Ask The Doc: Shoulder Rehab, Part 2

by MICHAEL CHIN|DPT, CSCS

The next stage of our shoulder rehabilitation program is to strengthen and re-educate the key muscles of the shoulder girdle to work together. We’ll be targeting specific muscles within the four groupings of shoulder muscles (see Shoulder Rehab, Part 1).

Shoulder Protectors AKA Rotator cuff (RC) muscles:

The “SITS” (supraspinatus, infraspinatus, teres minor, and subscapularis) muscles serve to assist in the rotation of the shoulder and arm.

The “SITS” (supraspinatus, infraspinatus, teres minor, and subscapularis) muscles serve to assist in the rotation of the shoulder and arm. Specifically, full shoulder elevation requires external rotation of the humerus. Also, as the humerus elevates, the humeral head (which articulates with the glenoid fossa of the scapula) is depressed and compressed by the SITS — basically creating a nice smooth glide and articulation within the socket. If the SITS muscles are weak, or inflamed and not activating correctly, then the deltoid will elevate the arm without a depressor effect, allowing the head of the humerus to rise and hit the acromion, which is what we call subacromial impingement.

External Rotation (Infraspinatus, teres minor):

Keep the elbow against the side of the body and bent  90 degrees. Bring the hand away from the body without changing the position of the upper arm. Be sure to maintain the same elbow position, as it is common to extend the elbow to compensate for external rotation weakness.

Internal Rotation (Subscapularis):

Elbow and arm position are the same as with external rotation exercise. Resistance should be applied while bringing the hand in towards the body.

Scaption (Supraspinatus):

Start with the arms to the side. Elevate the arm to shoulder level at a 45 degree angle away from the body.

Progression of rotator cuff exercises

Once your shoulders are stronger and there is pain-free motion without added load, we’ll start targeting the RC at 90 degrees of abduction.  If you have pain here, drop back down to the previous RC exercises and work on mobilization.

External Rotation and Internal Rotation:

Same arm position with 90 degrees of abduction and 90 degrees of elbow flexion. Rotate the hand backward for external rotation (resistance band in front) and rotate the hand forward for internal rotation (resistance band behind).

Scaption:

Elevate the arms to above 90 degrees.

Scapular Pivotors:

As outlined in Shoulder Rehab, Part 1, there must be adequate scapular movement for full shoulder elevation. We’ll be targeting these muscles here:

I’s, Y’s, and T’s (rhomboids, middle trapezius, lower trapezius):

Y’s in particular will be the hardest as it targets the neglected and often underdeveloped lower trapezius.

Don’t let these fool you. If you’re getting proper scapular retraction and full range of motion, they can get difficult; the key is for the scapula to move towards the spine. It should feel like you’re squeezing both scapula together. This isn’t an arm exercise; the extended arm is used as resistance for the scapular muscles. Y’s in particular will be the hardest as it targets the neglected and often underdeveloped lower trapezius.

Push up plus (Serratus anterior):

The key here is to get full protraction of the scapula, which means bringing the whole shoulder girdle forward.

This is one of the key muscles along with the trapezius for scapular rotation. In fact, the serratus anterior and trapezius work together as a force couple. Start against a wall, then progress to working off the knees and finally move into a full push-up position. The key here is to get full protraction of the scapula, which means bringing the whole shoulder girdle forward. It should feel like you’re pushing away your body as far as it can go.

Spiders:

All I’ll say as a warning is this: Prepare to feel the burn!

This exercise will activate all the muscles we’ve individually targeted, but now the focus is on stabilization positions and dynamic movement combined. Yes, I know spiders have eight legs, but we’re doing six positions (3 each side), and we’re calling it the spider exercise (go with me on this one). Keep one arm stable with the resistance band, then reach above, to the side, and down. Touch each six times before moving to the next one, then switch arms. All I’ll say as a warning is this: Prepare to feel the burn!

Remember: You do not have to wait until you are recovering from an injury to make sure that your shoulders have a full, healthy ROM. Taking good care of this important and complex joint should be part of your regular body maintenance.

References

M Dutton. Dutton’s Orthopaedic Examination, Evaluation, and Intervention. 3^rd ed. McGraw-Hill Companies, Inc. 2012

KL Moore, AF Dalley, AM Angur. Clinically Oriented Anatomy. 6^th edition. Balitimore, MD. Lippincott Williams, 2010.