Unstable Shoulder Exercises
When unstable, the shoulder is the most movable joint in the body, making rehabilitation difficult. The first step in unstable shoulder rehabilitation is identifying the kind of instability and any structural or muscle limitations.
Exercise is also crucial to healing, but it may be hard to know where to start when prescribing exercises with such a flexible joint. Learn how to control unstable shoulders. Check Out the shoulder course
⇒Tips for unstable shoulder exercise prescription
1) Consider the rotator cuff
Rotator cuff strengthening in shoulder rehab may seem repetitive, but it’s crucial for shoulder stability! Consider two factors with each workout you suggest.
Do you want to move or stabilise the rotator cuff? In early therapy, the cuff may be worked as a mover to achieve complete rotational range of motion and adequate strength with arm-supported activities.
After achieving enough range and strength with the arm supported, start exercising the rotator cuff muscles as movers and stabilisers. As the patient improves, add unsupported arm workouts and increase range and load. Infraspinatus moves during external rotation at 90 degrees abduction, whereas supraspinatus stabilises (1). This is an excellent example of a later-stage workout when the cuff works as both a mover and a stabiliser.
Second, which rotator cuff muscle is each exercise targeting? Each exercise’s plane of movement determines which cuff muscles function. Instead of supraspinatus initiating abduction, evidence reveals all four rotator cuff muscles co-contract. Research shows that the posterior cuff is more active in shoulder flexion and the anterior cuff in extension (2).
When recommending exercises, note that the plane of movement affects which cuff muscles are engaged most.
2) The cuff requires stability
Shoulder rehab must treat the scapulothoracic muscles clinically. However, the current agreement on scapula dyskinesis has confounded many therapists and upended a physio mainstay. Scapula dyskinesis affects 50% of healthy adults and 61% of overhead athletes (3). The consensus advises against testing for it.
This suggests that shoulder discomfort may heal while scapula dyskinesis remains same. However, a well-rounded rehabilitation programme should include exercises that engage both the rotator cuff and the scapular stabilising muscles, such as upper/lower trapezius and serratus anterior.
3) Is kinetic chain work needed?
A recent comprehensive review indicated that adding kinetic chain movements to shoulder workouts may boost axioscapular muscle activation (with stepping being more effective than squatting) and may help retrain scapula stabilising muscles (4). Another research indicated no advantage in adding lower-limb or kinetic chain activities to isolated shoulder workouts for overhead athletes, suggesting that kinetic chain exercises should be chosen depending on individual requirements (5).
Individualised rehab is key—if a patient struggles with the cocking portion of a pitch, a functional “cocking-based” exercise with a step-back action may help. If they’re a netballer unable to score, a steady support system may be better.
4) Apprehension position
All active rehabilitation activities must address the patient’s deficiencies and objectives. As the patient gains strength and stability, exercises should test the concern. For anterior apprehension, many use 90/90 abduction/external rotation.
Add speed and load to test shoulder stability after training the cuff and scapular muscles in this posture. From the start of rehab through discharge, you must develop confidence in your patient’s shoulder stability to help them proceed into more hesitant situations!
Summary
In end-stage rehab and return to sport, unstable shoulder exercise prescription might be challenging. Consider the patient’s beliefs and objectives, since these may affect rehabilitation. Start a good rehabilitation programme by choosing a few exercises based on the aforementioned concepts and increasing them as your patient improves. Learn about unstable shoulder examination, classification, and therapy. Check Out the shoulder course
Referances:
- Tardo DT, Halaki M, Cathers I, Ginn KA (2013) Rotator Cuff Muscles Perform Distinctly Different Roles During Shoulder Rotation Exercises. Clin Anat 26(2):236-43.
- Wattanaprakornkul D, Cathers I, Halaki M, Ginn KA (2011) “The Rotator Cuff Muscles Have A Direction Specific Recruitment Pattern During Shoulder Flexion And Extension Exercises. J Sc Med Sport 14(5) :376- 382.
- Schwank A, Blazey P, Asker M, Møller M, Hägglund M, Gard S, Skazalski C, Haugsbø Andersson S, Horsley I, Whiteley R, Cools AM, Bizzini M, Ardern CL (2022) Bern Consensus Statement on Shoulder Injury Prevention, Rehabilitation, and Return to Sport for Athletes at All Participation Levels. J Orthop Sports Phys Ther. 52(1):1-28.
- Richardson E, Lewis JS, Gibson J, et al Role of the kinetic chain in shoulder rehabilitation: does incorporating the trunk and lower limb into shoulder exercise regimes influence shoulder muscle recruitment patterns? Systematic review of electromyography studies. BMJ Open Sports Exerc Med. 6(1).
- Borms D, Cools A (2019). Is kinetic chain training beneficial for rehabilitation of overhead athletes with shoulder impingement symptoms: A randomised controlled trial. World Confederation of Physical Therapy 2019, Abstracts. Presented at the World Confederation of Physical Therapy 2019, Geneva, Switzerland. Image courtsey : 1 ,2
