A practical guide to Rotator Cuff Rehab
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Transcript of A practical guide to Rotator Cuff Rehab
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A Practical Guide to Rotator Cuff Rehabilitation
Julia Walton Specialist Shoulder Physiotherapist
Manchester Shoulder Clinic &
Wrightington Hospital
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Its been a journey………
● Joined The Nottingham Shoulder Unit 2002
● Picked up lots of ideas on the way…
● Isolated rotator cuff work
● Kinetic chain
● No recipe….
● BUT there are key ingredients………
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●Controls humeral head ●Push/shoulder flexion
●Supraspinatus, infraspinatus. deltoid, trapezius and serratus anterior higher activation
●Pull/shoulder extension ●Subscapularis & Lat dorsi higher activation (Wattanaprakornkul et al 2011)
●In combined ER/Abduction Supraspinatus main stabiliser. Deltoid has a role too ● Subscap less (Tardo et al 2013)
What does the rotator cuff do? Stabilisers
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●Infraspinatus -‐ Torque producer in 90 degrees abd for IR/ER (Tardo et al 2013)
The cuff has different roles in different positions
BUT all works synergistically
What does the rotator cuff do? Torque Producer
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Where do we begin?
● Improvement testing is the way in ● Positive predictor of physio success
● Scapula assist ● ER/IR recruitment ● Kinetic chain ●Grip ● Reinforce afferent input
● visual ●manual ● audible ● tactile
improvement test!
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What does the rotator cuff need?
● Intact/functional
● Comfortable as possible
● Functional range of movement
● Good mechanical position throughout
●With support from proximal control
● AND tap into the kinetic chain to generate functional power
All of these LEAD to happier rotator cuff
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What goes wrong?
● Ageing/Damage/injury ● Stiffness ● Disuse ● Pain inhibition ● Poor timing ● Poor control
● Doesn’t switch on
● Poor centralisation of HH
● Can’t cope with load
● Fatigues
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How do we rehab the rotator cuff? What and Where do we need to train?
● So is it all about strength?
● Control ● Proprioception ● Timing -‐ presetting ● Load ● Endurance -‐ can it cope?
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How do we rehab the rotator cuff? What and Where do we need to train?
● So is it all about strength?
● Control ● Proprioception ● Timing -‐ presetting ● Load ● Endurance -‐ can it cope?
● Through range
●What is functional to them?
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● So is it all about strength?
● Control ● Proprioception ● Timing -‐ presetting ● Load ● Endurance -‐ can it cope?
● Through range
●What is functional to them?
How do we rehab the rotator cuff? What and Where do we need to train?
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How do we rehab the rotator cuff? What and Where do we need to train?
● So is it all about strength?
● Control ● Proprioception ● Timing -‐ presetting ● Load ● Endurance -‐ can it cope?
● Through range
●What is functional to them?
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Key components for RC exercises
● Proprioception
● Kinetic chain
● Rotational control & loading through range
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Which exercises? Consider their value
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Key components: Proprioception
● Vital for RC function
● Reflex arc from capsule to shoulder musculature
● Mechano-‐receptors influence muscle recruitment
● Enhancing gleno-‐humeral control
● Stretch
● Compression
● Hand grip
● Isometrics
● Reinforce with afferent input
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Key components: Kinetic chain
●What is the rotator cuff attached too?
●Mobility vs stability
●Where does the functional power come from? ● 50% lower limb ● 30% thoracic ● 20% arm
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Key components: Kinetic chain
• A step increases scapulothoracic recruitment by 10%
• Rotator cuff strength improves by 24% when scapula is retracted/stabilised
Kibler et al 2006 Tate et al 2008
STOP THE PRESS!
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Key components:Kinetic Chain
● All these exercise are functional patterns we can recognise for a reason
● Textbook ways to move
● We become lazy or adapt to pain and injury
● TROUBLE!
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Key components:Rotator cuff rotational control and loading
● Sometimes rotator cuff with kinetic chain is not enough…
● RC constantly switches its roles depending on position and gravitation pull (eccentric/concentric, mover/stabiliser)
● Large ROM -‐ EOR often neglected
● Proprioceptively deficient -‐ appears stiff!
● Complements Kinetic chain
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