Shoulder Rehab Part I

Physical therapy of the shoulder using traditional rotator cuff exercises really gets me fired up, so I should probably warn any physical therapists, chiropractors, or physicians reading this to buckle up!  Actually I’m not going to try to offend anyone, I just like to challenge conventional thinking and ask questions – especially when it comes to dogma like rotator cuff exercises.

If you’ve ever been to physical therapy for a shoulder rehab then you’ve probably seen this one:

Shoulder External Rotation

and this:

Shoulder Internal Rotation

These are just 2 of many exercises that supposedly target the rotator cuff that are commonly provided by your health care provider.  In fact, many of you have probably been handed 2-3 pages of these and told to do 3 sets of 15 up to 3x daily.  Ever heard of the shotgun approach?  Your health care provider is hoping and praying that one of these might just work and make you feel better.

Now here is the reality of the rotator cuff:  It’s job is to stabilize the humeral head (the ‘ball’ of the shoulder) in the glenoid fossa (the socket)

The 4 Muscles of the Rotator Cuff

What most health care providers are going on are EMG studies that measure how hard a muscle can fire in isolation during a specific activity.  There is certainly great evidence that the rotator cuff muscles are firing during these exercises.  The problem as I alluded to before is that these muscles do not function in this way in real life.

These smaller rotator cuff muscles are stabilizers, not movers (like the larger deltoids, pecs, lats, etc).  The traditional rotator cuff exercises train the muscles like ‘movers’ which is not their true function.  I’m not going to argue that someone can’t show increased strength over time within these exercises, but I will argue is that there is no transfer to improved function (i.e. lifting, reaching, carrying, pushing/pulling, etc).

The reality of the rotator cuff again is to stabilize the humeral head (the ‘ball’ of the shoulder) in the glenoid fossa (the socket).  It performs this task reflexively meaning it happens without you having to think about it.  All four muscles quickly fire and relax in a specific sequence (depending on the activity) to stabilize the shoulder joint.  They never work in isolation like you have been trained in the past.

So what are the best ways to fire the rotator cuff reflexively?

  • Compression – this means putting weight through the arm.  Examples would include exercises that involve hands or forearms on the ground holding your body weight, any type of pressing, holding a weight (on your back with the shoulder flexed 90 deg. – think top of a bench press position; or with a weight overhead) just to name a few.
  • Distraction – this would include anything that pulls downward or outward on the shoulder (think traction).  This would include carrying weight by your side, pull-ups, horizontal rows, lifting from the floor, etc.

In any of the above activities, the brain immediately recognizes the need for stability and reflexively fires the cuff to prevent bad things from happening like dislocating your shoulder or falling on your face.  Now obviously I’m not trying to actually do these things to you, but forcing muscles to fire reflexively always works better when there is some sense of urgency.

I’ll leave you with a few of my favorites below, and in part 2 I’ll tackle more of the dogma of shoulder rehab.

Arm/Leg Diagonals – a.k.a. the Bird Dog – Shoulder Compression for Reflex Stabilization

Farmer’s Walk – Shoulder Distraction to elicit reflex stabilization

 

Kettlebell Arm Bar – The goal is reflex stabilization of the glenohumeral joint through compression (using a kettlebell) while performing thoracic rotation.  Lots of great things happening here!

Feel free to email any comments or questions to me:  joe@elitepttc.com