With the Shoulder: Keep it Simple
I was chatting with an orthopedic surgeon the other day, and he asked me what I thought the easiest joint to rehabilitate was. My mind flashed between several joints, and then oscillated between knee and shoulder. I ultimately chose shoulder, not because it is a simple joint, but because there is so much one can address between posture, strength, and mechanics.
The shoulder girdle is a complex interaction of 3 true joints, and 1 psuedo-joint. And this is the beauty of working with the shoulder: if one aspect of the shoulder girdle complex is injured or dysfunctional, we can work around this dysfunctional piece through the other pieces of the shoulder girdle complex and often improve one’s overall function. A large part of rehabilitating the shoulder involves increasing postural awareness and improving the dynamic stability of the shoulder girdle complex. Namely increasing rotator cuff and periscapular strength and endurance.
Therefore, therapeutic exercise and neuromuscular reeducation are vital parts of a shoulder rehabilitation program. Too often I see patients that have failed conservative management of the shoulder injury/dysfunction with another physical therapist; not from addressing the wrong deficiencies, but from not paying attention to the details. Simply put, the execution of their rehab fell short. Since we relay heavily on a patient performing a home exercise program, one better make sure that strict attention to detail is given when instruction them in their exercises.
Choosing the correct exercise to target the appropriate muscles is also crucial. It often tempting to get too creative with shoulder strengthening, but the truth is basic exercises that have been shown to have high EMG activation are often the most effective. Regardless of the shoulder injury or dysfunction, be it subacromial impingement syndrome, a SLAP tear, or shoulder instability, the following exercise are often going to make up the foundation of the strengthening portion of your rehabilitation program. These videos show a few of my foundational exercises for many patients with shoulder dysfunction: