Brian Schiff’s Blog
Injury Prevention, Sports Rehab & Performance Training Expert
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Tightness in the hip flexors is very common. If you have a job that requires extensive sitting or spend lots of time cycling, this may be a problem area for you. Stiffness can limit gait mechanics and optimal movement patterns thereby putting undue strain on the lower back. Below is a simple corrective exercise that can be done routinely to help improve flexibility using a sliding disc.
The last two weeks I have continued to see progress with my strength. My “shrug sign” lifting up my left arm is improving and now most noticeable when lifting my arm out to the side at 80 degrees and beyond. I have seen a steady increase in lifting capacity for my biceps and triceps but am still down more than 50% compared to my right side overall in strength.
New accomplishments
- Able to reach behind my head and wash my hair
- Able to drive and turn the steering wheel with just my left arm
- Begin wall push-ups and single arm rows
Remaining limitations
- Reaching up behind my back
- Unable to lay/sleep on left side
- Decreased elevation and external rotation
I have learned that the shoulder is still vulnerable if I do too much activity or push it too hard with the stretching. Generally, I stick to no more than 4/10 pain when doing passive stretching myself. In therapy, I have been just trying to block out the pain and endure the stretching even when it goes beyond that level. Last week, I had difficulty sleeping the same night following both of my PT sessions. I felt as if the PROM performed by the PT was more intense than it has been. While I was able to tolerate it during the session, the shoulder was increasingly sore and tight the same day after both sessions.
For those following my rehab journey, this entry will recap days 8-14 after surgery. At this point, I had been off pain meds for 4 days. However, I will admit I took one pain pill prior to my first PT session exactly one week out from surgery. For two decades I have listened to patients recount stories of their own or friends who report how painful therapy is after this surgery. Oddly enough, most of my patients over the years said it was not so bad. Perhaps, there is great variability in the intensity of the passive stretching among therapists.
Research Nuggets
The literature offers support and caution for early motion after rotator cuff repair. While ROM is generally better early on with early motion, there is some concern about higher re-tear rates. I am in the camp that gentle early passive range of motion (PROM) is okay given the proper regimen and patient compliance. Early active range of motion (AROM) or too vigorous PROM is likely to be more detrimental to the repair. Ultimately, these decisions are made based on the size of the tear, tear configuration, patient’s health and age, MD preference and whether or not this is a primary or revision repair.
The article abstract below is a great reference for activities and activation of the rotator cuff as measured by surface EMG to provide some insight for patients and clinicians regarding safe movement and exercise in the rehab process:
https://pubmed.ncbi.nlm.nih.gov/28704624/
In addition, here is another article that outlines post-op rehab (you can download the entire article for free)
https://pubmed.ncbi.nlm.nih.gov/29399735/
My First PT Visit
So, I would be lying if I said I was not nervous. I mean I was always the guy stretching the fresh post-op shoulders, and suddenly I am the one laying on the table a week out from surgery about to let someone move my stiff, sore shoulder. Fear of the unknown is probably the worst in that moment. My therapist is a colleague in my own clinic who actually reports to me. No pressure on him, right? LOL
He and I agreed to co-pilot my rehab and map everything out through constant dialogue and feedback. He has done a good job thus far. That first day the shoulder felt like a cement block to me. It seemed like super glue was preventing it from moving much. The focus was on gentle external rotation and flexion range of motion. Both hurt, but the flexion was by far the worst for me.
After doing pendulums and the PROM with him, my routine consisted of:
- Seated passive external rotation using a cane on my own – 2 sets of 15
- Scapular retraction (gentle squeezing of the shoulder blades together) – 2 sets of 15
- Seated table slides with a towel – 2 sets of 15
- Game Ready x 15 minutes with low compression
At times, athletes I work with have shoulder or low back pain that is related to restrictions in the thoracic spine. Rotational sports rely upon adequate mobility in the thoracic spine to ensure proper force transmission throughout the body’s kinetic chain. This exercise featured in one of my recent PFP online columns is a nice corrective exercise or mobility drill that can be used to optimize t-spine mobility and resolve any asymmetries.
Keep in mind that forcing through pain or stiffness is not advisable. This exercise can be done daily or as part of the warm-up routine.
Eliminating tightness in the TFL can reduce tension in the IT band as well as reduce knee pain associated with Runner’s knee or patellofemoral pain syndrome. Foam rolling prior to stretching is a good idea, but I think this stretch is a good one for all runners to add to their toolbox whether it be prior to or after a run. Check out the stretch from my online PFP column below:
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