Exercising Programming For Common Shoulder Dysfunctions
By Chris Gellert, PT, MMusc & Sportsphysio, MPT, CSCS, C-IASTM
Exercises selection and prescription is just one component of working with a client who has a movement dysfunction.
Do you know what exercises are safe vs. unsafe? There are a plethora of shoulder conditions that affect the four joints within the shoulder. In this article, we are going to talk about shoulder impingement and rotator cuff tear.
Shoulder impinfement: safe vs. unsafe exercises based on science
Background: Shoulder impingement is caused by Impingement between the humeral head and coracromial arch occurs from repetitive loads. With strong RTC muscles, the GH joint is properly supported. Weak scapulothoracic muscles leads to abnormal humeral positioning/humeral mechanics where humeral head is not synchronized with scapular elevation. Thereby, the rotator cuff impinges under the coracromial arch causing inflammation to the suprahumeral tissues.
Figure 1. Shoulder impingement
Emphasis: stretch the tight postural muscles, which includes the upper trapezius, pectoral and posterior capsule, while strengthening weak scapular/trunk muscles. Gradually increase chest exercises, but the focus of working with a shoulder impingement client is to train the posterior upper extremity chain. Targeting the rhomboids, low trapezius, mid back, spinal extensors, rotator cuff and core.
Safe exercises
Standing upper trap stretch posterior capsule stretch Mid row
DB Side raises Low trapezius pulldown Pull apart exercise
Unsafe exercises
1-Shoulder press: Places unnecessary loading and vertical stress to AC joint and surgical graft further stressing the shoulder.
2- Upright row: at end of range Upright row exercise places stress to AC joint creating further impingement.
3-Ketlle bell snatch: during from the beginning phase, maximally lengths the medial deltoid, supraspinatus, placing greatest stress, then with the overhead press, loads the AC joint, placing unnecessary stress to the surgical site.
Rotator Cuff Repair: safe vs. unsafe exercises based on science
Pathophysiology/Mechanism of Injury: Commonly occurs as a result of a traumatic accident or fall and is graded from one to three in severity. They are classified as acute, chronic, degenerative, partial or full-thickness tears.
Emphasis: stretch tight postural muscles, which include upper trapezius, pectoral and posterior capsule, while strengthening weak scapular/trunk muscles. The focus of working with a rotator cuff client is to avoid reinjuring the shoulder. Train the posterior upper extremity chain. Targeting the rhomboids, low trapezius, mid back, spinal extensors, rotator cuff and core.
Safe exercises
Standing upper trap posterior capsule stretch
DB Side raises Low trapezius pulldown Pull apart exercise
Unsafe exercises
1-Shoulder press: Places unnecessary loading and vertical stress to AC joint and surgical graft further stressing the shoulder.
2- Upright row: at end of range Upright row exercise places stress to AC joint creating further impingement.
3-Ketlle bell snatch: during from the beginning phase, maximally lengths the medial deltoid, supraspinatus, placing greatest stress, then with the overhead press, loads the AC joint, placing unnecessary stress to the surgical site.
