This week I have one of my favourite exercises for working on the motor control aspect of shoulder rotation. Keep in mind with this exercise that it is somewhat advanced. It’s not advanced in terms of the loads placed on the shoulder or the mobility demands, but it is advanced because it is an exercise that may come up later in the stages of rehab or on a shoulder that isn’t overly irritable and may only have end range pain or something a long those lines. Good luck giving this exercise to someone with serious pathology or in an acute/sub-acute stages of injury. But not actually good luck, because that would be a mistake to attempt!
The goal of this exercise is to centre the humeral head within the glenoid by creating a slight posterior pressure into a small item. I used a mint box here but anything that is probably 1-2 cm in height could work. Once this pressure is applied by your humeral head the goal is to maintain that pressure while taking your shoulder through an arc of movement from internal rotation to external rotation without ever losing that slight posterior pressure on the item. The shoulder will likely want to jut forward during both extreme ends of the ROM, but your goal is to control that as best you can. There should likely be some quivering with this exercise because you are trying to use maximal range of motion with proper joint centration which is going to result in motor learning. In particular after doing some passive/active mobility work to open the window of mobility first. I had seen this exercise before, but got the idea of using the item to add in some proprioceptive feedback while taking the Functional Range Conditioning course led by Dr. Andrea Spina last year. Check it out below.
On a side note from the point of this blog post, I want to take a second to talk about shoulder rehab exercise selection. As a new grad physio with a strength and conditioning background I made the mistake early in my career of giving fairly symptomatic shoulders fairly difficult exercises. As a young strength and conditioning coach who dealt with fairly healthy individuals before I became a physiotherapist I don’t think I had a full appreciation for shoulder pathology. Band wall slides, bear crawls, other more difficult closed chain exercises…..I didn’t want to be one of those physios who just gave everyone with a shoulder injury banded external rotations…how embarrassing would that have been??? After suffering a shoulder injury a couple years into my physio career though I realized just how advanced some of these flashy “functional” shoulder exercises can actually be for a symptomatic shoulder. Since then I have really tried to develop an appreciation for what loads a certain shoulder might be able to tolerate at different stages of their rehab. It doesn’t mean I’m bringing out some red bands and getting people to crush shitty technique external rotations with it, but trying to develop the progressions from the stage of rehab that might include light ROM and isometrics to the stage of closed chain, dynamically loaded complex movements. This middle phase of rehab is vital for shoulders because you can’t keep people at the baby exercises for ever and once they are able to do the more difficult movements they are likely in a very good place moving forward anyway. I wanted to bring this up in case there is anyone else out there that feels like they might have struggled with shoulders or if you are a strength and conditioning coach who wonders why your client who just wrecked their shoulder can’t handle a bear crawl….I thought it was functional bro (keep in mind I love bear crawls at the right time). You simply may be doing too much too soon or on the other hand you may be potentially being too careful with the rehab process as well. When I did rehab for my shoulder after a few weeks of taking it very easy and doing ROM/isometrics I started slow back into the gym working with very light loads on top of progressing more traditional rehab exercises. I would have minor discomforts here or there, but it was okay because I was slowly adapting my shoulder to loads again. I think this was a key part of my rehab and my shoulder healed up very well. I think if I had done ONLY lighter more traditional “rehab” exercises for a few months and tried to jump back into the gym later down the road when my shoulder was completely comfortable there would have been at best no difference and I think could have even been worse off/delayed. Keep in mind though that I am an active gym go-er and your 55 year old lady, not super active patient might not be used to any loads so this would need to be considered. Likely going to keep that person on a more traditional rehab style approach unless she shows interest of wanting to get active in the gym.