NJB: Partial Rotator Cuff Tear: Phase 2 (3-12-18)

Email Follow UP
- No problem with current exercises but having some bicep pain with possible proximal bicep tendonitis
My reply
- It is common the bicep becomes irritated because it has excessive pressure on it when the rotator cuff is weak or not contributing to supporting the shoulder as much as it should
- I do recommend ice regularly to control bicep irritation
- You will notice this week we focus more on tricep activation trying to minimize pressure on the bicep
- Let me know if you have any questions or issues with the updates
Phase 2: Progressive Closed Chain Scapular Stabilization and Posterior Shoulder Activation
- This phase will focus on control of shoulder position to reduce compression of the bicep and superior aspect of the rotator cuff
- Emphasis on maintaining good scapular control while loading the antagonist or opposing muscles to the bicep including tricep and posterior rotator cuff
- It is once again imperative that you feel no pain or pressure in the top or front of the shoulder
  - `If you do feel any pain or pressure in the front or top of the shoulder, try to move very slowly to that point in the range and then quickly move out of that position
  - Emphasis on reps being slow and controlled to maintain control and tension in the correct areas with each rep taking 3-5 seconds IN EACH DIRECTION…that is really slow
  - If you do feel anything in the front or top of the shoulder, you may be able to decrease it by focusing on the shoulder blade position into a back and down pull
- This phase will add a new movement each day to assess if a certain movement causes pain that night or the next day
- Ice is recommended after each session 10-20 minutes
Goals:
- Minimize Irritation using ice as needed
- Avoid over stretching, this will likely cause significant pain
- Establish good scapular control which will be needed as the movements become more challenging
- Activate posterior rotator cuff and triceps
Day 1
- Shoulder Extension Mountain Pose VIDEO
  - Light movement full through motion without eliciting a strong stretch, remain short of any significant pulling
  - Goal: 5-20 reps slowly in pain free range
- Deep Neck Flexor Activation Head Supported Chin Tuck VIDEO
  - Establish cervical stabilization
  - Hold 5-10sec 10-20x
  - This can be done throughout the day and should be applied lightly to all strengthening movements
  - There is a progression within this video so you may progress as able through the 3 position options
- Prone Latissimus Extension Off Edge of Bed VIDEO
  - Initiation of posterior rotator cuff activation and scapular stabilization
  - Hold each 5sec and lower down slowly 5-20 reps
- Humeral Head Depression Isometric From Low Level->Overhead VIDEO
  - This can be done throughout the day lightly at low level
  - Focus on shoulder height or just below, sometimes having a thumb up position helps
- Laying Down Humeral Depression with Progression to Pec Stretch VIDEO
  - Progression to more of a stretch for the pec while activating scapular control
Day 2
- Shoulder Extension Mountain Pose VIDEO
  - Light movement full through motion without eliciting a strong stretch, remain short of any significant pulling
  - Goal:5-20 reps slowly in pain free range
- Deep Neck Flexor Activation Head Supported Chin Tuck VIDEO
  - Establish cervical stabilization
  - Hold 5-10sec 10-20x
  - This can be done throughout the day and should be applied lightly to all strengthening movements
  - There is a progression within this video so you may progress as able through the 3 position options
- Prone Latissimus Extension Off Edge of Bed VIDEO
  - Initiation of posterior rotator cuff activation and scapular stabilization
  - Hold each 5sec and lower down slowly 5-20 reps
- Humeral Head Depression Isometric From Low Level->Overhead VIDEO
  - This can be done throughout the day lightly at low level
  - Focus on shoulder height or just below, sometimes having a thumb up position helps
  - 10-20reps
- Laying Down Humeral Depression with Progression to Pec Stretch VIDEO
  - Progression to more of a stretch for the pec while activating scapular control
  - 10-20reps
- 73.1) Updated Band Tricep Extension VIDEO
  - 10-20 reps
  - Be aware of shoulder blade position, especially as you straighten your elbows. When elbows straighten the shoulder blades will want to tip forward as you get tired
  - Band can be attached up high with a knot in the middle and closed in a door, or one arm at a time with end of band closed in the top of door
Day 3
- Shoulder Extension Mountain Pose VIDEO
  - Light movement full through motion without eliciting a strong stretch, remain short of any significant pulling
  - Goal:5-20 reps slowly in pain free range
- Deep Neck Flexor Activation Head Supported Chin Tuck VIDEO
  - Establish cervical stabilization
  - Hold 5-10sec 10-20x
  - This can be done throughout the day and should be applied lightly to all strengthening movements
  - There is a progression within this video so you may progress as able through the 3 position options
- Prone Latissimus Extension Off Edge of Bed VIDEO
  - Initiation of posterior rotator cuff activation and scapular stabilization
  - Hold each 5sec and lower down slowly 5-20 reps
- Humeral Head Depression Isometric From Low Level->Overhead VIDEO
  - This can be done throughout the day lightly at low level
  - Focus on shoulder height or just below, sometimes having a thumb up position helps
  - 10-20reps
- Laying Down Humeral Depression with Progression to Pec Stretch VIDEO
  - Progression to more of a stretch for the pec while activating scapular control
  - 10-20reps
Day 4
- Shoulder Extension Mountain Pose VIDEO
  - Light movement full through motion without eliciting a strong stretch, remain short of any significant pulling
  - Goal:5-20 reps slowly in pain free range
- Deep Neck Flexor Activation Head Supported Chin Tuck VIDEO
  - Establish cervical stabilization
  - Hold 5-10sec 10-20x
  - This can be done throughout the day and should be applied lightly to all strengthening movements
  - There is a progression within this video so you may progress as able through the 3 position options
- Prone Latissimus Extension Off Edge of Bed VIDEO
  - Initiation of posterior rotator cuff activation and scapular stabilization
  - Hold each 5sec and lower down slowly 5-20 reps
- Humeral Head Depression Isometric From Low Level->Overhead VIDEO
  - This can be done throughout the day lightly at low level
  - Focus on shoulder height or just below, sometimes having a thumb up position helps
- Laying Down Humeral Depression with Progression to Pec Stretch VIDEO
  - Progression to more of a stretch for the pec while activating scapular control
- 73.1) Updated Band Tricep Extension VIDEO
  - 10-20 reps
  - Be aware of shoulder blade position, especially as you straighten your elbows. When elbows straighten the shoulder blades will want to tip forward as you get tired
  - Band can be attached up high with a knot in the middle and closed in a door, or one arm at a time with end of band closed in the top of door
- 79.2) Plank With Single Arm Holds High to Low VIDEO
  - Start with the weight shift onto each arm side to side progressing to a 5-10sec hold on each arm
  - Once again make sure you keep elbow tucked in and shoulder blade down
  - If you feel bicep pain stop and email me
Day 5
- Shoulder Extension Mountain Pose VIDEO
  - Light movement full through motion without eliciting a strong stretch, remain short of any significant pulling
  - Goal:5-20 reps slowly in pain free range
- Deep Neck Flexor Activation Head Supported Chin Tuck VIDEO
  - Establish cervical stabilization
  - Hold 5-10sec 10-20x
  - This can be done throughout the day and should be applied lightly to all strengthening movements
  - There is a progression within this video so you may progress as able through the 3 position options
- Prone Latissimus Extension Off Edge of Bed VIDEO
  - Initiation of posterior rotator cuff activation and scapular stabilization
  - Hold each 5sec and lower down slowly 5-20 reps
- Humeral Head Depression Isometric From Low Level->Overhead VIDEO
  - This can be done throughout the day lightly at low level
  - Focus on shoulder height or just below, sometimes having a thumb up position helps
  - 10-20reps
- Laying Down Humeral Depression with Progression to Pec Stretch VIDEO
  - Progression to more of a stretch for the pec while activating scapular control
  - 10-20reps
Day 6
- Shoulder Extension Mountain Pose VIDEO
  - Light movement full through motion without eliciting a strong stretch, remain short of any significant pulling
  - Goal:5-20 reps slowly in pain free range
- Deep Neck Flexor Activation Head Supported Chin Tuck VIDEO
  - Establish cervical stabilization
  - Hold 5-10sec 10-20x
  - This can be done throughout the day and should be applied lightly to all strengthening movements
  - There is a progression within this video so you may progress as able through the 3 position options
- Prone Latissimus Extension Off Edge of Bed VIDEO
  - Initiation of posterior rotator cuff activation and scapular stabilization
  - Hold each 5sec and lower down slowly 5-20 reps
- Humeral Head Depression Isometric From Low Level->Overhead VIDEO
  - This can be done throughout the day lightly at low level
  - Focus on shoulder height or just below, sometimes having a thumb up position helps
  - 10-20reps
- Laying Down Humeral Depression with Progression to Pec Stretch VIDEO
  - Progression to more of a stretch for the pec while activating scapular control
  - 10-20reps
- 73.1) Updated Band Tricep Extension VIDEO
  - 10-20 reps
  - Be aware of shoulder blade position, especially as you straighten your elbows. When elbows straighten the shoulder blades will want to tip forward as you get tired
  - Band can be attached up high with a knot in the middle and closed in a door, or one arm at a time with end of band closed in the top of door
- 79.2) Plank With Single Arm Holds High to Low VIDEO
  - Start with the weight shift onto each arm side to side progressing to a 5-10sec hold on each arm
  - Once again make sure you keep elbow tucked in and shoulder blade down
  - If you feel bicep pain stop and email me
Day 7
- Rest
- Follow up email commenting on your current progress