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THE ROTATOR CUFF RESET
Olivia Robertson BASI Comprehensive Apparatus Program
2017
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ABSTRACT
With shoulder pain ranking as the third most common musculoskeletal complaint in the USA, it is important that we better understand the Rotator Cuff and its implications. In this paper, I outline a four-step program to reset the Rotator Cuff.
Totaling 12 weeks, the program is broken into 4 steps of 3 weeks each. In my experience, I have seen most gains with clients coming between 2 and 3 times per week.
Phase 1: Stretching Phase 2: Stabilization Phase 3: Strength Phase 4: Movement This felt, to me, like a logical structure, and is founded on understanding the
musculature and general skeletal structure of the shoulder girdle. Stretching and releasing the musculature allows imbalances to loosen and muscles to become pliable and ready for adaptive work. Once you have loosened previous muscular patterns, Phase 2 introduces a new and balanced range of motions that form the stable roots of the new movement patterns. Once the foundation of the Rotator Cuff is solid, Phase 3 strengthens the new movement patterns created and begins to incorporate primary shoulder muscles and scapular stabilizers, adding in complex and controlled movements. Phase 4 takes the client into a more advanced movement patterning, challenging foundations, strength and inviting exploration of movement.
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TABLE OF CONTENTS
The Shoulder Complex ……………………………………………… 4 The Rotator Cuff ……………………………………………………… 6 A Sad Rotator Cuff …………………………………………………… 8 Common Rotator Cuff Muscle Dynamics ………………………... 9 The Rotator Cuff Reset Program ………………………………….. 10 Conclusion …………………………………………………………… 14 Bibliography …………………………………………………………. 15
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THE SHOULDER: AN OVERVIEW
We have all heard or used the cue “Pull your shoulders down”. This cue
generally engages the lower trapezius to anchor the shoulder blade in place, forcing the
shoulders down. Goal achieved! This is generally alright until you want to raise your
arms and the shoulder blade is pinned down. Unable to move freely through its natural
range of motion, the muscles around the shoulder blade recruit other muscles to lever
the arm overhead. This compensatory action causes overdevelopment over time in
other muscles, leading to imbalance and poor shoulder mechanics.
This example highlights one small misunderstanding causing a lot of pain in what
should be an almost unconscious arm movement. When we think about the skeletal
structure of the arm - and how it hangs off one attachment at the base of the collar bone
(sternoclavicular joint) - we start to understand just how important the muscular
relationships in the shoulder become.
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The shoulders can be broken down into 3 basic categories: THE PRIMARY SHOULDER MUSCLES (Pectoralis Major, Deltoids, Latissimus Dorsi and Teres Major) SCAPULAR STABILIZERS (Trapezius, Rhomboids, Levator Scapulae, Pectoralis Minor, Serratus Anterior) ROTATOR CUFF (Teres Minor, Infraspinatus, Supraspinatus, Subscapularis)
*Note that not all muscles are shown on this image
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THE ROTATOR CUFF
A synergistic balance of the Rotator Cuff muscles “is imperative for shoulder
complex stability and function.” (*1) There are four muscles that make up the rotator
cuff; Teres Minor, Infraspinatus, Subscapularis and Supraspinatus. These muscles are
located strategically to ground the ball and socket joint where the head of the humerus
(upper arm bone) meets the collarbone. This point is called the Glenohumeral Joint.
The four muscles of the rotator cuff are strategically placed to keep the
glenohumeral joint functioning optimally and smoothly through arm movements. If any
one of these anchoring muscles is compromised (tighter, weaker, overused, etc.), the
floating bones of the shoulder joint could be pulled into one another, causing friction
within the shoulder girdle. This obviously results in the all-too-common rotator cuff
conditions ie. pain in the front of the shoulder.
INFRASPINATUS
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TERES MINOR
SUPRASPINATUS
SUBSCAPULARIS
(*Anterior view)
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A SAD ROTATOR CUFF
“Shoulder pain is the third most common musculoskeletal complaint reported to general practitioners in primary care settings.” (*1)
WOW! It is evident, based on this statistic, that our bodies adapt and
compensate to the technological world in which we live, not without its pitfalls. With
more and more people living in a virtual world, slouched behind desks, or logging
couch, phone, and/or study time, shoulders are rounding forward and impingement is
becoming more prevalent alongside “text-neck”.
Within our scope of Practice, the aim of the Pilates instructor is not to diagnose,
but to get our clients moving pain free as much as possible. We should, therefore, know
the underlying anatomy and general symptoms of rotator cuff impingement.
General Indicators of Rotator Cuff Dysfunction: (*1, 2)
● An acute injury to the shoulder ● Pain in the shoulder (specifically the front) ● Unable to abduct the shoulder, or lift the arm overhead ● Pain in the shoulder at night, or at rest ● Pain or catching when internally rotating the arm ● Look for shoulders slightly rounded forwards
~ Remember! These symptoms are warning signs! Refer out to specialists if your client
has not been diagnosed, and you suspect a rotator cuff issue. ~
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COMMON ROTATOR CUFF MUSCLE DYNAMICS THE ROTATOR CUFF DETECTIVE With Rotator Cuff injuries, the following are generally observed: (*1) TIGHT?
● Pectroalis Minor (SEE BELOW) ● Infraspinatus or supraspinatus or both
WEAK?
● Serratus Anterior ● Lower Trapezius (Unless being cued to “Pull your shoulders down”!) ● Scapular Stabilizers
THE PECTORALIS MINOR AND THORACIC SPINE
“A shortened pectoralis minor muscle at rest has been indirectly correlated with RC [Rotator
Cuff] tendinopathy, functional deficits, and pain.” This particular reference continues;
“research supports strengthening the scapular stabilizers and RC muscles, addressing
flexibility of the posterior shoulder structures, pectoralis minor muscle, the thoracic spine (with
postural education), and activity modifications.[...]” (*2)
According to this citation, in order to address rotator cuff dysfunction, we must also
address the musculature of the upper back (thoracic spine) and release tight pectoralis
major and minor muscles. This relationship between upper abdominal contraction,
thoracic spine and the shoulder joint is complex and one that I will only mention here (as
it requires an entirely different paper and set of research!).
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THE ROTATOR CUFF RESET PROGRAM
1. Each phase is 3 weeks
2. Each week you can plan anywhere between one and 3 sessions. (This is
determined by a number of factors; economic, time, the functional level that your
client is coming in at, etc.)
3. Depending on your client, you may need to dial down the initial foundational
work, adding in education around lateral breathing, abdominal connection and
neutral spine/pelvis, which I assume in my Reset program the practitioner and
client have already established.
4. I am offering guidelines. It is important to remember each body is different. Feel
free to eliminate or add whatever you need to the program as you work with your
client.
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PHASE 1: STRETCHING AND RANGE OF MOTION
WEEK 1 WEEK 2 WEEK 3
Warm Up Basic Mat *Emphasis on Lateral Breathing
Footwork Reformer (REF)
Abdominals (Reformer) (REF) Hundred Prep (REF) Hundred and
Coordination (REF) Hundred prep, Hundred
and Coordination
Hips (REF) Supine Leg Series: Frog, Circles Down, Up, Openings
Spinal Articulation
Stretch Stretching with a Pole. *Focus on Pec Major and Minor (ie. front of the chest - a lot of
expansion)
FBI 1
Knee Stretch Round Back and Knee Stretch Flat Back *Focus on the dynamic between shoulder stabilization
and spinal flexion/extension (REF) Scooter
Arms
*Nothing over shoulder height for the first 3 weeks and no weight, or even a Theraband* (Ped-A-Pul) Extension, Adduction,
Circles Up, Down, Triceps.
*Introduce idea of scapular Adduction and Abduction. No weight to start, then add 1lb hand weights if progressing.
(Ped-a-Pul) Extension, Adduction, Circles Up,
Down, Triceps
*Continue to work scapular adduction and abduction. Add the (REF) Supine Arms Series.
Add Cross Arm Pull with a Theraband
Legs (WC) Standing Balance (WC) Standing Balance Gluteals Side Lying Series
FBI 2
Lateral Flexion/ Rotation
(REF) Mermaid (LB) Side Over Prep
Back Extension
(MAT) Back Extension (MAT) Swimmer Just focus
on reaches with a soft shoulder.
(MAT) Swimmer
NOTES:
- Try to avoid Pectoralis Major or Minor Strengtheners for the first 2 Phases (ie. Plank, Push Ups, Hug-A-Tree or Punching)
- Invite your client to start developing awareness around their anatomy. This could take some time, be patient and encouraging!
- Allow the client’s shoulder to raise up naturally with arm movement, watching for hypermobility as needed, but try not to cue “Pull your shoulders down” as much as you cue to “soften” specific muscles.
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PHASE 2: STABILIZATION and MUSCLE RECRUITMENT PATTERNS
WEEK 5 WEEK 5 WEEK 6
Warm Up Basic *Focusing on depth and control
Footwork Reformer (WC) with Arm Stretches (WC) with Arm Stretches
Abdominals (CAD) Roll up with
RUB (CAD) Bottom Lift with RUB and
(WC) Standing Pike (WC) Standing Pike Reverse and
Sitting Pike
Hips (CAD) Basic Leg Springs
Spinal Articulation (REF) Bottom Lift (REF) Bottom Lift with Extension
Stretch (LB) Shoulder Stretch 1 and 2
FBI 1
(CAD) Push Through Series (Sitting
Forward and Side Reach)
(REF) Up Stretch 1 and/or Elephant (REF) Down Stretch
Arms
(REF) Sitting Series *Without Hug-A-Tree
(REF) Sitting Series *Without Hug-A-Tree. *ADD Arms
Overhead from Side Arms Kneeling Series with 1lb weight
(REF) Sitting Series *Without Hug-A-Tree. Add (REF) Cross
arm Pull from Side Arms Kneeling Series and (WC)
Triceps Seated Prone
Legs (REF) Single Leg
Skating (REF) Side Split Gluteals Kneeling Series
FBI 2
Lateral Flexion/ Rotation
(WC) Side Stretch (REF) Mermaid (Spine Corrector) Side over with Extended Arms
Back Extension (LB) Swan Prep MAGIC CIRCLE Swan Prep (CAD) prone 1
NOTES:
- Try to avoid Pectoralis Major or Minor Strengtheners for the first 2 Phases (ie. Plank, Push Ups, Hug-A-Tree or Punching)
- Slight focus on mobilizing through the Thoracic Spine as the shoulders start to open up.
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PHASE 3: STRENGTH with CONCENTRIC and ECCENTRIC FOCUS
WEEK 7 WEEK 8 WEEK 9
Warm Up Warm up on the Cadillac
Footwork (WC) with pole stretch? (CAD) (CAD)
Abdominals
(WC) Cat Stretch Kneeling
(REF) Abdominals Legs in Straps (Double leg and
Double leg with Rotation) (CAD) Roll up Top Loaded
Hips (CAD) Single Leg Supine (Spine Corrector) Supine
Legs Series * No Springs
(Spine Corrector) Frog, Openings, Scissors, Helicopter
*Springs
Spinal Articulation (CAD) Tower Prep (WC) Pelvic Curl (REF) Semi-circle
Stretch (REF) Standing Lunge (REF) Kneeling Lunge
FBI 1 (REF) Up Stretch 2 (REF) Up Stretch 2 (CAD) Sitting Back
Arms Rowing Back Series (1
and 2) Modified Kneeling Side Arms
Series with Theraband Rowing Front Series (1 and 2)
Legs Magic Circle Supine
Series (WC) Backward Step Down Magic Circle Prone Series
FBI 2 (REF) Long Back Stretch
Lateral Flexion/ Rotation
(CAD) Side Lift (WC) Side Kneeling Stretch (LB) Side Overs
Back Extension (CAD) Prone 1 (WC) Swan on Floor (LB) Swan Prep
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PHASE 4: MOVEMENT!
WEEK 10 WEEK 11 WEEK 12
Warm Up Warm up on the Cadillac
Footwork (CAD) (CAD) (CAD)
Abdominals (WC) Full Pike MAT Neck Pull (CAD) Roll up Bottom Loaded
Hips
(REF) Extended Frog, Extended Frog Reverse
(Spine Corrector) Frog, Openings, Scissors, Helicopter *Springs
(REF) Supine Legs Series
Spinal Articulation (WC) Jack knife (CAD) Tower (REF) Long Spine
Stretch (REF) Side Split (Spine Corrector) Kneeling Lunge (REF) Side Split
FBI 1 (REF) Long Stretch (REF) Up Stretch 3 (REF) Down Stretch
Arms Side Arms Kneeling Series Side Arms Kneeling Series
Legs (WC) Frog Front (CAD) Single Leg Side Series
FBI 2 (REF) Balance Control
Front (WC/REF) Tendon Stretch (Spine Corrector) Push Up
Lateral Flexion/ Rotation
(REF) Side Over on Box (CAD) Side Lift (WC) Side Pike
Back Extension (LB) Swan (CAD) Prone 1 (CAD) Prone 2
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CONCLUSION
While Rotator Cuff pain and injuries are prominent in today’s society, we are very privileged to be able to help our clients re-learn their bodies and more specifically their shoulders with a unique variety of equipment and specialized knowledge. The four-step Rotator Cuff Reset Program breaks down the sometimes overwhelming process of where and how to start with your client, walking you through a progression of exercises with the main focus around healthy shoulder mechanics. Branching the program into the rest of the body, and allows both the practitioner and the client to engage in the dialogue around the shoulder girdle and how it relates to the rest of the body.
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BIBLIOGRAPHY
Websites (*1) Int J Sports Pays Ther. 2016 Apr; 11(2): 279-301; Exercise Rehabilitation in the Non-Operative Management of Rotator Cuff Tears: A review of the Literature; Peter Edwards, MSc, Jaty Ebert, PhD, Brendan Jones, PhD, Get Bhabra, FRCS, Tim Ackland, PhD, Allan Wang, PhD, FRACS https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4827371/ ** (*2) Int J Sports Phys Ther. 2014 Apr; 9 (2): 274-288; Current Concepts of Rotator Cuff Tendinopathy; David Factor, DPT, EMPT-P and Barry Dale PT, PhD, DPT, ATCSCS, OCS, CSCS. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4004132/ Study Materials/ Books Human Kinetics. Champaign, IL; Pilates / Rael Isacowitz -- Second Edition. 1955-. Isacowitz, Rael. Study Guide (Reformer, Mat, Auxillary, Cadillac, Wunda Chair): Comprehensive Course. Costa Mesa CA.: Body Arts and Science International.
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