Sample Corrective exercise protocol for shoulder Impairment

The shoulder. It’s a marvelous wonder of evolutionary engineering. With the astonishing range of motion available at the shoulder, also comes the necessity of serious load bearing and force management characteristics. Given the complexity of the shoulder structure, and the high demands of athletics and daily life, it’s not too difficult to see how things can get out-of whack.

Now I won’t bore you with the whole anatomy of the shoulder, or all of the staggering statistics about shoulder dysfunction in the U.S. , but I will say this: There is only ONE bone that  connects your arm to your body, and there are at least 17 muscles, and half a dozen critical ligaments that contribute directly to the function (or dysfunction) of the shoulder joint, as well as keeping your arm from falling off. This is an important concept, because the muscles dictate the position of the bones (both immediately and progressively over long periods of time) and the position of the bones has everything to do with the functional capacity of a given joint, or through the entire human movement system. Read that last sentence again or write it down it’s an extremely important concept.. Position is everything!! The ability to produce force, reduce/absorb force, and stabilize the joints  efficiently depends on proper alignment and relative position of all structures involved.

Now, about the shoulder. It’s not just the 30 minutes or three hours you spend exercising everyday that affects the shoulder joint. all 24 hours of every day, the effects of gravity, modern life, emotional state, and nutritional status all effect the resting position (and therefore the working position) of the scapula, humerus, and clavicle. I’d like to use myself as a case study:

Name: Nick P.  Age: 27  Occuption: Personal Trainer and Bike Shop Manager  Job requirements: Various physical activities, lots of standing and walking, but a significant amount of desk/computer work.   Activities: Surfing – Mountain biking – Road Cycling – running (from most  >  least)  Incidence of pain: Front of shoulder (anterior glenohumeral joint) and base of skull mostly on right side (Atlanto-Occipital joint) Other Symptoms: Occasional headaches, tightness around jaw. Postural Deviation: Slight forward translation of the head, slightly rounded and elevated shoulders.

Now. If you are still with me, I hope that any of this sounds familiar! The postural distortion described above is OVERWHELMINGLY common. Sitting. At the desk. In the car. At the table. On the couch. these things take a huge toll!  Combine all this with some fun and strenuous activities that instigate even more scapular elevation, protraction, (surfing/cycling esp.) and you are on the fast track to some sub-optimal positioning of the shoulder complex.

Techniques for correction of my shoulder challenges in order of application:

  1. Self Myo-Fascial Release (for shortened, overactive tissues) uses manual pressure, or pressure applied by various implements (foam roller, lacrosse ball etc.) to isolate, and basically crush overactive muscle and bound-up fascia tissue until it releases some slack. Video- 0:05 – 0:55
  2. Static stretching (for shortened, overactive tissues) is probably the most well-known form of flexibility training, and is commonly misdirected at muscles that are already overly lengthened. This technique uses continuous external tension applied to a muscle, or group of muscles for a period of 0:30 – 1:00 to induce a relaxation response, and add to the slack from step 1. Video 0:55 – 1:05 and 1:18 – 1:20.
  3. Muscle Activation (for inhibited, shy and underactive tissues) via isolated strengthening and positional isometrics. This is essentially a way to take all of those lazy, underactive muscles and give them a chance to turn on and not be totally overwhelmed by their opposing muscle group.
  4. Integration (training movement patterns in the newly acquired range of motion) Uses total-body, or multi joint movement with ideal form, and a slow, controlled tempo to introduce your brain to this long-lost range of motion. This is the key part which assimilates the nervous system pathways that control movement in this “new” range of motion and body position.

This is merely an introduction to a concept that is instrumental in my practice. it is by NO means intended to be specifically instructional, and should be used with a reasonable amount of caution. The process is dependent on controlled, but considerable discomfort, and if you choose to dabble then that’s all on you. If it hurts too bad, back off. If your head explodes, it’s not my fault. But the benefits of this process are both immediate, and cumulative, just like how your posture became so turtle-ish in the first place!

I’m sure that this overly-simplified explanation will leave most of you with more questions than answers, but it is merely an introduction to my approach. I hope it gets your wheels turning, and keeps you coming back!

Ps. the white things I’m holding overhead at the end of the video are 20lb sand bags I made out of an banner with my friend’s sewing machine and some duct tape. :]

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