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I just got a new client who informed that both of his rotater cuffs are torn. From My understanding, it seems as though I should avoid all upper body exercises so that I don't injure them further.

I also know that external rotations are used for prehab to strengthen the shoulders before they get hurt, but can this exercise be used once the damage has been done? Can I help this client gain some strength in his shoulders using external rotaions?

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Did your client already have physical therapy? If not, that would be a good place to start. All rotator cuff tears are not equal. The tears can be partial or full thickness. They can involve any or all of the muscles so what works for one does not necessarily work for all. –  BackInShapeBuddy Jan 28 at 20:34
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I'm going to caveat this answer by informing you I am not a physical therapist. The routine I'm linking to is from the American Academy of Orthopedic Surgeons: Rotator Cuff Shoulder Conditioning Program. Some high points are:

  • The rotator cuff needs to heal. If your client has pain dealing with any of the exercises outlined, don't do them.
  • Strengthening all the muscles surrounding the rotator cuff will help the shoulder stability and prevent the rotator cuff from having to bear the weight it bore when it tore.
  • Keep any resistance light.
  • There's a lot more movement patterns than external rotation needed to rehabilitate the rotator cuff--though external rotation is certainly in the selection.

You really do need to interact with your client's doctor (with your client's permission) to determine the extent of the damage, and the doctor's recommendations. How soon the client can resume exercise and the type of exercise really depends on how bad the tear is. If it's a minor tear, then rehabilitation can start pretty soon. However, if it's a major tear you may need to just rest it for a while.

Another article that may be useful discusses whether physical therapy can prevent the need for surgery in bad cases. NOTE: in many cases it can (even full thickness tears). Good rehabilitation requires the following:

  • Restore shoulder mobility
  • Restore shoulder stability
  • Reduce the impact of the kinetic chain (i.e. correct any impingement or dysfunction in the shoulder).
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