Shoulder pain is a very common complaint as the joint inherently lacks stability so that we have increased mobility and range. Most shoulder pain arises from weakness and poor positioning of the stabiliser muscles.
Due to the multidirectional nature of the shoulder, painful activities can vary. However, activities like getting your wallet out of your back pocket, doing your seat belt up and driving can be quite painful.
A common cue I will hear, when people talk about shoulder rehab will involve setting the shoulder in a ‘back and down’ position before commencing the exercises. So, why is this exacerbating the problem?
Naturally the scapula (shoulder blade) upwardly rotates as the arm moves away from the body. If we drag the shoulder blade down and puff the chest out while trying to move our arm up, we won’t then have the freedom of mobility, which the shoulder demands.
Why is finesse and patience so important with shoulder rehabilitation?
Corrective exercise to minimise pain and improve function is always better. In the shoulder it is imperative due to the unstable nature of the joint, that the positioning is correct before we then load the shoulder.
Anatomically, our rotator cuff (Supraspinatus, Infraspinatus, Subscapularis and Teres Minor) is responsible for centring the head of the humerus in the glenoid fossa, essentially the ball and socket of the shoulder. This centring mechanism ensures that as we move our arm, the ball stays in the socket!
Furthermore, we have a subacromial space, which is 10mm in height. The main rotator cuff tendon, the supraspinatus, is 8mm thick and it passes through this space. Also in this space is a bursa and the biceps tendon. Preserving this space during exercise is a paramount, so we don’t squash all those structures by jamming our shoulder back and down.
Tips for shoulder rehabilitation and getting the most out of your exercises:
- ‘Back and Up’ shoulder positioning is the new ‘Back and Down’
- Lets aim to position the shoulder rather than jamming it into place before commencing a movement.
- Focus on strengthening 3 planes of movement to have a really good base strength and then work into range.
- External Rotation strength
- Elevation Strength
- Extension Strength
- Be prepared to strengthen shoulders properly, which can take 12 weeks.
In the next shoulder blog, we will discuss some more shoulder exercises to build on corrective exercise. So let’s stop throwing around the ‘back and down’ phrase and let’s start instructing the ‘back and up phrase’!