Brian, in Wiltshire, England asks:
"Since childhood I have had frequent subluxations in both shoulders which I can pop back in. An orthopaedic specialist told me that my rotator cuff muscles were extremely weak and advised me to strengthen these with the physio. Could you suggest some exercises that might help me?"
Marc Bernier, Senior Physical Therapist, Director of Healthsouth Soccer International, replies:
"In cases of congenital instability of the glenohumeral joint of the shoulder complex (as appears to be the case in your situation), the primary treatment option is rehabilitation that focuses on strengthening of the rotator cuff musculature. The rotator cuff is a group of relatively small muscles that are located deep in the shoulder and surround the joint. The primary function of these muscles is to provide dynamic stability to the joint. The goal during rehabilitation is to enable the rotator cuff to provide enough dynamic stability to compensate for the lack of static stability that is usually provided by the ligaments in the joint (these ligaments become either stretched or torn during subluxations).
"There are many excellent exercises that can be performed to focus on the rotator cuff. These exercises consist of movements that must be performed with perfect form to ensure that the proper muscles are being isolated. In our facility, we also place a heavy emphasis on strengthening the scapular (shoulder blade) stabilizers; weakness of these muscles will result in a shoulder blade that tilts downward, further contributing to instability of the shoulder. It is also important to note that the rotator cuff is an endurance type of muscle group, and therefore requires the use of lighter weights and high repetitions. I typically start my patients with 3 sets of 15 repetitions, and will progress to 5 sets of 30 repetitions depending on the particular exercise being performed.
"The following are a sample of some of my favorite exercises for rotator cuff strengthening:
Sidelying External Rotation
Lie on side with arm resting on stomach and a small rolled up towel under the arm. Slowly rotate arm upwards and stop when forearm is in a position just above horizontal. This exercise can be initiated using a 2-3 pound dumbbell.
Prone Horizontal Abduction
Lie on stomach with arm hanging over side of table and the thumb facing forward. Slowly raise arm straight out to the side and stop when arm is parallel to the body (going higher can cause excessive strain to the front of the shoulder).
Prone Elevation in the plane of the Scapula
Begin in the same position as in the exercise above, except rotate your hand so the thumb is rotated 45° out to the side. Slowly raise arm in a plane 45° forward and stop arm just below parallel to the body (going higher can cause impingement of the rotator cuff).
Prone Row with External Rotation
Begin in the same position as above, except rotate your hand so the thumb is facing towards the body. Perform a rowing motion with the elbow in the same plane as the shoulder, and stop when the elbow is even with the shoulder. After achieving this position, rotate the arm upwards until the forearm is just below parallel with the body. Next, rotate the forearm back down to the previous position, and then lower the arm back down to the starting position.
External Rotation with Thera-tubing (surgical tubing)
Stand while holding the tubing across your abdomen, with a rolled towel between your arm and body. Slowly rotate arm out to side until hand is pointing straight forward, and hold for 3 seconds. Slowly return to start position. It is important that the elbow is kept at a 90° angle throughout the motion; the motion should simulate sliding your forearm on top of a table.
Horizontal Abduction with Thera-tubing
Stand facing toward the attachment site of the tubing, with the arm extended straight out in front of you. Slowly pull arm backwards and out to the side, keeping the arm at shoulder height. As you perform this motion, try to pinch the shoulder blade backwards/inwards.
Rows with Thera-tubing
Hold ends of tubing in each hand. Perform rowing motion backwards, keeping elbows elevated at least 60° away from body. When elbows are approximately ½ of the way to the body, complete the motion by pinching the shoulder blades together.
Standing Elevation in the plane of the Scapula
Stand with dumbbells in your hands, with hands rotated 45° out to the side. Slowly raise arms at 45° angle approximately ¾ of way above head.
"It must be stressed that all exercises performed with dumbbells must be performed with light weights (2-3 pounds); using heavy weights will strengthen the larger muscle groups more (deltoids, lats) resulting in a possible muscular imbalance.
"These are just a small sample of exercises that can be performed. While all of these are very good at isolating the rotator cuff, not all may be appropriate to perform initially during the program."