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Expert Q&A

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What kind of strength work won't aggravate rotator cuff issue?

Asked by Renee, Cincinnati, Ohio

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I can't do a pushup or pull-up because of rotator cuff and carpal tunnel issues. What kind of exercise moves can I do instead that will get me the same sort of gains? Thanks.

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Diet and Fitness Expert Dr. Melina Jampolis Physician Nutrition Specialist

Expert answer

Hi Renee -- I commend your desire to incorporate strength training into your exercise routine despite your injury-related limitations. I highly recommend that you consult with a licensed physical therapist to figure out the best approach for your specific requirements, but in the meantime, I consulted with licensed physical therapist Colman O'Leary of Active Care Physical Therapy in San Francisco, California, and he had some great insights.

A deep pushup is stressful on the rotator cuff, but a ½ -depth, slow and controlled pushup can be equally -- if not more -- effective at working a variety of muscle groups at once. Carpal tunnel pressure is significantly increased by 1) heavy gripping 2) deviation of the wrist from neutral-extreme flexion or extension (as in the wrist position during a pushup). So, you can try using bar handles to neutralize the wrist with a light grip, or try making a light fist and stabilizing the neutral wrist on a soft exercise mat. If the force of a full gravity/horizontal pushup is too much load for the cuff or wrist, trying a wall or 45 degree inclined pushup may be a good progression toward the fully loaded pushup. Most gyms have a seated fly machine that uses the forearms as a pressure point to avoid all gripping, and the depth of the motion can be adjusted to reduce rotator cuff stress.

A vertical pull-up requires heavy gripping and there is significant muscular stress on the rotator cuff, especially when "hanging" at the bottom of the motion. O'Leary has similar clients try a horizontal pull-up at home with a pull-up bar in a doorway (from lying on ground) or with a similar setup at the gym (lying on a bench with a fixed horizontal bar set up above). This significantly reduces grip requirements and dramatically reduces cuff stress.

Another option to the above is to use ankle weights wrapped around the wrist or forearm to eliminate stress on the carpal tunnel by avoiding any need for grasping a weight or machine handle. You can then incorporate arm raises in multiple directions and also perform a "chest fly" motion to work the pectoral muscles directly.

Finally, Thera-Bands may be used to exercise the upper body safely. Light resistance colors may be used to minimize the need for heavy gripping. To simulate a pushup, you can lie on the floor with a piece of band wrapped behind you at the shoulder blades. Then, grasping either end lightly, perform a bench press motion to exercise the same muscles as a pushup. To safely simulate a pull-up, the Thera-Band is first wrapped around a pole or bed post. Next, lightly grip either end of the band while performing a "rowing" motion to work the back muscles as in a pull-up.

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