The Hamilton Spectator - - GO - ERNIE SCHRAMAYR Ernie Schramayr, CPT, is a Med­i­cal Ex­er­cise Spe­cial­ist in Hamilton who helps his clients man­age med­i­cal con­di­tions with ex­er­cise. You can fol­low him at ErniesFit­nessWorld.com. 905-741-7532 or erniesfit­nessworld@gmail.com.

Last week, I re­ceived an email from a lo­cal physi­cian that sim­ply said ... “We need Med­i­cal Ex­er­cise Spe­cial­ists in our of­fices!”

It in­cluded an ar­ti­cle from PubMed, an on­line re­source for med­i­cal lit­er­a­ture, re­search jour­nals and book ci­ta­tions. It was from “The Jour­nal of Orthopaedic and Sports Phys­i­cal Ther­apy” and dis­cussed the role that ex­er­cise plays in pre­vent­ing and re­cov­er­ing from shoul­der in­juries; specif­i­cally ro­ta­tor cuff tendinopa­thy.

Tendinopa­thy refers to dis­ease within a ten­don, of­ten in­clud­ing in­flam­ma­tion, pain and weak­ness. With an af­fected ro­ta­tor cuff, paint­ing a ceil­ing, reach­ing into a sleeve or throw­ing a ball can be very dif­fi­cult.

The ar­ti­cle en­ti­tled “Ro­ta­tor Cuff Tendinopa­thy: Nav­i­gat­ing the Di­ag­no­sis-Man­age­ment Co­nun­drum” says that peo­ple with shoul­der pain that par­tic­i­pate in a well­struc­tured, grad­u­ated ex­er­cise pro­gram can ex­pe­ri­ence the same im­prove­ment in symp­toms that had been seen in sur­gi­cal tri­als. Fur­ther­more, par­tic­i­pants also re­ceive the ad­di­tional ben­e­fits of ex­er­cise such as less sick leave, faster re­turn to work and re­duced costs to the health-care sys­tem.

One point of em­pha­sis is the idea that an “un­der­used” ten­don may suf­fer, just as an “overused” one will. To max­i­mize strength one needs to find balance. Too much stress isn’t good and now we know that too lit­tle stress can also be prob­lem­atic.

The prin­ci­ples guid­ing ex­er­cise for ro­ta­tor cuff tendinopa­thy as out­lined in the jour­nal ar­ti­cle are:

1. Rel­a­tive rest. In the case of the ro­ta­tor cuff, rel­a­tive rest means that you re­main ac­tive on the whole, while al­low­ing your shoul­der to rest. This means that you should con­tinue with your daily ac­tiv­i­ties to main­tain your gen­eral health and fit­ness. Part of rel­a­tive rest might in­clude the use of a sling or tap­ing of the area for sup­port. When I went through shoul­der surgery last year, it meant that I wore a sling and did lots of hik­ing in­stead of work­ing out in the gym.

2. Mod­i­fi­ca­tion of painful ac­tiv­i­ties. Ar­rang­ing a work sta­tion or kitchen to min­i­mize reach­ing over­head is an ex­am­ple. If you are a swim­mer; switch­ing to the breast stroke from the front crawl would be help­ful and an ex­am­ple of mod­i­fy­ing an ac­tiv­ity rather than stop­ping it al­to­gether.

3. An ex­er­cise strat­egy that does not in­crease pain. This be­gins with the use of “iso­met­ric” ex­er­cises to strengthen the shoul­der from sev­eral dif­fer­ent an­gles. Iso­met­ric means con­tract­ing a mus­cle with­out mov­ing it through a range of mo­tion. Imag­ine push­ing your arm out to the side against a wall for a 5 count. Due to the risk of in­creas­ing blood pres­sure, how­ever, peo­ple with hy­per­ten­sion should avoid do­ing iso­met­rics and in­stead should start by us­ing lim­ited range of mo­tion ex­er­cises with light re­sis­tance bands.

4. Con­trolled reload­ing. Once in­flam­ma­tion and pain have been re­duced and some strength has been re­stored, it is time to start in­creas­ing the de­mand that you place on your shoul­der by us­ing weight re­sis­tance ex­er­cise in a safe and ef­fec­tive way. Most strength move­ments will limit over­head ac­tiv­i­ties at this point and will fo­cus on the ro­ta­tor cuffs and the up­per back mus­cles around the shoul­der blades. An im­por­tant con­sid­er­a­tion at this point is to note the pres­ence of “night pain.” If your shoul­der keeps you up at night and/or you can­not sleep on it, then it is likely that you have gone too far, too fast and you’ve in­flamed the area. Slow down, take a step back and move for­ward at a more rea­son­able pace.

5. Grad­ual pro­gres­sion from sim­ple to com­plex shoul­der move­ments. This means that things like press­ing over­head and sport­ing ac­tiv­i­ties like throw­ing or swing­ing a club can grad­u­ally be added back into a strength rou­tine.

Last year I un­der­went shoul­der surgery to re­pair both old and new in­juries. I went through all of the stages above and am now back to do­ing the ac­tiv­i­ties that I did be­fore my op­er­a­tion. The bot­tom line is that we now have ev­i­dence that move­ment is bet­ter than in­ac­tiv­ity both for pre­vent­ing dis­ease and for restor­ing full health af­ter tendinopa­thy has been di­ag­nosed.


There is ev­i­dence that move­ment is bet­ter than in­ac­tiv­ity both for pre­vent­ing dis­ease and for restor­ing full health af­ter shoul­der in­jury has been di­ag­nosed.

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