Hey everyone, welcome back to PR1ME Time. This is Dr. Chad Kuntz, and as always, thank you so much for tuning in. I'm really excited to talk to you guys today about how you can help yourself return back to playing golf and/or tennis after a rotator cuff surgery. In fact, quite a few people end up having to, unfortunately, have a rotator cuff surgery as we get older. And I pick both those sports. It's kind of a country club kind of idea. You know, you're signed up as a member to one these country clubs, golf, and tennis, they're both sports that you can really truly play without really any age limit. You know, golf specifically, it's one of those fun things you want to try to shoot your age one day, right? So if you're 80, you're trynna, you know, shoot an 80 score, and tennis, there's even different leagues as you get older.
So it's just one of those things that a couple of those sports that you can just continue to play as you get older, it keeps you active, keeps you socially active, keeps your head with it, keeps you moving. And so, I want to help you guys, you know, continue to play both those sports even after sustaining a rotator cuff surgery. As you can imagine, and maybe as you are kind of going through it. Depending where you're at, you might be starting to ask yourself, "Man, I'm not so sure I can even play those two sports again because those sports both are so heavily demanding on my shoulder to actually do what they need to do." And, rotator cuff surgeries are really intense. Okay. Rotator cuff surgeries are very, very challenging. I worked with what feels like hundreds, if not maybe thousands at this point, of rotator cuff surgery repairs or protocols.
And honestly, some of the challenging components about it, it's because everyone is a little bit different. You got to take into consideration that the injury you had, your athletic, your athleticism, your range of motion, your strength, the quality of that joint, all of those factors go into the surgery, make a pretty significant impact. And then the surgery themselves, I feel like, the surgery themselves are consistently changing. We're kind of in this time period where different surgeons are playing with different types of protocols and different types of ways to perform the surgeries. So, you're going to get, you know, a little bit of a different angle on that. And then also, I have to kind of do justice to inform you that, you know, not every rotator cuff tear is created equal, right?
They really divide them, and I'm not going to get too far into it, but, they divide the rotator cuff tear into length and width, length would be, you know, small, it would be less than one centimeter. Medium would be between one to three centimeters. Large would be between three to five centimeters, and massive would be greater than five centimeters. So, there's a length component that you've gotta be considerate of. And then there's also a depth component. If I remember, I want to say the depth was either less than one centimeter, which was small, medium would be between one to three centimeters, and a large depth rotator cuff tear would be between three to five. And then, you know, furthermore divided into different types of classifications. So you have to kind of think through that. Now, the good news in terms of simplicity is that most of you, if you had a rotator cuff tear, hopefully, most of you it would be only or isolated to the supraspinatus. So, the supraspinatus is a muscle that sits kind of on top of the shoulder. It's your primary muscle that helps drive your elbow up and away from your body into what I call abduction, and it does some rotation as well, it does some externor rotation.
Now, typically that is a rotator cuff tear. Or that is a rotator cuff that's involved solely in the tear. The next level up, if you really did a good one, you'd also have a tear in the infraspinatus, that's usually round number two. And round number three would actually be the teres minor. Okay? So that's if you really did a massive tear. And if you did the complete shebang, you really did it all, you'd have the subscapularis involved too. Alright, so, rotator cuff tear surgeries and getting you back to playing those two sports with golf and tennis. Now, first off, just to get range of motion, just to get, I'm not gonna even say pain-free range of motion, but just to get full range of motion, where you can actively lift your arm up above your head. We're looking at usually 12 weeks. All right?
We're looking at 12 weeks just for you to be able to get your arm all the way up overhead. And, I've talked to, you know, quite a few surgeons and some of my clients and they say, you know, "My doctor said I really shouldn't even expect to get all the way up overhead in terms of my range of motion again." So, I think, you know, the pain is just so intense for most of my clients following that surgery. Some of you are lucky, you know, some of you get through with it and you're like, well I'm moving pretty good. It's not a problem. But, most of the time, the pain in the shoulder is very intense when trying to get into overhead motion again. I feel like you have to be somewhat crafting to kind of work with the joint to try to get into pain-free overhead motion as much as possible.
The slings make it tough. I feel like a lot of people are having trouble sleeping at night, which doesn't help with the recovery process, and people are just generally uncomfortable because most often it's even their dominant arm and the arm is kinda stuck in the sling. But, nonetheless, guys, we're looking at about 12 weeks to have full range of motion, and you should be incorporating some level of some strengthening exercises, usually around two months post-op. And again, there are varying different degrees, but we're looking somewhere around six to eight weeks after you had your surgery that you're starting to incorporate some at-home strengthen-base exercises. What we're really here to talk to is what's after that, what's required after you just get your full range of motion. And as you'll hear with a lot of my stories on podcasts, and as you just hear me out, getting your confident in that sport-specific range of motion is so important, and we've got to justify it.
We've got to be able to justify it mechanically that you can, you know, swing your arm as fast as you want. Let's just use a tennis serve, for example, that's a really aggressive move for the rotator cuff. So, as you go to toss the ball and as you go to reach up to swing that, and your arm's way overhead, your rotator cuff, remember, has a purpose to compress the joint and depress the joint. So, you can see, if you're watching this on a visual, you can see my hand's away from my femur, excuse me, from the head of the shoulder. It pulls it down, it pulls it, if you can imagine this on the podcast, if you're listening in, it pulls the head of the shoulder down away from the acromion so it actually gives you that space, and we need to keep that space as you reach up overhead.
A lot of post rotator cuff surgery clients who are trying to get back to playing tennis and golf, they have trouble with that overhead move because if the rotator cuff isn't firing properly, if it's not strong enough, if it hasn't learned to kind of co-activate and co-stabilize, the head of your shoulder will actually slide up north. It can run into problems like the subacromial bursa, subdeltoid bursa, hopefully they've done debridement near the surgery so there's no osteophytes or bone spurs hanging off, but, you could potentially kind of start banging back up into that acromion in the future, causing yourself another bone spur.
So, getting the shoulder and the rotator cuff to actually fire and get strong overhead is going to be incredibly important for you, particularly with the tennis serve. Now, with regards to golf, when you go into the backswing, the rotator cuff has to shorten and you have to have a lot of range of motion when you're golfing and you go into your backswing. If you take a look at a professional golfer, when they go back into the backswing, they have about 80 to 90 degrees. That can be very challenging in my experience for a lot of rotator cuff surgeries for you to get to that full motion. I find though, that there's a lot more guarding than there actually is mechanical justification for you to not get into that end range of motion. Meaning, it's not like you've got a bony block or something that limits you from going there.
A lot of times, this is musculoskeletal, that your muscles like your lats, like your pecs, heck, even your anterior delt. These muscles get really tight, and they don't allow the head of that shoulder to move where it needs to. It kinda locks it up, if you could imagine gears to the watch, right? The gears work all together in order for that watch to tick. It's kinda like putting a monkey wrench in between that and all of a sudden it can't move and you just find yourself stuck, and you're thinking to yourself, well, maybe something went wrong with the rotator cuff surgery itself, or maybe he didn't clean it out right. Now, a lot of times the body is very protective. It's guarding. It's not really trusting the body to be able to go back into that full range of motion. So, loosening up the tissues, getting stronger, again, being specific to that golf swing position, where you're reaching back, practicing that exercise, can be incredibly important.
And then, for the golf follow through, your muscles, your rotator cuff muscles need to learn how to go on to stretch safely, okay? A lot of times, in my experience working with these clients, when I try to really start stretching it, they get apprehensive. It's kinda like they visualize themselves maybe almost wanting to think that the rotator cuffs will tear again, right? And so fear plays a big role in the body holding yourself back from getting this full range of motion. So, what happens if you don't truly get those full ranges of motion and then you go out and you try to swing a big driver without warming up because you're scared but you still want to do it. You know, that's actually when you're at risk to hurting yourself. You know, you're actually at a much better chance to confidently, intelligently, yet aggressively get into these sport-specific motions under, of course, the health care supervision provider that you're working with so that you have that confidence.
And then, with regards to golf, start slow, you know, work with your provider, but there's nothing wrong with even just grabbing a putter and just, you know, banging away a hundred putts and just starting there. If you're really trying to get back in the game of golf. Next step, you know, just work your way up the ladder, start with your sandwich and start small. Start with 15 balls. If you're, you know, clear to do it, but you're still kinda nervous. Start with just 15 sandwich shots and start at like 50%. You know, you're barely swinging through it. Work your way up into the pitching wedge, 9-iron. And this doesn't even have to be on the same day, right? It's not like you have to get a hundred bucket of balls and then work your way all the way up to the driver the first time you get in the driving range. You could do that over the course of weeks. Now, obviously, sooner is better, you know, for me, personally, and if I was clear to go, I'd want to go play 18 holes with my buddies right away.
But we do have to do it somewhat intelligently and objectively to prove to ourselves that we're ready to take that next big step. So, you know, working your way up to 7-iron. And let's just say you felt a little uneasy, you felt a little twinge with the 5-iron, well, I'd stick up to the 5-iron, you know, 5-iron below, 6-iron, 7-iron, 8-iron, etc. And I would get really confident and comfortable there and kinda work with my provider and say, "You know, why did I feel that twinge? Did I swing harder? Do I not have the strength yet to be able to justify that much more leverage and that velocity?" And really kinda just, detail it out, figure out why wasn't I able to do that the way I wanted to pain-free instead of just saying, "Whoops, I can't do this again. You know, I guess I'll just have to hit a 6-iron off the tee every time."
But do your due diligence, and work with the provider to see what does it take? I'm a big fan of recording these motions, getting a slow-motion visual. Maybe something changed. If nothing changed, then we know it's strength related and it's time to get back in the gym and keep working out and strengthen that baby for maybe, you know, let's say two weeks and let's go after it again in the range. Let's get out that 5-iron, let's see if I can do it pain-free. Chances are you'll be able to.
Tennis, what's great about this is that we can kind of emulate and mimic the same things as what I just said with golf, which is kinda why they go together. There's kind of this transverse plane, this rotational movement required in both of them. So, with tennis, you know, analogous to the backswing of a golf, you're gonna go into the backswing of your shot. If your right arm, it's reaching back, you know, with your right arm, you want to take that slow, you might want to only do that, you know, 50% and the initial contact with the tennis racket into the ball can be challenging. So you might want to just start babying it. You know, just where you just make a little bit of contact, start with slow speed. You may not even hit over the net, like maybe you're just hitting it into the side of a wall, like a practice wall, you know, that you're hitting into. The backswing, the backhand for a tennis player can be challenging. Kinda like the follow-through for a golfer because you're putting those muscles on stretch.
And not only are you putting muscles on stretch, but you're actually asking your muscles to come out of that with some form of velocity. So I find that a backhand is probably more challenging than forehand for my tennis players because they have to put the muscles on stretch and then generate force. So, for you, you know, you're gonna have to learn how to just get into that pain-free stretch position and then just work on slowly coming out of it. Another nice way to practice this, if you can, is getting into a pool. And this goes for both my golfers and my tennis players. Grab, there are different types of things you can buy, but something that adds little resistance into the pool. You know, where you're just creating a little bit of turbulence and resistance and you're going back and forth, just kind of mimicking that forehand and backhand, or backswing, or back part of your swing or your fore swing, as you're coming through.
And that can give you actually a little bit of resistance where you actually have to generate some force, but you got some buoyancy to support your arm. So, there's something to be said about kind of aquatics training which I would guess somewhere between even a couple months post-op and thereafter would be a great thing to kind of interject to add in just some movement. And again, some sport-specific movement. Because if you're, one, you know, that just goes around everyday life, grabbing your coffee, newspaper, you know, driving, all of a sudden you get on the tennis court, you have it warmed up, you're late, and you're up next to serve and you're, you know, three months post, or say four months post-op or six months post-op surgery. That's still a lot for you. You know, that's still a lot.
So, just kinda something to keep in mind. So, we've talked about a lot so far, and I just want to also mention the importance of a proper warmup as we're kind of seguing from that. I know for me personally as a golfer, I haven't dabbled too much into tennis, but as a golfer, I've seen the tendency for golfers to just get out onto the tee, they're late and they just start swinging it. And not that you even have to make a big social like event that you're warming up when you get out there with your guys. Because I know how that is guys or gals might pick on each other, but, you know, it could be super simple, just grabbing an elastic band and you're welcome to kind of email me, shoot me a message if you're kinda interested in a warm-up. I'm sure we could get you some videos. But, the point is here that you need to be able to just have a simple five minute warm-up, particularly for golf, just to kind of get the blood flowing in there, get some confidence, make sure things are feeling good.
As well as for tennis, I think I like to kinda get a little bit more of a warm-up in tennis. I'm thinking more 10 to 15 minutes, a little bit more dynamic guys, and get the blood flowing. And again, just making sure that you're safe. I think, after rotator cuff surgery, you just wanna put a little bit more WD-40 on the shoulder, if you know what I mean. A little bit more blood flow into there before you really get out there and get aggressive. I just think that's really smart, as well as a cool down, right? You know, just spending a few minutes, five minutes afterwards stretching, maybe chatting with your guys about how the game went, or how the tennis match went. Just do yourself a favor, making sure you do a little cooldown. It's not uncommon for people to be a little achy and sore, whether they played 18 holes of golf or they play three sets, doubles even or singles.
And that's where you can either use a combination of ice or heat. If you want to take a little bit of Advil, you know, to kind of keep it down. But, the point is, guys, in this modern day and age, if you have a pretty significant rotator cuff tear and you have surgery, the fact is that you should still be able to go out there and compete. You should still be able to find a way to compete at some level and modify things. And then, let me also just kind of leave you with this thought, guys. It's really important for both these sports for you to have addressed your entire kinesthetic chains limitations. What I mean by that is, for instance, if you're having trouble with your backswing in, actually yeah, in Golf, you know, it requires your whole body to move.
It requires your hips to move. It requires your knees, your back, your trunk, your rib cage, hopefully not your neck, right? Because for golf you chin should stay down, but, you get the point. Really the entire body should be as primed as possible to help assist, in this case, your rotator cuff surgery so that your rotator cuff surgery doesn't have to do as much work. Same thing for tennis. If you're going to toss that ball up and go for that serve, your spine better have really good extension. Your hip strength may need to be really strong into hip extension. Strong quads, strong legs, strong core. So, think about also the way that you want to now assist your shoulder as much as possible. Chances are, most likely, you're not 100% or not what it used to be, but if you can support it by straightening up everything else around your body, heck, you might even do better than before because you've actually strengthened the weak links that you had in your games.
Does this take work? Does this take an offseason strength and conditioning program? Does this take time, money, and energy to work with a provider, to work with you over time, to figure out how to break through all these limitations? Absolutely. So, at this point, it's just how badly do you want to be able to continue to play as you get older at your country club or whatever it is and enjoy life and playing with your kids or the grandkids. For me, there's no price on that. Health is everything to me. It truly is and it continues to show itself like that as I get older. So, guys, if you guys have any additional questions, please feel free to reach out to me at ChadK@pr1memovement.com. It's been my absolute pleasure, and have a great rest of your day. Thank you.