Shoulder Rehab

Shoulder Rehab Part 2

In Part I, I discussed why physical therapy of the shoulder using traditional rotator cuff exercises does not always work .  Traditional methods of shoulder rehab often train the muscles of the shoulder in a way that they are not really used in normal everyday function.  If you haven’t caught that article yet, I suggest you read that one first. In this article I want to address a couple other pieces of the puzzle:  motor control and regional interdependence.

There are many cases in which a certain movements may look dysfunctional in a standing position, but may actually be completely functional in other positions where the patient is more unloaded like lying on their back, stomach, side lying, on hands and knees, or even in kneeling.  In these positions there are fewer joints and segments to control and in most of these cases less gravity to deal with.

Unless the movement pattern is tested in multiple positions, it is not possible to know with any certainty that the movement is limited because of a true mobility issue (think joint restriction or ‘tight’ muscle) or if it is because of a lack of motor control.

Here is a great example looking at a functional reaching pattern behind the back.  In standing, you should be able to reach up behind your back and touch the bottom of the opposite shoulder blade as in the picture below:

Previously I had a patient come in that could only reach to just below her belt line.  She had been given stretches to increase that movement but they really hurt her shoulder to perform.  If you’ve ever had a shoulder problem or therapy after a shoulder surgery then this exercise will look very familiar:

When I had her lie down on her left side, she could reach all the way up her back and touch the opposite shoulder blade!  So why could she not do it in standing but had no pain and no difficulty lying on her side?

By going to a more unloaded position in side lying, the other joints of the body are taken out of the equation, and there is much less to have to control.  In this position she could be successful.  This is a great example of poor motor control, not a loss of shoulder range of motion.  So of course the first question she asked me is why did she spend the last 4 weeks in therapy and at home trying to stretch out her shoulder?

During the evaluation is was also discovered that she had some loss of mobility in her neck.  Because the neck movements were not painful, these were addressed first using some IASTM soft tissue work to her upper trapezius, levator, and rhomboids.

Another soft tissue treatment modality we offer at  On Track Physical Therapy is   Dry Needling .

Another soft tissue treatment modality we offer at On Track Physical Therapy is Dry Needling.

Here is where that term – Regional Interdependence – comes into play.  In simple terms, regional interdependence is the interplay between different regions of the body.  In this case its easy to see how limitations in the neck can affect the shoulder since there are a number of muscles that run between the spine and shoulder girdle.  In other cases it could be dysfunction even further down the spine, the pelvis, hip, and beyond that could affect alignment and function at the shoulder.  Without the proper evaluation, it would be nearly impossible to find these relationships.

Once her cervical mobility was restored, we immediately went to corrective exercises to improve motor control of the neck and shoulder girdle.  These were fairly simple non-painful exercises that allowed her to successfully work through her neck limitations in a more unloaded position (hands and knees in this case).

Following that first treatment she could reach behind her back and nearly touch her opposite shoulder blade!

When the patient returned for her next visit, she had maintained her neck mobility and behind the back reach without shoulder pain.  We progressed to kneeling and standing motor control exercises, and by the end of the treatment she could touch her opposite shoulder blade without difficulty.

Needless to say, this patient was quite happy with the results.  Sometimes it is as simple as being in the right place at the right time with your treatment.  

Sports Specialist Physical Therapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist and strength coach specializing in athletic performance. He attended The University of Findlay as a student athlete. As an athlete he competed in both Indoor and Outdoor Track & Field where he earned honors as a 5x Division II All-American and 6x Division II Academic All-American. In 2013 he completed Graduate School earning his Doctorate of Physical Therapy (DPT). Greg is the owner of On Track Physical Therapy in Ann Arbor, Mi. Follow On Track PT and Performance on Facebook.

Anterior Plank - Not just an exercise for your abs

The Plank is often thought to be a core exercise. However, I'm here to tell you that there are other unforeseen benefits of the plank that you may not have considered before.

First we need to talk about what a good plank looks like. A good plank will show a nice straight line from your head to your tailbone. This line should be parallel with the floor. You should be actively reaching through both elbows pushing your chest away from the ground. Hold this position as you take a breath in through your nose and out through your mouth. When you breathe in through the nose your should feel your upper back expand. When you exhale, you should feel your abs turn on.

When performed in this fashion, here are some added benefits and applications you may have never considered before.

Shoulder - Reaching through your arms (elbows in this case) stimulates the serratus anterior which is needed for shoulder health. Reaching + Breathing creates an optimal relationship between the scapula and rib cage. All the while your rotator cuff muscle are firing in an isometric fashion.

Shoulder Rehab - this is an excellent way to start introducing closed chain activity for the upper extremity at a lower level to work scapula thoracic relationship.

Youth Sports Training - Obviously its a good exercise to gain core control, we know that. But many youth athletes struggle mightily with a pushup. 1) Due to lack of core strength/endurance to maintain a neutral spine position. 2) Lack of shoulder strength/stability. Performing a plank correctly can stimulate both of these components as you simultaneously work relative strength with a dumbell floor press.