Rotator cuff injuries are a common reason why many people stop lifting or are extremely limited in what they can do related to working out their upper body. I’ve found through experience that a torn rotator cuff can be a problem that lingers and becomes more and more degenerative and stiff as time goes on. I’ve also learned that you can recover and regain much of the lost function if you understand how to train for regeneration once basic medical rehabilitation has run its course. I tore my right labrum within my rotator cuff in the late 90’s playing college football. I never had surgery for it and allowed time to do the healing. After about 8 years a significant loss in lot of range of motion strength was apparent. It got to a point where I couldn’t throw a football or shoot a basketball without pain let alone doing a bench or shoulder press. I had what the doctors called “frozen shoulder”. I went to physical therapy for it and they were very helpful in facilitating an increased range of motion over a couple months of treatment. A combination of stretching and message therapy were used to assist in getting my shoulder back to a state of functionality. During this time, I was also listening to a chiropractor who was teaching a series on exercises used to regenerate the shoulder cuff. I took many of the principles taught during that series to the gym with me as I set out to rebuild my strength and functionality in that shoulder. I developed a workout program for myself that incorporated these principles and I found it very effective. After about six weeks I could do bench press again and through a football like I did before the rotator cuff injury over 20 years ago. I had not done bench press in years. It wasn’t long before I was benching more than I did as a college football player. Now I am a believer. The rotator cuff can be regenerated and you can train the pain and discomfort away if you just understand the physiology of the rotator cuff.
The rotator cuff muscles include the supraspinatus, the infraspinatus, the subscapularis and the teres minor, all of which are innervated by the subscapular and axillary nerves. The tendons of the rotator cuff combine to form one large band that is a 5 layer-structure. Most of the tears that occur to the cuff are the result of chronic, ongoing degeneration that results from the coracoacromial arch. Others like mine was the result of a traumatic acute injury. Pain is going to be the most commonly noticed symptom of a rotator cuff injury and is usually located anterolaterally and superiorly. It will be aggravated during activities in which the arm moves into an overhead position or is in a flexed position directly in front of you. You may also notice weakness and stiffness. The most common medical treatments include surgery or at least local steroid injections. I took the physical therapy route and believe it is a viable one due to the results I experienced.
After a rotator cuff injury happens the body will go through the typical four stages of healing (hemostasis, inflammation, proliferation, and remodeling) which unfortunately leaves many of us in a state of limbo between the proliferation and remodeling stages. To understand why we must first understand the purpose of the second stage called inflammation. The purpose of inflammation is to create an environment where an abundance of fresh nutrients and oxygen carried by our blood flows into the injured area to facilitate healing. It’s the flow of blood through the rotator cuff that creates healing. We can take that to also mean that the lack of flow will slow the healing process. This part is very important to understand. Let’s think about what happens during traditional weight training that causes people with rotator cuff issues the biggest problems such as bench press, shoulder press, and lateral raises. These are the exercises that cause internal rotation in the shoulder. This internal rotation creates an impingement that is not only painful, but restricts blood flow. Let’s look at the mechanisms of blood flow.
The body has a network of extremely small blood vessels called capillaries. Their primary function deals with the exchange of oxygen, hormones, amino acids, glucose and lipids among other things. The exchange of certain nutrients at the capillary level is sometimes referred to as nutrient transfer. This blood flow through the capillaries remains relatively constant under resting conditions, but as soon as a muscle starts contracting, the blood flow is increased. It’s with these extremely small capillaries that the muscles are supplied with all the nutrients they need for recovery.
Your capillary-to-muscle-fiber ratio is expressed as the term capillary density. Obviously, the more capillaries you have within the muscular system, the better the nutrient transfer. Unfortunately, increased fiber area (hypertrophy) through heavy resistance training leads to a decrease in capillary density. This could be one of the reasons why weightlifters with a large amount of muscle mass take longer to recover than their less massive peers.
Based on the above information, it’s clear increased blood flow within the muscle will increase nutrient transfer, thus aiding recovery. We also learned that heavy resistance training decreases capillary density by increasing the fiber area without a subsequent increase in capillaries. So, the obvious question is if there’s a way to increase capillary density? The answer is yes, and It’s called endurance training!
Let’s think about what we can conclude taking all this new knowledge into account. We understand that we can use endurance training to increase blood flow, and understand that we need to encourage the opposite of internal rotation in the gym to avoid impingement. Let’s look at my three top exercises that I found helped me facilitated the most healing in my shoulder by pumping a massive amount of blood through the normally restricted rotator cuff muscles.
- Alternate dumbbell reverse grip front raises: Doing this exercise with enough weight to pull your shoulders down enough to create some space in the joint but light enough to allow you to do at least 20 reps 15 reps without losing form. Keeping the hands palms forward opens the shoulder where it would be impinged with a palms down traditional approach. It is even better than when the palms are facing each other with a hammer curl grip. As you start to fatigue around the 12th rep of the exercise the blood flow reaches its peak around the anterior deltoids region. Not only will you feel a massive shoulder pump after a couple set, but that pain normally resident in that region is feeling better. High reps with palms in supination are the key to creating an opportunity for healing.
- Reverse grip bench press: This is the first form of bench press I could do while recovering from my torn rotator cuff induced frozen shoulder. I credit this exercise for preparing my return to regular bench press and making way for me to push 405 pounds for the first time in my life. I could take some of the pressure off my shoulders and use more chest and triceps in the movement thanks to the reverse grip. The stronger the muscles are that surround my rotator cuff, the less of a load my shoulder must carry. This is an awkward feeling grip at first, so I highly suggest you have a good spotter with in the beginning stages of a program that includes reverse grip bench. You could also start off on the smith machine to be safe. That is where I started off before graduating to the free barbell.
3. Face Pulls: This is a great exercise to do at the beginning of you upper body workout. Many people who suffer from shoulder pain associated with a rotator cuff injury also suffer from a postural deviation called
pronated shoulders; also known as rounded shoulders. This situation is caused by tight muscles in the front of the shoulder pulling the joint forward. As the joint is pulled forward the rear deltoids and other back muscles are stretched beyond their normal length. Just like a stretched out rubber band it causes those back muscles to become weak and further compound the problem. Exercises like face pull work to activate the rear deltoid’s and surrounding back muscles while simultaneously stretching the muscles of the anterior deltoids and chest. This helps to restore balance to the joint and facilitates increased blood flow into the injured area. Correcting the posture is critical to restoring function to a shoulder recovering from a rotator cuff injury
There are many other exercises I’ve incorporated into my program that follows along these same logical lines and played a role in the recovery of function and mobility in my right shoulder. The positive part of going through the ordeal that was my frozen shoulder; is that I developed an understanding of how to reverse the biomechanical limitations induced by the condition. I hope this blog sheds some light on how I overcame my rotator cuff issues and can help you or anyone you may know dealing with similar issues. Rotator cuff injuries are so common now days that I would be surprised if you didn’t have at least one friend or acquaintance dealing with it as we speak. As a token of appreciate for taken the time to read my blog until the end, I designed a four-week rotator cuff recovery program just for you. The best part is that it’s free. I try to add value to the fitness community once or twice a week with an informative post on topics of value that I have personal and professional direct experience with. Subscribe to receive my blog post in the future and I’ll send you my rotator cuff regeneration workout program free.
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