Introduction
Rotator cuff injuries are common among throwing athletes, and rotator cuff surgery is a procedure that is often necessary to help these athletes regain their strength and mobility. After surgery, it is crucial to gradually strengthen and stretch the shoulder over several months to avoid re-injury and ensure a successful recovery. In this case study, we will discuss the ROM exercises, modified strength exercises, and routines that would be appropriate for a throwing athlete who has recently undergone rotator cuff surgery and is looking to return to their pre-season training program.
ROM Exercises
Range of motion (ROM) exercises are essential to any post-surgery rehabilitation program. In the case of rotator cuff surgery, it is vital to start with gentle and simple exercises that gradually increase in intensity and complexity over time (Maugeri et al., 2021). The activities that follow will be appropriate for this athlete:
- Pendulum Swings: The athlete should stand with their feet shoulder-width apart, lean forward, and let their injured arm hang down. The athlete should then use their opposite arm to gently swing their injured arm back and forth, side to side, and in circles. This exercise helps improve the shoulder joint’s flexibility and range of motion.
- Wall slides: Wall slides are a simple and effective exercise for the athlete to improve upper body mobility and posture. To perform this exercise, the athlete should be on their feet with their back on a wall, the feet apart with the space in between them about the width of the shoulders, and be at least six inches from the wall. Keep your hips, shoulders, and head against the wall. Once the arms extend over the head, slide them back down to your sides. Repeat this movement for several repetitions. Wall slides can help improve shoulder and upper back mobility, correct rounded shoulders, and promote good posture.
- Wall Climbs: The athlete should stand facing a wall with their injured arm raised to shoulder height and pressed against it (Maugeri et al., 2021). The athlete should then slowly walk their fingers up the wall, maintaining contact with the wall at all times until they reach as high as they can. The athlete should then slowly walk their fingers back down the wall. This exercise helps to improve strength and mobility in the shoulder joint.
- Passive Internal Rotation: The athlete should lie on their back with their arm outstretched to the side and their elbow bent at a 90-degree angle. The athlete should then use their opposite hand to gently rotate their injured arm inwards, towards their body, until they feel a stretch in their shoulder. This exercise helps improve the shoulder joint’s flexibility and range of motion.
Modified Strength Exercises
After several weeks of ROM exercises, the athlete can gradually progress to modified strength exercises. The following activities that follow are suitable for this athlete:
- Banded External Rotation: The athlete should sit with their elbow bent at a 90-degree angle and their upper arm pressed against their side. The athlete should then hold a resistance band with their injured arm and rotate their forearm away from their body, keeping their upper arm still (Maugeri et al., 2021). This exercise helps to strengthen the external rotator muscles of the shoulder.
- Prone Y Extension: The athlete should lie face down on a bench with their arm outstretched over the head and their thumb pointing upwards. The athlete should then lift their arm towards the ceiling, squeezing their shoulder blades together as they do so (Skinner et al., 2020). This exercise helps hat to strengthen the muscles of the upper back and improve scapular stability.
- Standing Cable Row: The athlete should stand facing a cable machine with a handle attached to the cable. The athlete should then pull the handle towards their body, squeezing their shoulder blades together as they do so. This exercise helps strengthen the back muscles and improve scapular stability.
- Range of motion exercises: They are critical in restoring shoulder joint motion. These exercises can include pendulum swings, shoulder shrugs, and wall slides (Skinner et al., 2020). The goal of these exercises is to improve the flexibility and movement of the joint of the shoulder while also minimizing pain and discomfort.
- Rotator cuff strengthening exercises: The muscles are critical in maintaining shoulder stability and proper mechanics (Skinner et al., 2020). Strengthening these muscles can help to reduce the risk of re-injury and improve overall shoulder function. Examples of the exercises include external and internal rotation with resistance bands, prone shoulder extension, and external shoulder rotation with a dumbbell.
Phases of Rehabilitation
After rotator cuff surgery, athletes must gradually strengthen and stretch their shoulder muscles to regain function and avoid re-injury. The rehabilitation program typically involves three phases:
- Phase 1 which runs from 0 to 6 weeks with exercises that include passive range of motion, light stretching, and isometric muscle-building exercises.
- Phase 2 which runs from 6 to 12 weeks with exercises that include a range of motion, practical activities, and continuous resistance exercises.
- Phase 3 to 12 to 16 weeks where the athlete can resume sports-specific activities and advanced strengthening exercises.
Conclusion
Here are two published training formats for athletes following rotator cuff surgery. The “Codman Shoulder Exercises” are designed to strengthen motion in the shoulders and promote healing after rotator cuff surgery (Skinner et al., 2020). These exercises involve pendulum swings, arm circles, and shoulder shrugs. The athlete can perform the Codman exercises during Phase 1 of the rehabilitation program. The “Thrower’s Ten Exercise Program” is designed to enhance strength and flexibility in the shoulder and rotator cuff muscles. This program consists of ten exercises: external rotation, internal rotation, scaption, and wall slides. The athlete can perform the Thrower’s Ten Program during Phase 2 and Phase 3 of the rehabilitation program.
References
Maugeri, G., D’Agata, V., Trovato, B., Roggio, F., Castorina, A., Vecchio, M., Di Rosa, M., & Musumeci, G. (2021). The role of exercise on peripheral nerve regeneration: from animal model to clinical application. Heliyon, 7(11), e08281. Web.
Skinner, B., Moss, R., & Hammond, L. (2020). A systematic review and meta-analysis of the effects of foam rolling on range of motion, recovery and markers of athletic performance. Journal of Bodywork and Movement Therapies, 24(3). Web.