Paging Dr Rich-In-Tampa

[LeatherneckPA]

Hey Rich, the usual disclaimers are in place. But I have a quickie question, see if it makes any sense to you.

After my PT for the rotator cuff I was told to do lots of push-ups. These started out on an exercise ball against a wall and moved to flat on the floor. At the time I was 378 pounds and according to the scale, in a push-up position I was putting 312 pounds of stress on my shoulder. The last thing the PT told me on my release was "Do not EVER do bench presses!"

What's up with that? Seems like the same kinesthetic process to me. And bench pressing lets me start REALLY light (45 pounds) and work my way up gradually (currently only 120 pounds).

 

[Rich_by_the_Bay]

After my PT for the rotator cuff I was told to do lots of push-ups. These started out on an exercise ball against a wall and moved to flat on the floor. At the time I was 378 pounds and according to the scale, in a push-up position I was putting 312 pounds of stress on my shoulder. The last thing the PT told me on my release was "Do not EVER do bench presses!"

This is well outside my area of expertise, I'm afraid.

Here's a patient handout excerpt I find useful for rotator cuff strains/tendonitis:

Patient information: Physical therapy for rotator cuff injuries

Bruce C Anderson, MD , (c) Uptodate

The literature review for version 15.1 is current through December 2006; this topic was last changed on December 6, 2004. ...

These materials are for your general information and are not a substitute for medical advice. You should contact your physician or other healthcare provider with any questions about your health, treatment, or care. ...

The rotator cuff is composed of four muscles that attach by tendons to the upper arm bone (the humerus). Because of their location in the shoulder, the rotator cuff tendons are very susceptible to injury, either due to chronic wear and tear or to an acute insult (such as falling on an outstretched arm). Rotator cuff tendinitis (inflammation of the tendons) is one of the most common causes of shoulder pain. With significant injury, the tendons can actually tear.

Physical therapy plays a major role in the active treatment and rehabilitation of rotator cuff injuries. You can enhance your chance of recovery with the following:

Antiinflammatory therapy
Heat and massage
Stretching exercises
Muscle toning exercises
Activity limitations

The length of time exercises are used in the rehabilitation process varies. Two to four weeks is a minimum (the time course for most injuries), but this could be up to several months for rotator cuff tears. Patients with chronic tendinitis, who are unresponsive to treatment and are not good candidates for surgery, may need to perform stretching and toning exercises (see below) three times per week indefinitely.

ANTIINFLAMMATORY THERAPY — Ice can be used to reduce the inflammation that is usually associated with injuries of the rotator cuff. Ice packs should be applied over the outer shoulder to include the cap and upper deltoid muscle for 15 to 20 minutes every four to six hours. The response to ice is variable since the rotator cuff tendons are located deep in the tissues. Thus, an antiinflammatory medication may be necessary if you are having considerable pain.

HEAT AND MASSAGE — Heat and massage help prepare the tissues for stretching and should be performed prior to exercise sessions. The preferable method of heating is in a warm shower or bath for 10 to 15 minutes. Local heat (for example with a moist heating pad or a towel warmed in a microwave) is an alternative, but generally not as effective because of the deep location of the rotator cuff tendons.

STRETCHING EXERCISES — The weighted pendulum stretching exercise performs two functions:

Gently stretches the space in which the tendons pass to relieve pressure on the tendons
Prevents the development of a frozen (stiff) shoulder
This exercise can be started almost immediately after a shoulder injury, or approximately four days after receiving a steroid injection into the shoulder joint.

The exercise is performed as follows (show figure 1):

Relax your shoulder muscles
While standing or sitting, hold a 5- to 10-pound weight in your hand (a filled gallon container weighs 8 pounds) and keep your arm vertical and close to your body (bending over too far may pinch the rotator cuff tendons).
Allow your arm to swing back and forth or in a small diameter circle (no greater than 1 foot in any direction).
This exercise should be performed after heating for five minutes once or twice per day. As your symptoms improve, the diameter of swing may be increased somewhat.

A properly performed pendulum stretch exercise may cause a deep, achy pain in the armpit or down the inner aspect of the arm.

MUSCLE TONING EXERCISES — Muscle toning exercises are necessary to improve shoulder muscle strength, which helps prevent further injury. These exercises can be started approximately one to two weeks after beginning the pendulum stretch exercises, after the acute inflammation has resolved, or approximately three to four weeks after having a steroid injection into the shoulder joint. Don't begin these exercises too soon or your condition may worsen.

The joint should always be heated and stretched (as outline above) prior to beginning toning exercises. Following a two or three minute rest, perform sets of 15 to 20 exercises daily, each held for five seconds. Flexible rubber tubing, bungee cords, or large rubber bands are used for each exercise (show figure 2).

Outward rotation exercise — Hold your elbows at 90 degrees, close to your sides. Grasp the rubber band with your hands and rotate your forearms outward only two or three inches, holding for five seconds.
Inward rotation exercise — Hold your elbow at 90 degrees, close to your side. Hook the rubber band onto a door handle and grasp with only one hand. Rotate your forearm inward two or three inches and hold for five seconds. The forearm swings like a door.
Lifting exercise — Bend your elbow to 90 degrees. Place the rubber band near the elbows and lift your arms up four or five inches away from the body, holding for five seconds.
Mild soreness should be expected with these exercises. Sharp or severe pain may indicate a flare of the underlying problem; stop these exercises for a few days if this occurs.

ACTIVITY LIMITATION — Restrict lifting, reaching outward, and overhead reaching as much as possible. It is safest to keep the arm down and in front of and close to the body:

Lift objects close to the body.
Only lift light weights and below shoulder level.
Do sidestroke or breaststroke when swimming.
Throw balls underhand or sidearm.
Do not overhand serve in tennis.
Maintain good posture with writing, assembly work, etc.

WHERE TO GET MORE INFORMATION — Your healthcare provider is the best source of information for questions and concerns related to your medical problem. Because no two patients are exactly alike and recommendations can vary from one person to another, it is important to seek guidance from a provider who is familiar with your individual situation....

A number of web sites have information about medical problems and treatments, although it can be difficult to know which sites are reputable. Information provided by the National Institutes of Health, national medical societies and some other well-established organizations are often reliable sources of information, although the frequency with which they are updated is variable.

National Library of Medicine
(www.nlm.nih.gov/medlineplus/healthtopics.html)


American Physical Therapy Association
(www.apta.org/rt.cfm/Consumer)
...

GRAPHICS


Pendulum stretch exercise

Weighted pendulum stretch exercise

A weight of 5 to 10 pounds is held lightly in the hand (a filled gallon container weighs eight pounds). The muscles of the shoulder should be relaxed! The arm is kept vertical and close to the body (bending over too far may cause pinching of the rotator cuff tendons). The arm is allowed to swing back and forth or in a small circle (no greater than 12 inches (30 centimeters) in diameter). A properly performed stretching exercise may cause a deep achy pain, either in the armpit or down the inner aspect of the arm. This exercise can be performed just as effectively while sitting. The exercise should not be performed in people with acromioclavicular separation, glenohumeral dislocation, and hypermobility. Courtesy of Bruce C Anderson, MD.

Shoulder strength exercises

Strengthening exercises for the rotator cuff tendons

Part A: The inward rotation isometric exercise is performed by holding the elbow at 90º, close to the side. The rubber band is hooked onto a door handle and grasped with the hand. The forearm is slowly moved towards the body two to three inches, and held for five seconds. The hand should not rotate as the forearm moves.
Part B: The outward rotation isometric exercise is performed with the elbows at 90º, close to the sides. The rubber band is grasped with the hands. The formearms are moved outward two to three inches and held for five seconds. Sets of 15 to 20 exercises, each held for five seconds, should be performed daily. Courtesy of Bruce C Anderson, MD.

 

[Moemg]

The worst thing you can do after rotator cuff surgery is any exercise that has you lifting your arm above your head .It puts too much strain on the repair.

 

[LeatherneckPA]

OK Moemg, I understand that part. But what I don't understand is why pushups ar good, but bench press is bad. Seems to me they are the same exercise.

 

[dumpster56]

OK Moemg, I understand that part. But what I don't understand is why pushups ar good, but bench press is bad. Seems to me they are the same exercise.

I told you to stop throwing that curve ball during those softball games!! 8)

 

[Moemg]

OK Moemg, I understand that part. But what I don't understand is why pushups ar good, but bench press is bad. Seems to me they are the same exercise.

They are differnt in the way they affect the rotation of your shoulder. Use your good shoulder and try it .You'll feel the differnt pulls each exercise gives.The bench press puts too much strain on the repair.