotator cuff tear they need surgery it's a great question first of all not all rotator cuff tears are created equal you need to understand that the tendon is about a centimeter thick and a full thickness tear means that the full depth of the tendon is torn so partial tears which only go through 50 or 25 of the tendon generally don't need surgery 99 of people with a partial thickness tear don't need an operation anybody with tendinosis does not need surgery so patients who have a full thickness tear of the rotator cuff tendon who have pain need to have an operation it's important that you do monitor the size of your rotator cuff tear so say you're doing exercises to get to the root cause of why your tendon is tearing in the first place and you've got an ultrasound that's documented a centimeter tear six months after you've had the diagnosis you should have a repeat ultrasound to make sure the tear isn't getting bigger but most of the time you're going to know if you're having a problem because your pain will persist so if you fall into the surgery category you have a full thickness tear of the rotator cuff tendon then make sure that you're working with your doctor or your surgeon and they're monitoring you to make sure that you're taking the next best step so let's say somebody's got really acute pain i know some of the exercises that we're going to show people they might not be able to do them we're going to have them lifting their arms up overhead and doing all their movements so if somebody's pain is say a 4 out of 10 or more or they get up lifting their arm and they're about this level and it just hurts too much what will you have them do to settle them down so that they can do the exercises that we're going to teach them here yeah that's a great question eric first thing ice 15 minutes three times a day can really help to settle down your pain one of the most effective things i find is doing what's called a pendulum and all you do for this is and eric's going to demonstrate you just bend over at the waist and you let your arm hang and the goal here is to let gravity really distract your shoulders so that when you're just letting it hang here the the gravity is distracting and opening the joint and you can actually get your body swaying a little bit so that you're not having to use the muscles too much and you do little circles clockwise and counterclockwise which will really help to keep your motion and settle down the pain and then the trick that i think is most effective is doing cuff isometrics so you can stand just with your elbows bent 90 degrees and then you just push into my hand so that's an isometric contraction relax you hold to the count of five you can take a big breath in then you'll push into my hand relax push into my hand relax and then push back into my hand and relax this way you're activating all four of the rotator cuff muscles in an area where they're not vulnerable but the fact that the muscles are contracting and relaxing really helps to settle down your pain and how often should somebody do that the isometrics i would do the isometrics three times a day and just a couple of reps for each of the muscles and then as you start to feel better you can gradually abduct your arm so you can change the abduction and the rotation to activate with your arm in a different position because remember the cuff function is to keep that joint centrated in all positions of movement of your arm and if you can waken up the rotator cuff muscle in these different positions without stressing it too much with the dynamic motion it'll go a long way to getting you ready for the next steps right and we find this with every joint it's if you can get some activation that's safe and that's not causing further damage which these exercises will do then that's going to speed up your healing significantly so now doc why don't we share why don't you share the three keys to dealing and really rehabbing rotator cuff tears so that you get to the root cause and don't don't just put a band-aid on the symptoms here let's start off with uh key number one okay so key number one has to do with posture and alignment of the shoulder girdle if you have poor posture you're hunched over a hunchback or thoracic kyphosis and medical speak what it does is it affects the space that the rotator cuff travels through and so if you are rounded over you're decreasing the space for the rotator cuff and you're leading to increased chances of wearing your rotator cuff tendon so it's really important that you get your thoracic spine mobile and you correct head forward posture right we just recently published a video on youtube dealing with exactly that so we'll just put a link up above and in the description so you can check that out if you need to address your posture and then the second has to do with the alignment of the shoulder joint itself and probably the most common problem that i have seen in my clinical practice is what i refer to as a posterior capsular contracture or tightness at the back of the shoulder the capsule that joins the ball of the humerus and the glenoid or the saucer is made up like a shirt sleeve and if the back of that capsule gets too tight it changes the alignment of the shoulder so that when you go to lift your arm over your head the tight posterior capsule actually pushes the humeral head up and leads to impingement of your rotator cuff and actually shuts your rotator cuff off so if you have this posterior capsular contracture you can't even activate the rotator cuff so i test for that by standing i stand behind the person and i put my hand on top of the shoulder blade or the scapula to stabilize it i don't want the shoulder blade to move because i'm testing the back of the shoulder and then i bring the arm up and i see how far in front of your body i can bring the arm so this is eric's non-dominant arm and then his dominant arm i it's a little less he's actually um pretty symmetrical here which is good but oftentimes what we'll see is the person can't bring their arm in front of their body so that would be a tight posterior capsule and that's really important to detect and fix so that you can activate your rotator cuff effectively right so if you get that test done maybe you have a friend do that for you it's not too difficult just play around with it then if you have a type to posterior capsule then we'll post a link to a technique that dr b taught me which we call the active sleeper and that link will be up above or in the description down below and if you do that technique we'll just say do it every day or a couple times a day for how long would it take somebody to help start to release that probably four to six weeks if it's been there for a long time say you're an overhead athlete probably six weeks but you'll start feeling better right away right so that link will be up above make sure you check that out if you have a tight posterior capsule so is there anything else that you have to deal with when it comes to shoulder alignment also i find that the pec minor can be very tight and the upper fibers of the serratus anterior okay so let's demo those exercises right now to release the serratus anterior elevate your scapula place your fingers on top of your collarbone or clavicle and then push your fingers back towards your scapula then roll your scapula up and back and down a couple of times in a clockwise and then two or three times in a counterclockwise direction this can be extremely sensitive and uncomfortable so go slowly and apply the amount of pressure that you can tolerate comfortably to release your pec minor place your hand behind your back and a ball on the front of your shoulder just below your clavicle then support the ball against the wall and roll your shoulder against the wall three times in a clockwise three times in a counterclockwise direction and then try and open your shoulder by tilting your scapula posteriorly do this with the ball in two or three positions and your pec minor will be happy okay so the second key for fixing your rotator cuff pathology is the position of your scapula or your shoulder blade eric i'm just going to get you to turn around but the most common problems that we see or that the shoulder blade is tipped too far to the front or an anterior tilt the shoulder blade can be too low or it can be protracted or pulled around the front so those three abnormalities need to be corrected so that we can get your rotator cuff muscles turned on correctly and of course the position of your shoulder blade is also affected by the mobility of your thoracic spine which we have already mentioned and we'll have you look at the head forward posture video for exercises to correct that so we're going to get into a couple of exercises to fix your scapular position right now to start fixing scapular position we're going to do the shoulder rotation robot and some variations so to start off you need to make sure that your scapula is posteriorly tilted so it's not winging but it's tucked into your rib cage then you lean up against the wall and you maintain the position of the scapula the whole time raise your elbows up about 30 degrees and externally rotate one arm from there you're going to keep externally rotating the top arm and keep internally rotating the bottom arm hold it for five seconds and switch sides and hold that for five seconds to progress this technique can add a little bit of a reach so at the end range of rotation you're going to reach one arm up and the other arm down keeping the arms up against the wall the whole time make sure that the scapula is posteriorly tilted for the whole exercise the next technique to retrain your scapula we call the 4s shoulder saver and this actually will help to retrain your scapula your shoulder your spine and the serratus anterior muscle for this technique you just need to stand up and from there the first movement is shoulder extension where you're reaching your arms behind you simultaneously you want to posteriorly tilt the scapula so tuck the bottom edge of the scapula into your rib cage hold that for five seconds keep trying to increase the range of motion as you're holding and then you're gonna move to shoulder flexion which is reaching your arms up in front of you overhead while simultaneously posteriorly tilting the pelvis engaging the abs and keeping the rib cage down keep activating at the end range where you're going to hold for another five seconds keep breathing and then repeat go back down into shoulder extension with posterior scapular tilt keep trying to push the end range of motion while you're breathing for about five seconds and back to shoulder flexion reaching up while engaging the abs posteriorly tilting the pelvis and keeping the ribcage down okay so the third and final key is strengthening the rotator cuff and making sure that it's active through the full range of motion when we have pain in our shoulder and particularly if we've had poor position of our scapula and poor alignment of the glenohumeral joint our poor little rotator cuff can't turn on so our brain actually has to figure out a way to get the job done whatever that is whether it's throwing a ball or reaching up reaching for something in the cupboard and you develop compensations so now we have to undo those compensations we have to turn on the rotator cuff we have to get it strong we have to get the rotator cuff working with the muscles around your shoulder blade in your scapula in a coordinated fashion and the more that you want to do the stronger you have to be right so that's why we're going to go through a couple of exercises one that's focused on strength and one that's focused on making sure that the rotator cuff is active and functional through the full range of shoulder motion the shoulder circle crossover will integrate the rotator cuff into the full range of shoulder movement for this technique start off by internally rotating the shoulder putting the backs of your hands towards your thighs and then extend the shoulder reaching back behind you as high as you can and once you get stuck start to externally rotate the shoulder as you keep reaching up overhead and you're trying to imagine that you're pushing your hands and trying to touch the backs of your hands behind you as you reach up overhead so you keep pushing the arms back when you get to the overhead position come in front of the body on your way down and cross your arms over in front of you keeping the elbows straight come back to the start position where you internally rotate to the backs of your hands or by your thighs and then repeat extend the shoulder reaching up as high as you can once you hit the sticking point externally rotate as you keep lifting the arms up overhead and as you get in front of your body cross right over so we're working the shoulder through its full range of motion the side lying external rotation is a great exercise for building strength in the rotator cuff muscles and strengthening that tendon and remember build up your strength to the level that you need so if you're doing some intense movements like serving a tennis tennis ball really hard or throwing a 100 mile an hour fastball then you'll need to build more strength for this technique lie on your side and place something could be a rolled up towel in between your elbow and the side of your body grab a dumbbell with a good strong grip and make sure your wrist stays in neutral as you externally rotate to the full range of motion and then make sure you're going slow through the eccentric controlling the weight down the whole time with the rotator cuff repeat keep going up engaging the rotator cuff pulling the shoulder into the body to the end range pause for a second at the top and go slow lengthening the rotator cuff as it's controlling the weight coming down so there you have dr b's three keys to effectively rehabbing and fixing rotator cuff tears in pain and many people if you follow these exercises and strategies that we've shown in this video you'll find you'll get some relief within one to two weeks if you do that's awesome keep it up and keep going but with shoulder control that's the course that we've put together there's more exercises that address all of the common compensations and dysfunctions and weaknesses that occur with the shoulders and that happen to people over time so you can learn more about that course with the link up above or in the description down below and see how you can use it to make sure that your shoulders are good for you for the long term well that's fantastic i i love shoulder control because it does address those three key areas that we've mentioned and takes it to the next level not only do i like it but sort of my rotator cuffs right so check that out and hopefully we'll see you next time [Music]

Channel: Precision Movement

Views: 1,061,734

Keywords: flexibility, mobility, stretches, exercises, routines, programs, workouts, fitness, training, strength, power, conditioning, decrease pain, movement, injuries, rehab, prehab, shoulder exercises, shoulder rehab, rotator cuff, rotator cuff injury, shoulder injury, rotator cuff tear, shoulder surgery, avoid shoulder surgery, rotator cuff pain, rotator cuff pain relief, shoulder pain, shoulder pain relief, shoulder mobility, torn rotator cuff, precision movement, eric wong, Dr Erin Boynton

Id: o9fiTFfW4uU

Length: 22min 10sec (1330 seconds)

Published: Thu Dec 09 2021