Rotator cuff, rehabilitation

«ROTATOR HEADSET: anatomy, diagnosis and injurious mechanism

Treatment and rehabilitation

INTRODUCTION: maintaining a good balance of the muscles over the years helps to make muscles and tendons toned and efficient by improving the coordination of movements. Conversely, with disuse, these important anatomical structures will become weaker, more rigid and obviously more susceptible to injury.

If the cuff injury is significant and the athlete is very young, surgery is usually recommended to avoid the risk of fractures, dislocations and arthritis. In the majority of cases this operation is performed under arthroscopy (shoulder arthroscopy) thanks to the help of optical fibers. In most cases (75-90%) the surgery considerably decreases the pain until it completely disappears. On the other hand, functional recovery is less predictable, which is complete only in a modest percentage of cases (40-50%).

Conservative treatment, which is always attempted before moving on to any surgery, involves regular administration of anti-inflammatory drugs in the initial period to reduce pain and inflammation. Eventually the doctor may opt for a local injection of cortisone, especially if the pain is particularly intense. When the symptoms are significantly reduced, we move on to strengthening and stretching exercises of the muscles.

Spontaneous healing of a partial rupture is rather unlikely given the anatomical complexity of the region and the poor blood circulation of the tendons. The healing period obviously varies in relation to the type and extent of the lesion and according to the chosen treatment (conservative or surgical).

In general, recovery times in the event of an injury are quite long: after a period of initial immobilization (6-12 days wearing a brace that protects the joint), in fact, passive micro-mobilization exercises are started.

Only after four or six weeks can active exercises of increasing intensity begin over time which after 4-6 months of injury will restore much of the strength to the shoulder that it had previously. Particularly useful are the following mobility exercises to be carried out initially with free body then against elastic resistance or in water:

Exercises for the Rotator Cuff

PENDULUM EXERCISE, Codman type: while standing, bend the torso forward (45-90 °) leaning with the healthy limb on a support (eg. A table); relax the muscles of the injured shoulder and swing the limb gently: forward backward; internally / externally; with circular movements clockwise / counterclockwise and gradually increasing the width of the circle. During the movements keep the muscles as relaxed as possible. Repeat each movement 10-15 times. This exercise can also be useful in the initial warm-up or final cool-down phase to improve the functionality of the shoulder complex and prevent injuries.

INTERNAL ROTATION EXERCISE behind the back: grasp the upper end of the rod (or elastic) with the hand of the healthy limb and the lower part of the limb to be rehabilitated. Bring the elastic behind the back as shown in the figure and with the hand of the healthy limb slowly raise the rod and the other limb as high as possible. Maintain the position for five seconds, then slowly return to the starting position and repeat ten times .

SHOULDER EXTENSION EXERCISE: while standing, grab the stick behind the head keeping the elbows extended at the height of the hips as shown in the figure. The palms of the hands must be facing backwards (hand prone). Slowly push the wand backwards so as to move it away from the body without bending the torso forward. Maintain the position of maximum extension for 5 seconds, then slowly return to the starting position and repeat ten times. Starting from the same position repeat the movement extending only one limb at a time. As in the previous case, perform 10 repetitions per side maintaining the position of maximum extension for five seconds; then repeat for the opposite side. To conclude, slowly raise the wand upwards, grabbing it with both hands pronation) as long as mobility allows (bend the elbows but without involving the trapezius in the movement; the collarbones must then be kept downwards).

INTERNAL / EXTERNAL ROTATION: lie on the ground, supine, with a pillow under your head, hold the wand with both hands at shoulder width. The elbows should be bent at 90 ° and kept close to the hips throughout the movement. Gently rotate the injured arm externally, moving only the forearm. Maintain the position for five seconds, then return to the starting position and repeat ten times. The same sequence will then be repeated by internally rotating the injured arm.

ANTEROPOSITION / SHOULDER RETRACTION: standing slowly bring the shoulders forward, hold the position for a couple of seconds. Slowly rotate your shoulders backwards (externally), until you reach the position of maximum rotation, hold the position for 2 seconds and slowly return to the starting position. Repeat ten times.

WARNINGS: before performing these exercises to increase the mobility of the shoulder and improve the elasticity of the muscles and tendons that make up the rotator cuff, ask your doctor for advice. In particular, remember to always perform a general warm-up before starting the movements of stretching; wear comfortable clothing that does not impede movement; choose a relaxing environment and respect the correct breathing technique; avoid sudden movements and excessive stretching. If shoulder pain occurs during movements, stop exercising immediately and seek medical attention if the pain is particularly intense or does not go away after a few days of rest.