A practical guide to Rotator Cuff Rehab
•
10 likes•2,533 views
The document provides an overview of rotator cuff rehabilitation. It discusses that the rotator cuff has different roles as a stabilizer and torque producer depending on the position of the shoulder. Rehabilitation should focus on improving control, proprioception, timing, loading through the range of motion, and endurance. Exercises should incorporate the kinetic chain and provide rotational control and loading through the full range of movement.
Recommended
More Related Content
What's hot
What's hot (20)
Viewers also liked
Viewers also liked (20)
Similar to A practical guide to Rotator Cuff Rehab
Similar to A practical guide to Rotator Cuff Rehab (20)
More from The Arm Clinic
More from The Arm Clinic (11)
Recently uploaded
Recently uploaded (20)
A practical guide to Rotator Cuff Rehab
- 1. A Practical Guide to Rotator Cuff Rehabilitation Julia Walton Specialist Shoulder Physiotherapist Manchester Shoulder Clinic & Wrightington Hospital
- 2. 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………
- 3. ●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
- 4. ●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
- 5. 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!
- 6. 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
- 7. 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
- 8. 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?
- 9. 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?
- 10. ● 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?
- 11. 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?
- 12. Key components for RC exercises ● Proprioception ● Kinetic chain ● Rotational control & loading through range
- 13. Which exercises? Consider their value
- 14. 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
- 17. 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
- 18. 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!
- 19. 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!
- 25. 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