Shoulder Rehab Made Easy

Shoulder rehab is hard right? There are so many things that can go wrong in there- subacromial bursitis, supraspinatus impingement, biceps impingement, rotator cuff weakness, frozen shoulders. The list goes on and on. How do we know what is what? And what do we do specifically if we don’t know what is specifically wrong? And maybe worse, what do we do when we do know what the problem actually is? Looking through a well-regarded text like Kendall’s ‘Muscles; Testing and function’, with its 100+ pages of muscle tests for the upper extremity alone can tempt even the most stoic of anatomy nerds to place shoulders into the ‘too hard basket’. It needn’t be this hard.

Suddenly our ideal ’corrective’ exercises are suddenly not only useless, they may be reinforcing dysfunctional patterns already present! 

Let me give you two pieces of information that may ease your frazzled mind.

1) As an Exercise Professional, it is not your job to diagnose. In fact, as a Personal Trainer or Exercise Physiologist diagnosis exists outside of your scope of practice.

2) Regardless, diagnosis of the specific injury is superfluous to what you actually need to do for effective shoulder rehab.

For a shoulder to be happy, healthy and functioning beautifully you really only need to tick three boxes.

They are: Good resting postural alignment; correct stabilisation of the scapula on the thorax throughout movement ranges; and adequate scapulohumeral rhythm. Trust me, if you can be excellent in prescribing (and ensuring excellent execution of) exercises to address these three things you can rehabilitate almost any chronic or acute shoulder complaint and you do not need an accurate diagnosis to get started.

The question I get often get asked at this stage is ofcourse ‘so what exercises do I do to fix what I see?’ First of all you need to fully understand what it is you see and how that compares to an ‘ideal’. An analogy that Max uses, that I’ll steal is that investigators into counterfeit currency spend their careers becoming faultless experts in ‘real’ currency so that they can pick faults in counterfeit notes. We must be experts in anatomy if we are going to great assessors.

From here we can move onto corrective exercises.

Remember those boxes we needed to tick? Posture, Stability and Mobility. We could address those with; Prone Thoracic Extensions; Four-Point Single Arm Lifts; and Overhead Dumbell Presses. Easy.

But what if, for those respective exercises we allowed our client to; Hinge the spine from the L2-L3 level whilst keeping the thoracic level rigid during thoracic extensions; wing their scapulas during four-point; and drive overhead pressing via coupling the levator scapula and upper trapezius resulting in a hitch with restricted upward scapula rotation?

Suddenly our ideal ’corrective’ exercises are not only useless, they may be reinforcing dysfunctional patterns already present! 

Those exercises are invaluable, only if performed well. So we need to be excellent assessors and excellent at prescribing exercise appropriate to your assessments. But didn’t I say shoulder rehab is easy? It is if you are equipped with a small number of very simple assessments and exercises.