photo credit: screenrant.com
The shoulders are a very common area of the body that are plagued by pain and dysfunction. As mentioned in my previous posts 3 Ways to Get Out of Shoulder Pain, Part I and Part II, there are multiple reasons why someone may suffer from shoulder pain.
Time and time again, when someone suffers from shoulder pain, I see physical therapists or strength coaches providing their patients/clients with exercises that come from a pre-fabricated sheet of exercises that are given to everyone with shoulder pain. Some of those exercises include: I's, Y's, T's, Full Can, etc.
Now, don't get me wrong, there is a time and place for these exercises. Typically, after someone has had shoulder surgery, the muscles of the rotator cuff and muscles surrounding the scapula are dysfunctional and have atrophied. In turn, they become weak and unstable and need to be strengthened in order to provide a stable base for the shoulder to work off of.
Muscles of the rotator cuff and the ones surrounding the scapula need to be BOTH STRONG and provide adequate STABILITY. Those two words do not mean the same thing.
In prior posts, I've used the slingshot example.
Strength is the ability to pull the elastic band back and Stability is the ability to hold the slingshot stable and not let it come flying towards you. It is the ability to resist a change in position.
The rotator cuff consists of 4 muscles:
photo credit: http://physioworks.com.au/injuries-conditions-1/rotator-cuff-injuries
There are many functions of the rotator cuff. It acts in the movements of:
and is also active during other various arm movements as well. But the true function of the rotator cuff is to dynamically stabilize the shoulder.
What this means is that during any type of shoulder motion, the rotator cuff reflexively fires and centrates the head of the humerus into the glenoid.
photo credit: http://singaporeosteopathy.com/2015/05/06/shoulder-101/
What does that mean? When the rotator cuff reflexively fires, it causes the glenoid to become centered in the joint and move about an axis of rotation that is conducive for the health and function of the shoulder. By moving about a certain axis of rotation, it keeps the stress on the muscles of the shoulder and off of the passive structures.
If the cuff is having issues with centrating and maintaining a stable shoulder, then this can cause issues from rotator cuff tendinitis and subacromial impingement to rotator cuff and labrum tears. If your shoulder de-centrates one time, bad things will not happen. What happens over time through repetitive stress and strain is micro-traumatic damage that can eventually lead to one of these potential diagnoses.
The exercises mentioned above do well at strengthening the muscles of the rotator cuff and surrounding musculature, but they aren't the best for helping to improve dynamic stabilization of the shoulder of the rotator cuff.
Ways to Improve Dynamic Shoulder Stability
There are various ways to improve dynamic shoulder stability. One is through something called Rhythmic Stabilization.
Rhythmic Stabilization is any activity that causes the rotator cuff to have to reflexively fire to stabilize the arm in an attempt at being moved.
Here is a video of an example of rhythmic stabilization at the shoulder:
You can also vary the angles that rhythmic stabilization is performed at. Start with the arm at approximately 110 degrees of shoulder flexion (basically arm straight up to the ceiling) and eventually bring the arm farther and farther overhead. As you go farther into shoulder elevation, the more difficult it will be to stabilize the arm.
You can also apply the pressure starting proximally near the shoulder and then work distally towards the elbow and wrist which, in turn will make the exercise more challenging.
This should not be something where the coach or physical therapist who is administering this should be trying to over-power the patient/client. This is a technique for the athlete/client to work on controlling the position of the arm and we are looking for good quality movements.
If this is something you or your client does well at, there are other various methods to improve rotator cuff dynamic stability.
For this next series of exercises and progressions, I prefer to use a kettlebell. I like to use the kettlebell because it can be used to add in an element of instability. With this element of instability, the arm, shoulder, and rotator cuff have to work to stabilize the arm in a certain position.
I first heard of using a kettlebell for various shoulder stability from Mike Reinold. He did a webinar a few years back speaking specifically to kettlebells and their use with the shoulder. Some of the information here I learned from him and his webinar series. Check out his Inner Circle for various webinars each month on topics ranging from physical therapy and injury prevention to strength and conditioning and performance.
Let's start with the easiest progression and work our way up to more difficult options.
Kettlebell Bottoms Up Static Holds
Supine Kettlebell Press
Kettlebell Press and Twist (Screwdriver)
Incline Kettlebell (KB) Press w/ or w/o Screwdriver
This can be useful for someone who lacks shoulder stability above 90 degrees of shoulder flexion. The incline bench allows them to work on it above shoulder height in a pressing fashion without doing direct overhead pressing.
KB Side-lying Arm Bar
KB Side-lying Arm Bar to Press
All of these options can be used in either bottoms down or the bottoms up position. If one movement is too difficult, then regress to the previous option, decrease the amount of weight, or go from a bottoms up to a bottoms down position.
These are just a few options you have if someone is returning from a shoulder injury, rehabbing an injury, coming back from surgery, or are just looking to maintain healthy shoulders.
Stay tuned for my next post on more advanced shoulder stability options!
Here I will be writing and posting about topics ranging from physical therapy, injury prevention/reduction, and strength and conditioning.