By: Marisa Schoepflin and Katie Griffis
Kinesiology
 To
educate readers on the more common
shoulder injuries and provide a framework to
link rehabilitation principles to
postrehabilitation strength and conditioning
program design
OVERARCHING
 Themes
PRINCIPLES
of postrehabilitation
management that need to be addressed
 Rotator cuff strength
 Scapular strength
 Stability
 Rhythm
 GH joint mobility

Weight training enhance muscle performance
and is useful in the rehabilitation of injuries

The likelihood of injury increases with




improper attention to exercise technique
biased exercise selection
unfavorable shoulder positioning required of the more
common exercises
It is essential that postrehabilitation training
programs consider documented injury trends and
risk factors
 Restrictions
can vary and are based on
several variables

Procedure, surgeon preference, and extent of
the injury.
 Over the course of the rehabilitation, these
restrictions are gradually lifted.
 As
the individual enters into
postrehabilitation precautions should not
be avoided rather trained
 Exercise
selection with regard to technique
and shoulder positioning should be
considered
 Professionals designing postrehabilitation
weight-training programs must be mindful of
exercises that

Place the shoulder in the “high-five” position

Impingement position

End-range amortization position
 Rotator
cuff
 Glenohumeral
joint instability
 Labral
 The
primary culprit for rotator cuff
pathologies is the supraspinatus
 Impingement syndrome

Compression of the soft tissue between the
acromion and greater tuberosity of the humerus
 Tendinopathy

Overuse of the upper extremity, especially in
positions that stress the rotator cuff muscles
 Muscle/tendon

tears
Leads to surgery
 Very
slow process of recovery and high
rates of failure of the repair
 Gradual
progression of resistance
exercises that stress the rotator cuff

Lateral raises and military press, with some
basic strengthening in the planes of external
rotation.
Goal
is to restore the normal
anatomy
 Arthroscopic
Success
or open surgical techniques
is measured through
 Subjective
functional outcome scales
 Range of motion
 Healing of the repair site
 Programs
are individualized and dependent
on the size of the rotator cuff tear, age of
patient, prior level of function, and
rehabilitation goals
 Guidelines:
protection of the repair,
progressive mobility, and strength/balance of
the scapula and rotator cuff repair
 Sleeper


stretch
http://www.youtube.com/watch?v=HU6bdtdDess
Used to improve internal rotation mobility
 Cross
arm stretch with internal rotation over
pressure

Prone horizontal abduction with external
rotation (“Y” and “T”)

Isolated external rotation side lying or prone at
90/90 position


http://www.youtube.com/watch?v=tlaOi1_Kkw&playnext=1&list=PLDFwhc5T0K8UreU9t_C5kaoC3Pu3_s8j&feature=results_video
Full can elevations

http://www.youtube.com/watch?v=nwMFih5BABA
 GH
joint is susceptible for developing
instability.
 Instability
occurs through disturbance in any
one or more of the following:





Rotator cuff
GH joint capsule or labrum
Area of contact between the
glenoid and the humeral head
Proprioception loss
Neural mechanisms.

Have had GH instability- need to be aware
of the direction of the instability and
whether there was a surgical intervention.

Recurrent instability -may need to have
permanent modifications to their weighttraining program to avoid positions of
stress to the joint capsule.
Traumatic


instability
usually involves anterior shoulder dislocation
patients with this injury are often surgical
candidates
Atraumatic

instability,
commonly the result of microtraumatic
stresses to the shoulder and laxity of the GH
ligaments, resulting in multidirectional
instability.

Multidirectional instability is often treated
conservatively, with physical therapy
 Focuses
on retraining motor control and
proprioceptive input to the GH joint and
scapular stabilization
 Sport-specific
activities are often
withheld for at least 6 months
Weight-training programs should focus on rotator
cuff strengthening because it provides dynamic
stability at the GH joint.
 Programs should be inclusive of closed kinetic
chain exercises



Stability: front plank-up and side plank
Progressed throughout the phases of
rehabilitation, and emphasis is placed on
neuromuscular control and proprioceptive
training through



Closed kinetic chain exercises
Oscillatory and impulse training
Dynamic activities
 Glenoid
labrum is a
fibrocartilaginous ring
that serves as a static
stabilizer of the
glenohumeral joint
 The
long head of the
bicep tendon attaches
to the superior labrum
concern to rehab

Causes extreme tension of the labrum during
external rotation

Individuals with labral pathology need to be
aware of positions and lifts that stress the
superior labrum and proximal biceps tendon.

Avoidance of the high-five position will reduce
stress on the anterior GH joint.

Common exercises that may cause irritation of
the biceps tendon or the superior labrum.

Dips, incline bench press, and military press.
 Tears
to the superior labrum are referred to
as SLAP.

(Superior Labrum, Anterior, Posterior)
 SLAP
tears are surgically repaired through
arthroscopic approaches, involving suture
anchors to fixate the torn labrum.

As patients progress, the extremes of rotation,
horizontal abduction, and extension are
protected during intermediate phases and
eventually allowed in late phases.

Progression to return to prior athletic activities
is allowed 6-9 months after surgery

Consistent with other shoulder pathologies,
outcome studies involving surgical intervention
or rehabilitation rarely examine return to
weight-training activities.
 Focus
strengthening on rotator cuff strength
and closed kinetic chain stabilization
 Strengthening
exercises commonly focus on
strengthening of the rotator cuff
 Strength,
rhythm, and balance of the
scapular musculature are also a focus
throughout rehabilitation because of the
association with GIRD

glenohumeral internal rotation deficit

All rehabilitation and strength and conditioning
professionals involved in recovery need to have a
strong grasp of the functional anatomy and the
process of returning the individual to prior level
of athletic and recreational activity.

Through clear and open communication and
education of the complexities of the specific
injury, surgical interventions, formal
rehabilitation, and complete recovery process,
strength and conditioning specialists and
rehabilitation professionals will be able to best
design effective comprehensive strength and
conditioning programs.
 Pabian,
P. S., Kolber, M. J., & McCarthy, J. P.
(2011). Postrehabilitation strength and
conditioning of the shoulder: an
interdisciplinary approach. Strength &
Conditioning Journal (Allen Press), 33(3), 4255.