Lawn mower shoulder exercise. How To Reduce Shoulder Pain – 12 Best Rotator Cuff Exercises

Safety Tips on Cutting Grass

Individuals with osteoporosis or low back pain and people recovering from either a hip replacement or knee replacement need to pay special attention to their movements when mowing the lawn. I cover these safety tips and more in this blog post on cutting grass.

If you have osteoporosis, osteopenia, or low back pain, you should follow these six safety tips on cutting grass:

• Establish a power position behind the lawnmower.
• Push with your legs with both hands placed shoulder width apart on the mower handle.
• Make sure the height of your lawnmower is adjusted to your height.
• Look back before you start moving backwards.
• Use a double arm pull back technique rather than a single arm.
• Trim low hanging branches before you cut grass to avoid bending under the branches.

Later in the post I provide guidance for people who are recovering from either a hip replacement or knee replacement and want to get back to mowing their lawns.

Those of you with low bone density, osteopenia or osteoporosis need to pay special attention to how you cut your grass. Individuals who have not followed a regular conditioning program need to be careful not to cause back, shoulder or neck problems.

Lawn Mower Position When Cutting Grass

It is important that you establish a power position behind the lawnmower. This will allow you to push through with your legs and torso and not rely exclusively on your arms and back while cutting grass.

Mid waist is an ideal power position.

Get your elbows in and push the lawn mower from the legs.

In the power position, the handle should be sitting above the height of your hips and below the height of your chest. Somewhere mid-waist is a really good power position.

The power position is especially important when you’re initiating the push of the mower. For example, if you start from a standstill position or if you encounter an uphill grade with long grass, you need to get more power behind the mower.

Make Sure the Height of Your Lawn Mower is Correct

Before you start cutting grass make sure that the lawn mower height is correct for you. Someone may have used the lawnmower before you and the height could be too high or too low.

The correct height should align with your power position.

Get your elbows in and really push from the legs.

For a tall or short individual, move the handle bar setting so that the whole handle gets moved up and allows your hand position to be in a much safer and better position for your height.

Walking Forwards and Backwards When Cutting Grass

If you want to reduce the strain on your back, you should use a double hand pull back instead of a single hand while cutting grass.

Also, make a point of looking behind you before moving backwards. You could easily trip on something and cause a fracture.

Low Hanging Limbs and Cutting Grass

Consider trimming low hanging limbs before you cut the grass. Many people have the habit of bending down and going under low hanging tree branches to access parts of the lawn below the branch.

Put your spine health ahead of your tree health.

Instead of continuously ducking underneath the low-hanging limbs, save yourself a lot of grief and save stress on your back by eliminating the low hanging branches.

Exercise Recommendations for Osteoporosis

It is really important to do activities of daily living with proper form. However, you need to do more than that if you have osteoporosis. Exercise is an essential ingredient to bone health. If you have osteoporosis, therapeutic exercise needs to be part of your osteoporosis treatment program.

But what exercises should you do and which ones should you avoid? What exercises build bone and which ones reduce your chance of a fracture? Is Yoga good for your bones? Who should you trust when it comes to exercises for osteoporosis?

A great resource on exercise and osteoporosis is my free, seven day email course called Exercise Recommendations for Osteoporosis. After you provide your email address, you will receive seven consecutive online educational videos on bone health — one lesson each day. You can look at the videos at anytime and as often as you like.

I cover important topics related to osteoporosis exercise including:

• Can exercise reverse osteoporosis?
• Stop the stoop — how to avoid kyphosis and rounded shoulders.
• Key components of an osteoporosis exercise program.
• Key principles of bone building.
• Exercises you should avoid if you have osteoporosis.
• Yoga and osteoporosis — should you practice yoga if you have osteoporosis?
• Core strength and osteoporosis — why is core strength important if you have osteoporosis?

Enter your email address and I will start you on this free course. I do not SPAM or share your email address (or any information) with third parties. You can unsubscribe from my mail list at any time.

Mowing the Lawn After Hip Replacement Surgery

I often work with patients after their hip replacement surgery. Many are anxious to return to an active lifestyle that includes garden work, mowing the lawn, cutting grass, and house work. Here are a few things to consider before mowing the lawns after hip replacement surgery.

Anterior or Posterior Hip Replacement Surgery

Pay special attention to whether you have had an anterior or a posterior hip replacement surgery. The type of contraindications during the six week period after hip replacement surgery are determined by the type of surgery.

Here are the two type of hip replacement surgeries:

• Anterior approach involves an incision in the front of your hip. Your buttock muscles are unaffected.
• Posterior approach involves an incision through through your buttock muscles and occurs behind your hips. Your buttock muscles are affected.

If you have had a posterior hip replacement surgery, your list of activities to avoid may include the following:

• Bending your hip further than 90 degrees.
• Crossing your legs.
• Lifting your leg to put on socks.

It is important that you follow the guidelines given to you by your surgeon and rehabilitation team in order to protect the new hip from dislocation.

I believe that mowing your lawn after hip replacement surgery is not important enough that you join the 3% to 4% of people with hip replacement that have a hip dislocation. (1)

When Can You Mow the Lawn After Hip Replacement?

Eight to twelve weeks after a successful hip replacement, you should be able to safely mow your lawn. This assumes that you:

• Can walk without any external support.
• Have been diligent and done your prescribed therapeutic exercises. Your hip muscle strength and balance should be good enough that you can push a lawn mower on level ground with little resistance — as shown in the video.

I recommend you avoid pushing the lawn mower on steep inclines — at least until you have fully your strength, balance and mobility.

If you had complications from your surgery, are still challenged walking without support, or have poor balance I recommend you to seek further advice from a Physiotherapist on how to improve your strength, balance and gait before you mow your lawn.

Cutting Grass with Riding Mowers

The physical and cognitive demands of operating a riding mower are much greater than driving a car. Avoid operating a riding mower until at least two weeks after the period when your surgeon or rehabilitation team gives you the green light to drive a car.

On another note, riding a mower has more contraindications to a posterior approach than pushing your mower on level ground.

If you had a posterior hip replacement surgery, be aware of your seat position. Seat position affects the position of your hips relative to your knees. You should speak to your surgeon or Physiotherapist before jumping on your riding mower.

Also, be aware of the effect that pain and pain medication can have on your ability to safely drive.

Cutting Grass with Gas Mowers

To fuel the gas mower you need to knee down on the ground. I recommend that you not do this after either hip or knee replacement surgery. This might be a good time to consider an electric mower for both you and the environment.

Mowing the Lawn After Knee Replacement Surgery

Like hip replacement surgery, it is important that you follow the post-operative guidance given to you by your surgeon. If you can walk without any external support, you have been working on your hip and knee muscle strength, and your balance is good you should be able to safely push a mower on level ground with little resistance — as shown in the video.

Once you have mastered mowing your lawn on level ground, you can graduate to low inclines. It is wise to avoid pushing a lawn mower on steep inclines until you have regained your full strength, balance and mobility.

It is common for individuals to have a partial or medial compartment knee replacement rather than a complete knee replacement. Generally the recovery is much faster. In addition, the return to household and garden chores, such as cutting your grass, occurs with more ease.

Conclusion

I am confident that these six lawn-mowing tips will help you to avoid undue stress on your back and reduce your risk of a compression fracture. I encourage you to consider your posture and body mechanics throughout your work and play life.

Individuals recuperating from hip or knee surgery need to be especially attentive before mowing their lawn or doing other garden work.

Exercise Recommendations for Osteoporosis

It is really important to do activities of daily living with proper form. However, you need to do more than that if you have osteoporosis. Exercise is an essential ingredient to bone health. If you have osteoporosis, therapeutic exercise needs to be part of your osteoporosis treatment program.

But what exercises should you do and which ones should you avoid? What exercises build bone and which ones reduce your chance of a fracture? Is Yoga good for your bones? Who should you trust when it comes to exercises for osteoporosis?

A great resource on exercise and osteoporosis is my free, seven day email course called Exercise Recommendations for Osteoporosis. After you provide your email address, you will receive seven consecutive online educational videos on bone health — one lesson each day. You can look at the videos at anytime and as often as you like.

I cover important topics related to osteoporosis exercise including:

• Can exercise reverse osteoporosis?
• Stop the stoop — how to avoid kyphosis and rounded shoulders.
• Key components of an osteoporosis exercise program.
• Key principles of bone building.
• Exercises you should avoid if you have osteoporosis.
• Yoga and osteoporosis — should you practice yoga if you have osteoporosis?
• Core strength and osteoporosis — why is core strength important if you have osteoporosis?

Enter your email address and I will start you on this free course. I do not SPAM or share your email address (or any information) with third parties. You can unsubscribe from my mail list at any time.

Best Shoulder Pain Relief Exercises | Rotator Cuff Tendinopathy

Activities of Daily Living

Visit my page dedicated to Activities of Daily Living to learn about other activities of daily living.

About Margaret Martin

Margaret Martin is a Physical Therapist with 36 years of clinical experience. Her expertise is in the treatment and prevention of osteoporosis through exercise, safe movement and fall prevention. For the last 15 years, she has concentrated on bone health and has treated thousands of patients for their osteoporosis, osteopenia and low bone density.

Margaret is the author of three books on osteoporosis and exercise. All books are available on Amazon in both print and Kindle formats. She has produced a number of home exercise workout videos on safe exercise for people with osteoporosis.

She is the creator of the continuing education course, Working with Osteoporosis and Osteopenia. This course is accredited by all Physical Therapy Licensing boards across the United States. Thousands of Physical Therapists in the United States, Canada and around the world have completed her training course. Margaret has trained physicians, Physical Therapists and other healthcare staff at Genesis Rehab Services, Jewish General Hospital in Montreal, Charles Lemoyne Hospital in Montreal, Ottawa Hospital Rehabilitation Centre, Bruyere Hospital in Ottawa, Osteoporosis Canada, and West Carleton Family Health in Ottawa.

Margaret graduated from the School of Physical and Occupational Therapy at McGill University in Montreal, Canada in 1984. She is licensed to practice Physical Therapy in Ontario and California.

Margaret’s work in osteoporosis and Physical Therapy has been cited in a number of Physical Therapy textbooks. She has been interviewed as an expert in osteoporosis prevention and treatment by WebMD, the Toronto Star, CTV Ottawa Morning Live, the Senior Rehab Project podcast, and Dr. Rebecca Risk’s podcast, Falling Through the Cracks.

She has done research with McGill School of Physical Therapy into the use of a web-based exercise program for patients with osteoporosis. Margaret has presented at the Canadian Physiotherapy Association and the Ontario Physiotherapy Association on treating aging adults and osteoporosis.

She is the proud recipient of the 2011 Award of Distinction from the College of Physiotherapists of Ontario for her significant contributions and achievements as a Physiotherapist.

Margaret operates her Physical Therapy clinic, MelioGuide Physical Therapy, in Ottawa, Ontario where she focuses on patients with osteoporosis, osteopenia and low bone density.

Reader Interactions

Комментарии и мнения владельцев

I had a T12 fracture in Oct. 2017.still in pain. but wondering if it is safe to use a old fashioned push mower.

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How To Reduce Shoulder Pain – 12 Best Rotator Cuff Exercises

Follow these simple stretches to relieve the stress and pressure on your shoulders.

Expertise: Diet Plans and Exercise Schedule For Weight Loss

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Expertise: Diet Plans and Exercise Schedule For Weight Loss

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Charushila Biswas MSc (Biotechnology), ISSA Certified Fitness Nutritionist

Expertise: Nutrition Fitness

Charushila is an ISSA certified Fitness Nutritionist and a Physical Exercise Therapist. Over a span of 6 years, she has authored more than 400 articles on diet, lifestyle, exercises, healthy food, and. more

Charushila Biswas MSc (Biotechnology), ISSA Certified Fitness Nutritionist

Expertise: Nutrition Fitness

Charushila is an ISSA certified Fitness Nutritionist and a Physical Exercise Therapist. Over a span of 6 years, she has authored more than 400 articles on diet, lifestyle, exercises, healthy food, and. more

Charushila BiswasCharushila Biswas. MSc (Biotechnology), ISSA Certified Fitness Nutritionist Jul 7, 2023

The rotator cuff is a small group of muscles that rotates your shoulder and therefore helps control its movements. Rotator cuff exercises keep your shoulders strong and pain-free and help to rehabilitate any shoulder injury. The main symptom of a rotator cuff injury is a constant dull pain in the front or side of your shoulder. Lifting your arm up or doing daily chores can become extremely painful. Strengthening the rotator cuff muscles through physical therapy exercises can help reduce the pain and heal the muscles. You will be able to move your arm freely, lift objects without pain, and do daily chores with ease. Here are a few rotator cuff exercises you can do. Scroll down!

Note: Take your doctor’s permission before doing these exercises.

What Are The Rotator Cuff Muscles?

Understanding shoulder anatomy is important for both injury prevention and enhancing shoulder mobility.

The rotator cuff muscles are a group of four shoulder muscles that support the movements of your arms and shoulders. Also referred to as SITS, the four muscles of the rotator cuff are:

These muscles help stabilize your shoulders and move them in, out, up, back, and down when your arms do various tasks.

Without enough strength, balance, and stability in the rotator cuff, it would be impossible to lift your arms and do various movements freely. If you ever had a shoulder injury, you know that even lifting your hand can become extremely painful. So, what causes rotator cuff muscle weakness or pain? Find out in the next section.

What Causes Injury To The Rotator Cuff Muscles?

Injury and pain to the rotator cuff muscles are caused by weakness in the rotator cuff muscles combined with the overuse of your hands, arms, and shoulders – the muscles cannot support the movement of your limbs. Poor posture and incorrect form may also lead to irritation, inflammation, calcification i X An abnormal process of accumulation of calcium salts in the body tissues, causing them to harden degenerative thinning, and tendon tear in the area. A rotator cuff muscle injury can also occur due to aging. Here is a list of possible rotator cuff injuries:

• Rotator Cuff Tears
• Rotator Cuff Tendinopathy i X A broad term that includes all the painful conditions occurring in and around the tendons due to its overuse.
• Rotator Cuff Tendinitis i X An inflammation or irritation of tendons (thick fibrous connective tissue) that attach muscles to bone.
• Shoulder Impingement Impingement Syndrome i X Shoulder pain caused by connective tissue due to inflammation from repetitive shoulder activities.
• Shoulder bursitis

When any of these four injuries occur, you may experience pain and other symptoms, such as:

Symptoms Of Rotator Cuff Injury

If you have any of these symptoms, you must check with your doctor immediately. Your doctor will ask about your daily activity routine, medical history, and age, do a physical examination, and may ask you to get an X-ray and/or MRI done.

If a rotator cuff injury is confirmed, you may need to take NSAIDs (Non-Steroidal Anti-Inflammatory Drugs), physical therapy, or may require shoulder surgery if your injury is severe. Post-surgery, the recovery will take place in four different stages:

• First, your shoulder will be immobilized for 4-6 weeks so the surgical area can help.
• Second, you will do passive movement exercises for 4-6 weeks, where the physical therapist will stabilize your arm at a particular position and gently exercise the shoulder rotator cuff muscles without any effort from you. This will help regain the shoulder’s range of motion, flexibility, and shoulder stability.
• Third, you will perform active exercises for 3-6 weeks to further improve your range of motion, add strength, and increase flexibility.
• Fourth, you will perform strength training exercises for 8-12 weeks using resistance bands and light weights to strengthen the muscles.

In this post, I will talk about the shoulder strengthening exercises recommended in the third and fourth stages of recovery. You will learn about the various active shoulder exercises you may perform under the supervision of your physical therapist. Talk to your doctor and therapist before starting these exercises to boost your shoulder health. At any time, if you experience increased pain, stop immediately and seek medical attention.

With these points in mind, let’s see which exercises are best for increasing strength, stability, and range of motion after a rotator cuff injury.

Top exercises used by physiotherapists were statistically evaluated in a recent study published in Musculoskeletal Care to determine the most suggested exercise for treating rotator cuff injuries. Participants from various countries took part in the survey to help analyze which exercise is recommended the most by physiotherapists. The graph below shows resistance exercise as the most preferred recommendation, with motor control exercises coming in second.

Best Exercises To Strengthen The Rotator Cuff Muscles After Injury

Side-lying External Rotation

Target – External rotators

• Lie down on a yoga mat, and support your head on a foam roller or rolled towel. Stretch your other arm out in line with your bottom ear or support your head with your elbow. Slightly bend your knees.
• Hold a 1-pound dumbbell at your waist with the hand of the affected shoulder. Flex your elbow so that your upper arm is perpendicular to the forearm. Keep your palm facing away from you. Place a towel below your elbow for support.
• Slowly, pull your hand up, keeping the elbow bent and not allowing it to separate from your waist Squeeze the back of your shoulder.
• Bring it back to the starting position with control.

Sets And Reps

3 sets of 8 reps in the initial stage. Increase the reps and sets as you progress.

High-To-Low Rows

Target – Rhomboids i X A collective group of muscles important for upper limb movement and the stability of shoulder muscles traps, and lats.

• Hold the rope attached to the cable stack with both hands.
• Step back and get into a staggered stance (one foot in front of the other). Keep your core tight, and weight on the front foot.
• Pull the ropes towards your chest with your elbows going down and back to 45 degrees. Squeeze your shoulder blades together.
• Release the hold slowly and extend your arms fully without hunching or rounding your shoulders.
• Repeat.

Sets And Reps

Reverse Fly

Target – Posterior deltoids, rhomboids, and traps.

• Kneel on both knees. Hold light weights with your palm facing inward, hands under your shoulders.
• Slowly, pull your hands up to shoulder height, keeping the elbow bent and rotating your pinky fingers up to the ceiling
• Bring your arms back to the starting positionSets And Reps

3 sets of 8 res, 1 additional set with the injured side

Lawn Mower Pull

Target – Posterior deltoids, pectorals, lats, biceps, and hamstrings.

• Hold one edge of a broad resistance Band. Secure it to a wall or bar at shoulder height and then step on the other end of the Band. Twist the Band in your hand for the required amount of resistance so the Band is taut.
• Stand with your feet shoulder-width apart, knees slightly bent, and the free hand placed on your waist. This is your starting position.
• Straighten your knees and stand. As you do so, pull the resistance Band towards your hip with your elbow pointing back, and your shoulder blades squeezed.
• Straighten your arm to the starting position with control and without rounding your shoulders.

Sets And Reps

3 sets of 12 reps for each arm

Doorway Stretch

Target – Subscapularis and pectoralis.

• Stand near a door with the affected arm facing away from it. Secure a resistance Band on the handle of the door. Hold the other end of the resistance Band with your affected arm.
• Bend your elbow so that the forearm is perpendicular to the upper arm. This is the starting position.
• Keeping your elbow glued to the body, pull the resistance Band away from your body.
• Return to the starting position with control and repeat.

Shoulder Pain and Popping (SHORT & LONG TERM FIX!)

Sets And Reps

Pendulum

Target – Shoulder joints

• Rest your non-injured good arm on a table and lean over. Keep one foot in front of the other and the affected hand hanging.
• Start swinging your body so that your arm starts to swing as well. Direct the swing in clockwise and anticlockwise directions.

Sets And Reps

5 sets of 10 clockwise and 10 anticlockwise movements.

Individuals with lower back pain or lack of balance can practice the pendulum exercise on a table or bed.

Crossover Arm Stretch-Low Rows

Target – Posterior deltoids, lats, and triceps.

• Place the hand of the affected arm on the opposite shoulder. You may use your good arm as support to do so.
• Grab the elbow of the affected arm with your non-injured good arm and raise it to shoulder level.
• Gently and slowly, pull your elbow toward the opposite shoulder. You will feel a stretch along the side and back of your shoulder.
• Hold it for 20 seconds and repeat.

Sets And Reps

2 sets of 20-second holds – 10 repsets of 10 reps

Sleeper Stretch

Target – Posterior shoulder

• Lie down on the affected side. Keep your arm a little extended out so that it is not directly below your shoulder.
• Flex your elbow and keep your forearm in an upright position.
• Hold the wrist of your affected arm with the other hand.
• Gently push your affected arm down and hold for 10 seconds.
• Release.

Sets And Reps

You can place a towel under your upper arm to extend and deepen the stretch in the back of your shoulder. The extra support from the towel helps decrease pressure on the shoulder.

Shoulder External Rotation

Target – Teres minor, posterior deltoid, and infraspinatus.

• Stand near a door with the affected arm facing away from it. Secure a resistance Band on the handle of the door. Hold the other end of the resistance Band with your affected arm.
• Flex your elbow so that the forearm is perpendicular to the upper arm. This is the starting position.
• Keeping your elbow close to the body, pull the resistance Band away from your body.
• Get it back to the starting position and repeat.

Sets And Reps

Shoulder Internal Rotation

Target – Subscapularis, teres major, and lateral deltoids.

• Stand near a door with the affected arm near it. Secure a resistance Band on the handle of the door. Hold the other end of the resistance Band with the affected arm.
• Bend your elbow such that the forearm is perpendicular to the upper arm. This is the starting position.
• Keep your elbow close to the body and pull the resistance Band toward your body.
• Return to the starting position with control and repeat.

Sets And Reps

Resisted Shoulder Extension

Target – Teres major, lats, posterior deltoids, and triceps.

• Stand with your feet shoulder-width apart. Anchor a resistance Band in a doorway.
• Hold the other end of the Band so your hands are next to your hips. This is the starting position.
• Pull the Band and move your elbows back, keeping your shoulders down. Don’t let your shoulders roll forward.
• Return to the starting position with control.

Sets And Reps

Shoulder Abduction Using A Resistance Band

Target – Deltoid and supraspinatus.

• Stand with your feet shoulder-width apart. Secure the resistance Band under your shoes and hold the other end of the Band with the affected hand. This is the starting position.
• Raise your arm out to the side, palm facing down, and elbow slightly bent, in a slow and controlled motion. Stop when you feel pain.
• Return to the starting position in a slow and controlled motion.

Sets And Reps

It’s important to stretch your shoulder muscles as well as strengthen them so they don’t become overly tight. Keep reading for healthy shoulder stretches.

Key Takeaways

Learn the 10 best rotator cuff exercises that can help strengthen and stabilize your shoulder. Check out this video to prevent injuries and improve overall shoulder function.

Rotator cuff exercises help reduce shoulder pain and improve the range of mobility. Poor posture, overuse of hand or shoulder muscles, and incorrect techniques can all lead to rotator cuff injury. Weakness in shoulders, trouble reaching behind your back or sleeping on the affected shoulder side may all hint at a rotator cuff or shoulder tendon injury or strain. High-to-low rows, reverse flys, cross-over arm stretches along with the other shoulder rehabilitation exercises mentioned above can help you recover faster from shoulder pain or injury.

Frequently Asked Questions

Can a rotator cuff tear heal on its own?

A rotator cuff tear may not heal on its own without surgery. However, not all rotator cuff injuries need surgery and may heal with exercises and other treatment methods.

What exercises should you avoid with a rotator cuff injury?

Squats with bars, deadlifts, swimming and exercises that put force on the shoulders and have a pulling effect on the arms should be avoided if you have a rotator cuff injury.

Do push ups help rotator cuff?

Deep push-ups should be avoided with a rotator cuff injury. However half push-ups and wall-pushps may help strengthen the rotator cuff when done properly and under supervision.

Is ice or heat better for rotator cuff pain?

Ice is better early on for rotator cuff pain as it may help reduce the inflammation. Heat may be used on injuries that linger beyond 6 weeks and may help loosen up tightened muscles.

Rotator Cuff Injury

Medically reviewed by Drugs.com. Last updated on May 30, 2023.

What is a Rotator Cuff Injury?

Four tendons attach muscles from the shoulder blade and ribs to the upper arm bone (humerus). Because these tendons help to rotate the arm within its socket, this sleeve of tendons is called the rotator cuff.

Tendons in the rotator cuff can be injured easily because they move within a tight space. When the shoulder is turned or lifted at the limit of its natural range of movement, the tendons in this tight space are moved, too. Occasionally, the rotator cuff tendons can bump or rub against a bony knob (the acromion) above them or against a ligament at the front of the shoulder.

This friction is known as impingement syndrome and causes inflammation in the rotator cuff. Rotator cuff friction is most likely to cause inflammation if your shoulder movement is rough or repetitive. Inflammation can cause three problems:

• Rotator cuff tendonitis — Inflammation of a single tendon causes pain only during specific movements, when the muscle that pulls against that tendon is being used or when you are reaching upwards.
• Shoulder bursitis, also called subacromial bursitis — Bursitis occurs when inflammation spreads into the of fluid that lubricates the rotator cuff tendons. Pain is often worse at night and occurs when you move your shoulder in almost any direction, particularly if you are reaching upwards.
• Rotator cuff tear — The tendon may tear after it has been weakened by inflammation.

Several types of shoulder use commonly trigger rotator cuff injury:

• Pushing off with your arms — People with arthritis of the knee, other painful conditions in the legs, or weak quadriceps muscles in the thighs often compensate by pushing off with their arms when they rise from a chair. The shoulder is not built for this use. During the push off, the shoulder’s socket and humerus function like an upside-down mortar and pestle, crushing and grinding the rotator cuff tendons. Falls onto an outstretched arm, head-on automobile accidents and sports collisions also can crush the tendons.
• Repetitive reaching — Overhead arm positions narrow the tight space that the rotator cuff tendons must pass through. Pushups, pitching a baseball, swimming, house painting, filing, building construction, auto mechanic work and other activities can cause injury of the rotator cuff.
• Forceful or abrupt overhead arm movements — Tears are particularly common in athletes in throwing sports, racquet sports and wrestling. Abrupt movements, such as pulling to start a lawn mower, can tear a weakened tendon.

In addition, your shoulder can be injured more easily if it is out of shape. The narrow space that envelops the rotator cuff tendons becomes even narrower if your shoulder muscles are weakened or tight. When this happens, routine shoulder movements are more likely to cause tendon friction.

Symptoms

Rotator cuff injuries cause pain in your shoulder and upper arm. The pain may be most noticeable when you reach up or out. When you turn your arm as you lift it, the tendons are more likely to rub against surrounding structures. For this reason your shoulder symptoms may be worst when you try to comb your hair or slip your arm into a sleeve. You also may have dull, aching shoulder pain at night.

Rotator cuff tears that affect a significant portion of the tendon cause weakness of the shoulder, limiting your ability to hold your arm out to one side or to lift an object. Difficulty using the shoulder because of pain does not always mean that there is a tear. Rotator cuff injuries cause pain in your shoulder and upper arm. The pain may be most noticeable when you reach up or out. When you turn your arm as you lift it, the tendons are more likely to rub against surrounding structures. For this reason your shoulder symptoms may be worst when you try to comb your hair or slip your arm into a sleeve. You also may have dull, aching shoulder pain at night.

Rotator cuff tears that affect a significant portion of the tendon cause weakness of the shoulder, limiting your ability to hold your arm out to one side or to lift an object. Difficulty using the shoulder because of pain does not always mean that there is a tear.

Diagnosis

A rotator cuff injury usually is diagnosed by physical examination. Your doctor will rotate your arm at the shoulder and then will raise your arm. If this type of motion causes pain, the rotator cuff may be inflamed.

If you have noticeable weakness, you will need further testing to check for a rotator cuff tear. Your doctor may inject a numbing medicine into your shoulder to help distinguish actual weakness of the tendon from your muscle giving way because of pain.

If a tear is suspected, a magnetic resonance imaging (MRI) scan can confirm the diagnosis. An alternative diagnostic test is a shoulder arthrogram. An arthrogram is an X-ray of a joint following injection of dye into the joint. Because MRIs provide excellent pictures without putting a needle into a joint, arthrograms are done less frequently today.

Shoulder X-rays are not always needed, but may be helpful if you have had trauma to the shoulder or if your doctor cannot move your shoulder through its full range of motion. Another reason to do a shoulder X-ray is too look for calcium deposits in or around the shoulder. Calcium deposits form on a persistently inflamed tendon, causing a condition called calcific tendonitis.

Expected Duration

Without proper treatment, symptoms of a rotator cuff injury or tear can persist for months or years, and usually become worse over time. Most rotator cuff injuries respond to treatment within four to six weeks, especially if an injection is part of the treatment.

Prevention

In many cases, a rotator cuff injury can be avoided. To avoid reaching over your head repeatedly, use a step stool or ladder during projects. Avoid using your arms to push off from a chair. For people who are in poor athletic shape or who have arthritis in the knees, exercises to strengthen the quadriceps muscles in the thighs can be very helpful, so that it is not necessary for you to use your arms to get up from sitting.

Elderly people who are dependent on their arms to rise out of a chair can raise the seat of their favorite chair with a thick folded blanket or a short platform to make it easier to get up.

Exercises that strengthen the rotator cuff muscles also are an important part of prevention. Some of the rotator cuff muscles pull down on the upper arm bone as they work, widening the space that the tendons travel through. Physical therapy that strengthens the rotator cuff muscles can make your shoulder less vulnerable to injury.

Treatment

Tendonitis, bursitis and small rotator cuff tears in the shoulder can be treated effectively with an injection of a corticosteroid medicine followed by physical therapy exercises to restore shoulder movement and strengthen the rotator cuff muscles. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin and others) are useful to decrease pain and inflammation.

If your doctor determines that you have calcific tendonitis (calcium deposits), other treatments may be helpful. There is some evidence that treatment of the shoulder with ultrasound or a procedure called lithotripsy, which uses powerful ultrasound waves known as shock waves, may help to break up calcium deposits and speed healing.

Surgery may be necessary for frequently recurring rotator cuff injuries or large tears in a rotator cuff tendon. Either arthroscopy (camera-assisted surgery) or traditional open surgery can be used.

Treatment options

The following list of medications are in some way related to or used in the treatment of this condition.

When To Call A Professional

A doctor should evaluate shoulder symptoms that last for more than one week.

Prognosis

People with a rotator cuff injury typically recover well with treatment. However, it’s common to injure the same shoulder again, especially if you do not change the way you use your shoulder. Elderly people are prone to rotator cuff problems and have a harder time recovering because their shoulders have a less robust blood supply.

Additional Info

National Institute of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov/

National Rehabilitation Information Center (NARIC) http://www.naric.com/naric/

American Academy of Orthopaedic Surgeons (AAOS) http://www.aaos.org/

National Athletic Trainers’ Association http://www.nata.org/

American Orthopedic Society for Sports Medicine http://www.sportsmed.org/

Learn more about Rotator Cuff Injury

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Scapular Dyskinesia

Scapular dyskinesia (SD) is a term that describes a physical impairment in which the scapula’s position and motion are altered. The words dyskinesia or dysrhythmia are often used instead of dyskinesia. [1] [2] [3] One of the other terms used for SD is scapular winging, but it is a different condition that results in scapular dyskinesia usually after a long thoracic or spinal accessory nerve injury. [4] [5] [6]

SD can be seen in overhead athletes or patients with shoulder pathology such as rotator cuff disease, glenohumeral instability, impingement syndrome, and labral tears as well as in healthy people. [7] [8]

Scapular Biomechanics [ edit | edit source ]

The movement of the scapula can be divided into 3 motions and 2 translations.

• Upward/downward sliding on the thorax
• Medial/lateral sliding around the curvature of the thorax

Common patterns of the scapula are called scapular retraction (external rotation, posterior tilt, upward rotation and medial translation), protraction (internal rotation, anterior tilt, downward rotation and lateral translation), and shrug (upward translation, anterior tilt, and internal rotation). [9] [10]

During the normal overhead upper extremity elevation with internal/external rotation being minimal until 100°, primary scapular movement is upward rotation and secondary scapular movement is posterior tilt. [11] [12]

The coordinated movement between the scapula and humerus which is necessary for efficient arm movement is termed scapulohumeral rhythm. [13] An early study [14] found an overall ratio of 2:1 between glenohumeral elevation and scapular upward rotation. Another study [12] found that during the scapular plane elevation of the arm, there was a consistent pattern of scapular upward rotation, posterior tilting, and external rotation along with clavicular elevation and retraction.

The altered mechanics in SD are increased scapular anterior tilt, increased scapular internal rotation, and altered scapular upward rotation. [15]

Etiology [ edit | edit source ]

The causes of SD are many, but they can be looked at in these three groups:

1. Shoulder-related: Shoulder pathologies associated with SD (acromioclavicular instability, shoulder impingement, rotator cuff injuries, glenoid labrum injuries, clavicle fractures [17] [10] ), inflexibility of the pectoralis minor and short head of the biceps, and stiffness of the posterior glenohumeral capsule can be counted for this group. [18] [19] [12]

2. Neck-related: Mechanical neck pain syndromes and cervical nerve root-related syndromes. [16]

3. Posture-related: Excessive thoracic kyphosis and cervical lordosis, which are the changes that athletes are more tend to show are related causes of SD. [20]

Clinical Presentation [ edit | edit source ]

Patients with SD can be symptomatic or asymptomatic. [21] Symptoms of SD can be one or a combination of the following: [22]

• Anterior shoulder pain
• Posterosuperior scapular pain (may radiate into the ipsilateral para spinous cervical region or radicular/thoracic outlet-type symptoms in the affected upper extremity can be found)
• Superior shoulder pain
• Proximal lateral arm pain

Clinical Examination [ edit | edit source ]

There is no standard clinical assessment of SD. However, some assessment methods have proven to be reliable. [8] [8]

Determining The Presence or Absence of Dyskinesia [ edit | edit source ]

Based on visual observation, one of the four types can be determined during arm movements in terms of the presence of SD: [23] [24]

• Type 1: Inferior angle prominence,
• Type 2: Medial border prominence,
• Type 3: Excessive superior border elevation,
• Type 4: Absence of SD, symmetric scapular motion.

Manually Assisted Movements of Scapula [ edit | edit source ]

To determine the role of the scapula position in shoulder pain two tests that apply manual assistance to the scapula are The Scapular Assistance Test (SAT) and The Scapular Reposition (Retraction) Test (SRT). [25]

In the SAT, the patient is asked to do arm flexion and rate the pain on the numerical pain rating scale. The same process is repeated while the examiner pushes upward and laterally on the inferior angle, and pulls the superior aspect of the scapula (to produce posterior tilt). If two or more points of pain decrease after assisted movement, the test is positive. [26] [27] [28] [29] [30]

In SRT, the patient is asked to do 90 degrees of flexion with shoulder internal rotation while the examiner stabilizes the medial scapular border with one hand. Then the patient is asked to hold the position while the examiner is applying resistance with the other hand. If the pain felt by the patient is decreased or the strength is increased with the assistance the test is positive. [31] This test is described by Kibler et al [32] to establish the scapular retraction stabilization on the improvement of supraspinatus strength deficits in patients with SD. [33] [34]

Assessment of Surrounding Structures [ edit | edit source ]

The structures around the scapula can be assessed for pain, loss of function, soft tissue laxity and muscle power. [31]

The sternoclavicular (SC) and acromioclavicular (AC) joints should be assessed for instability. AC joint can be assessed for anterior-posterior (AP) laxity by mobilizing the acromion in an AP direction while stabilizing the clavicle. [31] [2] Manual muscle tests for rotator cuff/biceps muscles can be applied. The infraspinatus strength test shows good reliability to assess infraspinatus weakness due to SD. [8]

Muscle Tests [ edit | edit source ]

Three specific muscle tests that the clinician observes the scapula position and considers the scapular muscle weakness if the break in the position and scapular movement occurs are: [3]

• Manual resistance of the arm at 130° of flexion (for the serratus anterior) [35][36]
• Manual resistance of the arm at 130-150° of abduction (for the lower and middle trapezius) [35]
• Extension of the arm at the side (for the rhomboid) [37]

Core Evaluation [ edit | edit source ]

With the low row test, if core and hip strength facilitate the scapular motion can be assessed. The examiner stands behind the patient. The patient is asked to do slight arm extension and resist the movement of the arm into flexion. The same movement is repeated with gluteal muscle contraction. If the strength increase with gluteal contraction core/lower extremity strengthening can be added to the treatment plan. [3]

Outcome Measures [ edit | edit source ]

DASH is a measure that includes 30 items and assesses the disability and symptoms of the upper limb in patients with musculoskeletal disorders. [38]

Physiotherapy Management [ edit | edit source ]

Treatment of SD aims at the restoration of scapular retraction, posterior tilt and external rotation. Specific exercises for scapular rehabilitation are [8] :

Flexibility exercises: To increase the flexibility of the pectoralis minor and the external rotation and posterior tilt of the scapula, shoulder horizontal abduction at 90 degrees and 150 degrees of elevation. [39] [40] [41]

Stabilization exercises based on stretching and strengthening to optimize scapular kinematics, and improve muscle strength and joint position sense [42] [43] [44] : Closed and open kinetic chain exercises, including push-ups, lawnmower exercises, and resisted scapular retraction. [42] [44]