I’m Off To The Physiotherapist...

Yep, I’ve been seeing a physiotherapist now for the last 4 weeks for my right shoulder.

It seems I have a pulled rotator cuff with some pretty bad tendonitis of the rotator cuff and it really, really sucks.

For those of you who don’t know what the rotator cuff is or what tendonitis of the rotator cuff is :

See this article here - Weight Training And Rotator Cuffs

It all started a while back from all the crazy weight lifting I was doing but it really got bad after this last move.

I had the responsibility of moving our household across the county and this really aggravated an already upset shoulder.

When I got back to Ontario (Canada), my shoulder was in complete agony. It got to the point that I couldn’t even sleep on my side and back. I was popping Ibuprofen like they were pop corn.

After talking with my girlfriend, I decided it would be best to go see a physiotherapist since I knew it was my rotator cuff that was the problem. So, I showed up to the physiotherapy clinic and after doing some light movements and some light massage, my therapists concluded that my rotator cuff was badly pulled and that I had tendonitis of the rotator cuff.

Now, for those of you who have never had tendonitis of the rotator cuff, thank your lucky stars and I strongly urge you to read my training recommendations at the bottom of this article because it can save you a lot of pain and aggravation.

For those of you who have had (or are currently experiencing) tendonitis of the rotator cuff, than you know exactly where I’m coming from. You never really know how important your shoulder is until you injure it because it is involved in all of your upper body movements (including walking - and with this injury, you feel it!). Forget about weight training because most of your mobility is impaired and the pain is simply too much. In all honesty, simply moving your arm in certain directions will cause a surge of pain that shoots from the top of your shoulder to the end of your fingertips - Not fun at all!

So, I started going to my physiotherapist with the hope that they would be able to do something about my shoulder and the tendonitis of the rotator cuff. Here is the regiment I am currently following from the physiotherapist:

- Heat therapy 5 to 10 minutes;
- Warm up using pulleys;
- Intense friction massage - front of the shoulder;
- laser and ultrasound therapy;
- Rotator cuff strengthening exercise regiment;
- Intense friction massage - back of the shoulder;
- Ice therapy 5 to 10 minutes

The complete visit takes about an hour and a half and I go twice per week. The only thing that I don’t like about the therapy is the friction massage. Don’t let the massage part fool you because it can be quite painful. The massage technique is basically a deep tissue massage that directly targets your problem areas. You see, I thought my pain was coming from the sides of my shoulder but after my therapist massaged a few areas on the front and back of my shoulders, she pin pointed my problem areas. The main rotator muscle group that is injured is the supraspinatus, and this muscle group happens to be the most commonly injured rotator cuff injury.

Now, the friction massage is a deep tissue massage designed to break up adhesions, draining excess fluids and to increase blood flow to the area. In conjunction with the ultrasound/laser therapy and exercise sessions, the massage works great. Now, when it comes to strengthening your rotator cuffs, it is nothing like going to the gym and bench pressing 300 pounds.

The strengthening exercises are strictly meant for the rotator cuffs and not the deltoid area so I was very weak when I was performing these exercises. When it comes to the rotator cuffs, strengthening exercises are absolutely necessary. Here’s why:

Once the rotator cuff is injured (tendonitis of the rotator cuff for example), it keeps getting weaker and weaker until it eventually tears which usually requires surgery and 6 to 12 months of therapy to heal. Once you tear your rotator cuff muscle/s it can be very painful to repair and heal.

Actually, my therapist told me that if I would have kept on training, the cuff would have torn! Believe me, I’ll stick with 6 to 8 weeks of therapy for a pulled cuff instead of 6 to 12 months (plus surgery) with a torn cuff. This is very important! If you have any discomfort in your shoulder area - See you doctor immediately.

The prescribed exercises are as follows:

- External rotation: 3 sets of 15 repetitions
- Front scapation: 3 sets of 20 repetitions
- Horizontal external rotation: 3 sets of 15 repetitions
- Side cable raises: 3 sets of 12 repetitions

The most important thing that I can stress with these exercises are light weight and high repetitions. You have to remember that the rotator cuffs are small and weak muscles meant to stabilize the shoulder joint, not to lift heavy weight.

How Is It Working?

My rotator cuffs are feeling so much better, even after 3 ½ weeks of therapy. I can now sleep on my back and now only have small flair ups in the affected shoulder. Although the shoulder isn’t at 100% and I still can’t train, which really sucks. However, I can now do some of the things that I couldn’t do before when I originally injured my shoulder, such as tucking in my shirt.

I have about 3 to 6 more weeks of therapy and the way it’s going, I believe I’ll be back in the gym shortly thereafter. However, I will not be able to do some of the movements that I was once able to do. Most of my pressing movements will be restricted to half repetitions because full range exercises will put too much stress on my cuffs.

For example, I will now have to perform these exercises “in the box” since I will not be able to go all the way down and press all the way up. What is “in the box?” Well it simply means that I will have to train within an imaginary box when performing pressing exercises. That is, I will only lower my arms until they are parallel (or slightly past) to my body. I know, it sucks but that’s the way it goes.

My Recommendations

If you’re reading this now, I’m going to assume that your interested in protecting your rotator cuffs from tendonitis of the rotator cuff and other shoulder problems.

The most important thing that I can recommend to you is the following:

1) Warm up, stretch and lightly exercise your rotator cuffs before commencing any upper body workout. Here is a page I found that is perfect for your stretching and exercising your rotator cuffs.

body results.com

My thanks to the folks at www.bodyresults.com for letting me borrow these images.

2) Always take 2 weeks off from heavy lifting after 8 to 12 weeks of an intense program. Your only asking for trouble if you insist on training heavy for 8 months out of the year. You may be able to get away with this kind of training when you are young but believe me, that injury is on lay away.

3) Never train when you are not properly warmed up. Attempting 1 rep max lifts with no warm up is simply crazy. Take this warning - If you continue to do this, you will get injured since it’s only a matter of time and the severity of the injury will dictate how long you are out.

4) Always perform the exercise in the strictest form. This is probably the number one reason most trainers get injured. If you can perform the exercise in strict form, you will be using the target muscle in the most efficient and safest position. Injuries happen when you start getting sloppy with heavy weights.

5) Try and use rotator cuff friendly exercises and stay away from others that put your shoulders in awkward positions ie: upright rowing and press behind the necks.

6) Make sure your diet is high in quality nutrients. Poor diet + poor training practices = Injuries. Be smart about your diet and you will improve your results by 100% and greatly reduce the number of training related injuries you receive. You may also want to increase your water intake since it helps in the lubrication of joints and connective tissues.

7) Ice your shoulders every once in a while. This way you help reduce the amount of inflammation occuring in your tendons. This helps with the pain.

8) If you have problems lifting your arms past your head, tucking in your shirt, lifting your arms sideways, or any other pain in the shoulder area, STOP TRAINING IMMEDIATELY. Take this from someone who knows, you don’t want to injure your shoulders. Get your butt to a doctor or qualified physiotherapist and have the injury diagnosed and plan a recovery program. Sorry to bust your bubble but weight training is going to be out of the question for awhile. Of course, this all depends on the severity of the injury. The important thing is to have it properly diagnosed.

Just remember, I’m no doctor or physiotherapist so if you have any discomfort in your shoulder area, I recommend to get it checked out immediately.

I strongly recommend a good physiotherapist because they can make all the difference in the world when it comes to healing a rotator cuff injury.

I hope this info helps and gets you back on the road to recovery.

Update* November 25 2010. My shoulder is near 85% recovered. Although I can't go all out like I used to, I can now train using heavier weights.

Update* May 2014. Its official, I have a partial rotator cuff tear. Using an MRI we discovered I have a tear in my suprspinatus rotator cuff muscle.

All the best,

Blake





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