Wednesday, August 13, 2014
Thursday, May 8, 2014
As we get older, rotator cuff injuries become more common, a result of the natural aging process. A similar mechanism operates in the discs separating the vertebras in your lower back. These cartilaginous structures lose water over time, becoming less flexible and more brittle as the decades roll by. In the case of the shoulder, the rotator cuff tendon is pulleyed to and fro as the arm swings forward and back and up and down. As the years pass, this constant motion may cause fraying in the rotator cuff tendon and inflammation in the muscles that comprise the rotator cuff. Eventually, partial or full thickness tears may develop in one or more of these musculotendinous units, causing pain and some loss of function. Importantly, conservative care may be all that’s needed to reduce pain and restore needed motion.
The shoulder joint is beautifully designed and a marvel of engineering. Its construction makes possible a full 360-degree arc of motion in both the sagittal and frontal planes. In other words, you can swing your arm in a complete circle from front-to-back and to-the-side-and-up-and-around. In the third, horizontal, plane, 180 degrees of motion is available. The overall combination of movements in three-dimensional space makes the shoulder joint the most freely movable joint in your body. However, as with all freedoms we enjoy in this life, there is a price. The shoulder joint’s great mobility is countered by its very limited stability.
The shoulder’s lack of stability needn’t concern us in our average day-to-day tasks. Protection to the joint is built-in by way of the rotator cuff muscles, which form a strong hood that envelops the intersection of the arm bone and shoulder blade. Falling on an outstretched arm may result in a dislocated shoulder, so we need to have some care in this regard.
If you’re a young athlete and have suffered a rotator cuff tear, surgery may be an appropriate option. But for the vast majority of people, especially for those over age 40, most rotator cuff injuries are chronic rather than acute and can be treated with rest and rehabilitative exercise. Again, if you’re a 60-year-old skier who has torn his or her rotator cuff in a downhill accident, surgery could be indicated. For the rest of us, rehabilitative exercise is the key.
Four or five primary strength training exercises are involved in shoulder or rotator cuff rehabilitation. The three basic shoulder exercises are (1) seated overhead press, which trains all the shoulder girdle muscles simultaneously; (2) standing side [lateral] raise; and (3) seated or standing bent-over raise. The lateral raise specifically trains the middle deltoid muscle and the bent-over raise specifically trains the posterior deltoid muscle. Specific rotator cuff strength training exercises include internal rotation and external rotation on a flat bench using very light dumbbells. More painful injuries with greater loss of mobility may require (1) Codman pendulum exercises and (2) finger-walking (up a wall) to the front and to the side.
The goals of rotator cuff rehabilitation, as for any mechanical injury, include decreased inflammation, decreased pain, return to more full active range of motion, return to more full muscular strength, and restoration of function.
Wednesday, February 26, 2014
Back stretches can go a long way towards relieving the muscle tension that is the most common cause of back pain. Stretches for your lower back should be done carefully to avoid injury. Here are some simple lower back stretches that you can do at home; some of the stretches require a chair.
1) Cat StretchYou'll perform this stretch on the floor, on your hands and knees. Make sure your hands are positioned immediately below your shoulders and your knees are positioned immediately below your hips.
- Start by arching your back towards the ceiling. Drop your head and pelvis. Keep your legs and arms straight and strong.
- Return to your original position.
- Drop your belly toward the floor; lift your face and hips toward the ceiling. Keep your legs and arms firm.
- Repeat this stretching sequence five to ten times, breathing slowly and deeply throughout. Inhale as you lift your face toward the ceiling; exhale as you drop your head and arch your back.
2) Seated Torso Twist
You'll perform this stretching exercise in a chair. Be careful with torso twists; if you don't do them properly, you can injure your spine. Keep your spine straight and don't force your body into the twist; allow your spine to move into the twist on its own, and only as far as is comfortable.
- Sit upright in a chair with your palms on your thighs or knees. Your head should be directly above your shoulders and you should be balanced firmly on your pelvis.
- Twist to the left. Place your right hand on the outside of your left knee, but don't use the hand to exert any pressure; simply place it there. Your spine should be doing the twisting all by itself.
- Allow your head to move into the twist as well. Once again, don't force it.
- As you twist, look as far to that side just by moving your eyes. This makes the twist more energizing.
- Hold the twist for 20 to 30 seconds, breathing deeply and fully into the lower abdomen and lower back. When you're finished, repeat the twist in the other direction.
3) Seated Forward BendSome people like to perform this lower back stretch while seated on the floor with their legs extended in front of them. However, if you lack flexibility in your calves, hamstrings and lower back, you're better off performing this stretch while seated in a chair.
- Sit upright in a chair; keep your spine straight and your head held erect above your shoulders.
- Place your palms in your lap. Relax your shoulders and arms.
- Place your feet at least hip width apart; you may want to separate the feet even more. If your feet are further apart than the width of your hips, turn your toes in toward one another slightly.
- Inhale; when you exhale, lean forward over your thighs. Allow your hands to dangle on either side of your feet. Keep your shoulders relaxed and your neck elongated.
- Breathe deeply into your lower back. Hold this stretch for 20 to 30 seconds. Come up slowly, so that you don't pass out.
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