Shoulder Rehabilitation

Rehabilitation of the shoulder, as in other body regions should concentrate on restoration of normal function and then a restoration to athletic function. The principles of flexibility, proprioception, strength, and  muscular endurance apply to the shoulder as they do anywhere in a rehabilitation program.

Both open chain and closed chain exercises can be utilized to accomplish these goals. Multiple positions, light load,
(5 lbs), used with high repetitions ( 25-100 ) and multiple daily sets. While this concept certainly does build upon the idea of muscle endurance, it may be somewhat limiting in building muscle power and bulk for contact or collision sports.

Any shoulder program must first concentrate on flexibility along with scapulo - thoracic stabilization and then progress on to the cuff and or specific other muscles.

Flexibility

Cross body stretch, behind the back stretch (posterior cuff), stick exercises for anterior cuff and capsule, supine exercises for anterior cuff and capsule. Care must be exercised when stretching the anterior cuff and capsule, these structures help provide for anterior shoulder stability and should not be over stretched.

Scapulo - Thoracic Stabilization

The scapula must be firmly connected to the thorax to best provide a firm base for gleno humeral articulation. The following are but a sampling of some scapulo thoracic stabilization exercises.

Shoulder Shrugs - Upright Rows - Supine Punches - Press Ups - Bent Over Flys - Ball Balance - Push Ups - Pull Ups

Core Program for scapulo-humeral muscles (rotator cuff)

4 Primary exercises,

• internal & external rotation at both base and in a throwing position
• elevation in the scapular plane with thumbs down & up,
• flexion & extension in the sagittal plane and press ups ( closed chain rehab ).

Exercises can be performed with elastic tubing or band, pulley machines and on an Impulse Inertial Machine. A weighted ball rebounder can also be used in the late stages to incorporate more eccentric (negative loading).

Any upper body ergometer (arm bicycle) can be used for restoration of muscular and cardio vascular endurance.

These are just a few ideas of what you can use in shoulder rehabilitation. Follow the general principles of the rehab process and of exercise progression and use common sense. Know the anatomy consider each athlete as an individual and be inventive and innovative. Explain to the athlete his problems and your goals for the patient so they know what should expected from the rehabilitation program.

The information presented in this text is by no means original. It is difficult to quote all of the sources that were used to compile this information. For further reference, please consult: The Shoulder, (Saunders Press, by Rockwood and Matsen)
Injuries to the Throwing Arm, (Saunders Press, by Zarin, Andrews, Carson) Orthopedic Sports Medicine, Saunders Press, by DeLee and Drez)

Developed and written by the TCU Athletic Training and Sports Medicine Staff.
All pictures used with permission and or original products of TCU Sports Medicine. Reproduction for education will be granted upon permission.