Shoulder dysfunction is one of the most common things we treat and assess in a rehab setting. Regardless if your client is an overhead athlete or someone who simply needs to reach into high cabinets, reaching (and lifting) overhead is a part of life. How can we get our patients there safely? Of course local muscle strength and posture is important, but how can we progress our patients through a spectrum while following principles of mobility, stability and development? First things first we need to make sure that we have enough overhead mobility. Here is a great article and video on how you can assess and work on overhead mobility: http://www.physioanswers.com/2014/09/5-minute-overhead-mobility.html
Now we are ready for the next steps. We have progressed our “traditional” RTC exercises (sidelying ER, prone Y, serratus punches) to the point where we have symmetrical firing and balance through glenohumeral and scap stabilizers. Here is a simple progression that we have used with great success to combine several different philosophies with our patients to get acclimated to the motor control of overhead work, starting with the simplest and ending with the most difficult.
Video 1: Supine Arm Slides with Breathing
Maximal body contact while working on active range of motion and rib depression/core activation through breathing. Although we start our progression here this exercise can be done in sitting or standing as well as part of an advanced HEP.
Video 2: Sidelying Arm Bar
Decrease in body contact with increased stability requirement while allowing GH/scap to work in greater isolation and control in gravity resisted patterns. This may be done with resistance or adding a shoe to build motor control.
Video 3: Mission Impossibles
The name speaks for itself! Here we continue our focus of scap and GH stabilization while eliminating weight bearing through the spine and hips. Multiple positions are possible here including keeping the knees down, placing feet against a wall or using something more sturdy such as a weight bench if the patient is unable to control motion on the stability ball.
Video 4: Tall or ½ Kneeling Overhead Carry
Further increased stability requirement by reducing points of contact while progressing to loaded spine now requires further demand on proper breathing and scap kinematics. Static holds are done first to re-educate overhead stabilization: Control motion before you “create” it. Challenge further by varying front foot position (ie wide to narrow)
Video 5: Standing Overhead Press with Midline Stabilization
Progressed to functional positioning (standing) and resisted transverse plane motion to control midline while overhead pressing. This prevents arching/hinging through the thoracolumbar region which is a common “overhead fault”.
Was this helpful? Have you tried different variations with your patients? What do you think we missed/what would you add?
Until next time Happy Rehabbing!
References:
Boyle, Michael, Mark Verstegen, and Alwyn Cosgrove. Advanced in Functional Training: Training Techniques for Coaches, Personal Trainers and Athletes. Santa Cruz, CA: On Target Publications, 2010. Print.
D’Agati, Eric. “FMS Level 2.” FMS Level 2. Montclair, NJ. 22 Aug. 2014. Lecture.
Honarbakhsh, Behnad. “SFMA.” SFMA. Philadelphia, PA. 3 Oct. 2014. Lecture.
Reinold, Michael, et al. “Current Concepts in the Scientific and Clinical Rationale Behind Exercises for Glenohumeral and Scapulothoracic Musculature.”JOSPT 39.2 (2009): 105-17. Web.
