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Rotator cuff tears are among the most common conditions affecting the shoulder. In 2010, close to two million people in the United States went to their doctors because of a rotator cuff problem. In this Ask the Doctor, Dr. Perkash addresses a question posed by a member of the TRX Community who was diagnosed with a possible rotator cuff tear. Question: In 2007, after working out three times a week with a personal trainer who emphasized heavy weight lifting, I developed severe shoulder pain and was diagnosed with a "possible" torn rotator cuff. After two cortisone injections in two years, I have been pain free. I have given up the weights for bands. Would TRX aggravate this condition, or are there specific exercises I could use for continuing rehab? Answer: The rotator cuff is a combination of four muscles in the shoulder: the supraspinatus, infraspinatus, subscapularis and teres minor. The function of the rotator cuff is to stabilize and move the shoulder joint, which is a ball (the humerus) and socket (the glenoid) joint. These muscles and others are responsible for movement of the entire shoulder girdle, which includes the shoulder blade (scapula) and the clavicle. Injuries to the rotator cuff are quite common, both with aging and with exercise and activities. Athletes who perform overhead activities such as those participating in football, baseball, tennis, weightlifting, volleyball and water polo are particularly susceptible to rotator cuff injuries. The rotator cuff can be injured due to a strain injury or trauma, or it can become inflamed due to chronic overuse such as with swimming or other repetitive motions of the shoulder. With aging, degeneration of the joints in the shoulder or formation of bone spurs can predispose to rotator cuff injuries. Degenerative changes can also occur in the nearby acromioclavicular joint, which can also cause shoulder pain. Diagnosis of rotator cuff injuries is usually clinical initially, but x-rays can show bone spurs and degenerative changes in the shoulder joints, and and MRI scan can reveal a potential rotator cuff tear. Treatment usually involves rest, ice, anti-inflammatory medications, physical therapy and rehabilitation exercises, cortisone injections and less commonly surgery to repair a significant rotator cuff tear. Small or partial tears can usually heal themselves with appropriate treatment, but full thickness tears usually do not heal and often require surgery to repair the rotator cuff. In someone who has had complete resolution of symptoms of a "possible" tear, the prognosis is quite good long term with appropriate rehabilitation and preventative measures. Overhead activities with heavy weights such as military press place the shoulder in a relatively unstable position and should be performed with caution, or only light weights should be used. Strengthening of the rotator cuff and shoulder girdle musculature can markedly reduce the risk of injury in the future. If the shoulder pain symptoms have completely resolved, there may not be any specific restrictions that are necessary. Anyone with a prior injury to the rotator cuff should clarify with his physician whether he needs to follow any specific restrictions given his individual situation. Check with your physician whether you have any specific restrictions with regard to your shoulder condition. The TRX Suspension Trainer is an excellent tool for strengthening the rotator cuff, improving functioning and performance and decreasing the likelihood of future injury. The following exercises are excellent for the ongoing rehabilitation of a previous rotator cuff injury and stabilize the shoulder girdle: - TRX Shoulder Series - TRX Swimmer Pull - TRX Biceps Curl - TRX Chest Press - TRX High Row Another good exercise for shoulder stability is the TRX Serratus Slide. Again, it is important to take guidance from your physician and physical therapist regarding exercise selection for your specific situation. For more on how to integrate TRX Suspension Training into your rehab/fitness programs in a way that's safe, scalable and effective for you or your patients, check out our TRX Sports Medicine Course. NOTE: Any medical information in this blog is of a general nature and not a substitute for the advice of a medical professional. If you need medical advice, see a doctor.
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Foto: Shutterstock RAMENI zglob je od velike važnosti za sve sportaše. Gotovo da nema aktivnosti koje ne uključuju neku vrtu pokreta u ramenom zglobu, bilo da uključuje bacanje, hvatanje, podizanje, guranje, udaranje… I upravo zbog toga, ozljede ramenog zgloba su relativno česte. Među njima se kao posebno česta ističe ozljeda rotatorne manšete ramena. Što je to točno i o čemu se radi? Krenimo od strukturalne građe ramena i građe i funkcije rotatorne manšete. Rameni zglob je najpokretljiviji zglob u našem tijelu; omogućuje pokrete nadlaktice u svim smjerovima – odmicanje i primicanje od i prema tijelu, kao i vanjsku i unutarnju rotaciju. Kako bi to bilo moguće, rame je anatomski građeno tako da je razmjerno velika glava nadlakticne kosti u doticaju s puno manjom zglobnom ploštinom na lopatičnoj kosti, a čvrstoću i stabilnost mu daje anatomska struktura koju nazivamo ROTATORNA MANŠETA RAMENA. Rotatorna manšeta je tetivno mišicna ovojnica koju sačinjavaju četiri mišića: subskapularis, supraspinatus, infraspinatus i teres minor. Sva četiri mišica polaze s lopatice i hvataju se na koštane izbočine nadlaktične kosti. Rotatorna manšeta ključna je struktura ramena, a funkcija manšete je dinamička stabilizacija glave nadlaktične kosti. Ovo znači da se ova četiri mala, duboko smještena mišića aktiviraju kako bi čvrsto držali zglobnu glavu nadlaktice u relativno plitkoj zglobnoj čašici lopatice, jer bi inače, pri pokretima ramena koji uključuju velike mišiće ramena, prsa i leđa, zglobna glavica jednostavno iskočila iz čašice. Zbog svog položaja i funkcije najčešeće dolazi do oštećenja tetive supraspinatusa (oko 90 posto), izolirano ili u kombinaciji s infraspinatusom. Tetiva subskapularisa puno rjeđe je podložena oštećenjima, pogotovo izoliranoj rupturi. Oštećenje tetiva manšete uključuje upalu tetiva (tendinits, tendinozu), parcijalnu i potpunu rupturu tetive. Upala tetiva zahtjeva konzervativno liječenje, a ruptura u većini slučajeva operacijsko liječenje. TEKST SE NASTAVLJA ISPOD OGLASA No, možemo li učiniti nešto da do ovoga ne dođe? Vježbe kao što su vanjska rotacija ramena direktno jačaju supraspinatus i infraspinatus, čime se rameni zglob učvrščuje u svim pokretima gdje je ruka podignuta iznad glave (pri čemu je rameni zglob u nestabilnom položaju, i stoga podložniji ozljedama). Bitno je da koristite vrlo male težine, i pokret izvodite polako. Cilj je da snažna, vanjska muskulatura (deltoidni mišići) ostanu gotovo neaktivni tijekom pokreta; velika težina, trzanje, zamah tijelom i "pumpanje" ne dolaze u obzir. Ne samo da vježba tako neće imati željeni efekt, nego riskirate i povredu upravo rotatorne manšete. Mala težina, lagano izvođenje pokreta, dvije serije u 12 - 15 ponavljanja. Preporučam da ovo izvedete u sklopu zagrijavanja prije treninga koji uključuje rameni zglob (dips, bench i military press, zgibovi). Ono što bi trebali osjetiti, je ugodno stezanje duboko u zglobu ramena, ispod deltoidnog mišića. Jačanjem rotatorne manšete, vaši rameni zglobovi postaju i ostaju stabilni i bez ozljeda.