My Top 5 Shoulder Rehab Exercises

As a so called shoulder 'expert' I often get asked what are my favourite rehab exercises for them. But this is a tricky question to answer as there are so many different variables that make me choose an exercise. However, there are some exercises that I do seem to find myself regularly falling back on, so I thought I'd write a little bit about them, and for a change, I thought I would base this piece more on my clinical experience and opinion rather than just what research and evidence says (although it always influences my choices and is never far away), and for the sake of brevity I thought it best to keep it to just five exercises.

So why have I have chosen these five exercises? Well firstly, I seem to use them a lot with different patient groups, with different presenations of shoulder pain, so I class them as multi purpose exercises. Next, they are simple, easy to coach/teach and require little or no equipment. Finally they can be adapted and progressed easily. However, they are not the most exciting, fancy, or cutting edge exercises, as I tend to find with most things in this profession you cant go wrong if you focus on doing the simple this well, and leave the fancy shit for the guru's and show offs!

Before I get started let me make it clear that I have come up with this list based on 'MY' experience and these are the five exercises I find 'MYSELF' regularly prescriping due to the shoulder issues 'I' encounter. Your clientele maybe different, and although they can be used with a lot of shoulder problems they may not be suitable for some.

I am also NOT saying these exercises are the best for injury prevention or any performance or functional improvements. And talking of function I'm sure some of the functional movement nazi's will have a few comments on these exercises! It seems these days you just cant just give an exercise to get someone stronger, its has to be bloody 'functional' all the freaking time!

Ok disclaimers done, let's get started…

No 1: Rotator Cuff Isometrics

Ok, I'm cheating here with my No 1 exercise as it's really three exercises, but the simple, basic isometric exercise is too often over looked and under used. This is a shame as I find it very effective in reducing a lot of shoulder pains in many people that it rightly deserves my No 1 spot despite them being perceived as boring and simplistic nature. Although recently they are gaining some popularity and credibility again.

Isometric exercises for those non therapists reading, is when a muscle/tendon is asked to contract but there is no movement of the joint and so no change in the length of the muscle/tendon, just like when you flex your pecs and biceps in the mirror after a shower… No!!! just me that does that then, ok moving on…!

In my clinic I see a lot of people with acute shoulder pains brought on usually after an increase in activity, sport or training and most I beleive have a reactive cuff tendinopathy. Most of these shoulders have quite high pain levels for the first few weeks and we know that isometrics are great for reducing pain (source) and they do produce some significant forces and tension in the cuff, so can be thought of beginning the needed loading program.

There are lots of variations and I don't think it matters too much how you do them, it's more important how hard and how much you do them, more on this in a bit.

The isometric exercises I usually give are a 'Back of the hand Wall Press' used when I suspect a more superior cuff tendinopathy, it's done simply by standing next to a wall and pressing the back of the hand into the wall in the scapular plane (called Scaption) at approx 30° of abduction (see images below)

Next is 'External Rotation in Neutral Press' used for when I suspect more postero-superior cuff tendinopathy, this is done by resisting external rotation by pressing the back of hand into a wall again with the arm bent at 90° or by simply using the other hand, this can also be done in different angles of shoulder elevation if to painful to reduce compression effects (see images below)

Finally is the 'Belly Press' used for when I suspect more antero-superior cuff tendinopathy, this is done by placing the hand against the belly, elbow and wrist in line and push the belly in (see images below)

Isometric rotator cuff exercises

The sets, reps and frequency of these exercises that I advise are simply self directed by the patient, with an emphasis from me for them to do lots throughout the day, usually in groups of 3-5 at a time, holding each one for a long duration, usually 15-30 seconds plus, with strong-ish intensity. This parameters have been found to produce the greatest pain relieving effect (source) albeit in healthy subjects. Isometrics are also guided by pain levels, in that it shouldn't produce more than 4-5/10 discomfort when doing them (10/10 being worst possible pain imaginable).

The reason for this rather lazy prescription technique which usually goes against my own fastidious and at time over strict exercise prescription ethos, is due to there being evidence that by allowing patients with tendinopathy pain to self guide how many exercises they do is just as effective as when given set amounts (source) ok this is only seen in Achilles tendinopathy but there is also some early evidence that self managed rehab is just as effective as set prescribed amounts for cuff tendinopathy (source).

Finally I think self managed exercises when in pain produces better compliance to the regime, and as our primary goal with these exercises is for pain modification via neuro modulation rather than physical tissue adaption for strength or endurance basically it doesn't really matter how much they do or don't do, just as long as pain reduces.

No 2: Prone Y Arm Lift

This next exercise is also one I find myself regularly giving to most of my classical sub acromial pain patients (I don't use impingement as I think it's a misleading term and not a diagnosis). I usually give this exercise when the patient has a clear reduction in pain with the use of the Scapular Assistance Test as described by Jeremy Lewis (source) or in those that I think have poor scapular movement, although links to scapular position and movement causing pain and pathology is tenuous (see Chris Littlewoods piece on this here), as is our ability to spot it. However, most people I see with classical sub acromial pain tend to have weak posterior shoulder muscles and this is a great exercise to start addressing this.

The prone Y lift is simply done by lying on your front, on a bed or bench, with your arm hanging over the edge, then lift the arm up and out to raise it above your head, and I like to instruct that the thumb is on top pointing upwards to ensure the shoulder is in external rotation (see image below). Again as with the isometrics the exact angle of the lift can be varied, but for best results the research says 120° of abduction produces the stongest contraction in the supraspinatus (source) and upper/lower trapezius muscles (source). I also place a big emphasis on the eccentric action of this an most all other shoulder exercises. Eccentrics are known to produce higher forces in musculotendious units than concentric actions and maintain or increase myofibril length, all essential and positive effects of rehab.

Prone Y Lift

Now before the 'functional exercise nazis' start jumping up and down and explode with rage that I've dared to get someone lying down doing a shoulder exercise, I say… give me some credit for getting them doing it with just a single arm.

These can be done with both arms, and there are the group of exercises called the I, Y, T, W lifts that all target similar muscles, but as they ask both arms to move together and symmetrically, which really get the functional exercise nazis twitching.

Anyway, this exercise can be progressed into standing positions with the use of cable machines, dumbells or therabands (see image below), some times referred to as the PNF diagonal patterns of movement, and to keep the 'functional exercise nazis' even happier, you could get your patient doing them standing on one leg, or combined with trunk rotation, or when doing a lunge or squat, or…. well you get the idea!

Keeping the functional movement nazis happy

I think the Y lift exercise gives a lot of 'bang for your buck' targeting two commonly weak areas in one exercises, producing high forces in the upper and lower trapezius muscles both key in producing scapular upward rotation, important in scapula kinematics, as well as in the supraspinatus tendon key in humeral head control, as well as encouraging thoracic extension, usually lacking in most.

The final reason I like this exercise is that I find a lot of patients like the challenge of this tough little exercise, most look at me when I demonstrate it and I can see them thinking… “pah easy” only to be a little surprised when they try it. This I think increases compliance as most patients I meet like to be challenged and work on something they thought they could do, but can't!

No 3: 'Lat' Pull Downs

Now this is a bit of a curve ball for No 3, and you maybe a little surprised that a physio is recommending what's traditionally thought of as a gym based strengthening exercise for shoulder rehab, but let me explain why I like the Lat pull down for a lot of shoulder problems.

The 'Lats' or Latissimus Dorsi muscle has a bit of a image crisis, with it being seen by many therapists and coaches as a contributor to a lot of shoulder issues, with it often being blamed in restricting over head movement of the shoulder when it becomes stiff and tight. Also as it is an internal rotator of the shoulder it also can contribute, with the pecs in overpowering the weaker external rotators and so develop shoulder joint imbalances.

Now all the above can be true, but I think the poor old Lats are normally the victim rather than the culprit in poor shoulder movements or imbalances, and simply stretching them or using manual therapy techniques to loosen them off does bugger all.

Instead I find giving a Lat Dorsi strengthening exercise is a great way to actually help improve restricted shoulder elevation, counter intuitive eh? If the focus is again on the eccentric action of the movement, not the pull down, but the return back to it's starting position over head slow and deliberate, this is what I think helps improve and encourage better overhead shoulder mobility. This maybe through sarcomereogenisis, the addition of sarcomeres (smallest units in muscle) in series to the Lats, and / or via reducing stretch mechanoreceptor firing rates so improving an individuals stretch tolerance.

Now when I say 'Lat pull downs' I don't mean the tradional type you are probably thinking, as seen in a gymnasium, sitting down on a machine pulling a bar behind your neck with both hands oh no, no, no… I have a couple of techniques that target the 'Lat pull down' exercise in a different way, that will hopefully placate the 'functional exercise nazis' a little, I can feel you guys all twitching from here!

Just as with the Y lifts, single arm movements I think are far better for most, and in a standing position is also better if able. This can be a challenge due to the height needed, if not able then I find leaning forward at the trunk or even kneeling is a good alternative. As I said earlier the focus of this exercise is not on the pull down, but on the slow controlled rise back up of the hand above the head, and I also think it can be done with the elbow straight throughout the movement, so producing a longer lever, so generating more torque force away from the centre of mass, encouraging co contraction of other lumbar and abdominal muscles as well (see image below)

Single arm Lat pull downs

Another reason I like this exercise is that it really helps those with classical sub acromial pain who present with a painful abduction arc. I find when they do resisted adduction exercises such as this, it can in a lot eliminate their painful arc immediatly, and they think you are magician and they love you for it… and BOOM, you've got your way in, their attention and hopefully their compliance to do some rehab! I think there is a HUGE psychological effect in eliminating someones painful arc which shouldn't be over looked!

Now the magic removal of the painful arc with resisted adduction exercises is not due to them producing greater rotator cuff co contraction as I've heard some therapists explain, that's a myth. In fact this exercise is pretty useless for cuff activation. Instead Lat Pull Downs work by reducing the deltoids activity of superior humeral head migration, so eliminating the painful arc (source)

No 4: Overhead Shoulder Press

Again probably thought of as another strange exercise for a physio to use in shoulder rehab, but the standard weighted overhead shoulder press I don't think is used nearly enough or early enough in shoulder rehab.

The over press is a great movement that uses a lot of shoulder, scapula and trunk muscles and of course can be thought as functional as most people want to, need to, reach over head. The weights used don't need to be great and even to begin with it can be unweighted just to develop the movement pattern.

There are many variations of the overhead shoulder press but my favourite is the 'Arnie' shoulder press, yes it's named after Arnold Schwarzenegger, whose credited with designing the exercise, although I can find no reliable source to confirm this so it could be just one of those gym based myths bro!

The Arnie press is great as it works the shoulder through a greater range and through multiple planes of movement and it's harder and more challenging to perform. Also as its harder the weights don't need to be to as high to get the desired strengthening effects.

To perform an 'Arnie shoulder press', simply hold a dumbell in your hand just in front of your shoulder with palm facing towards you, then press/push the weight up over your head and as you do, twist your hand so that when your arm is straight above your head your palm is now facing away from you, reverse this movement as you bring the weight back down in front of your shoulder (see images below)

Arnie Shoulder Press

For an added dimension of difficulty and fun try doing an Arnie press with a kettlebell, up side down, what's called a 'Bottoms Up Kettlebell Press' (see image below) The unstableness of the kettlebell makes for a much harder press movement with fine corrections having to be made all the time so working all the shoulder muscles, developing greater speed or quickness of muscle/tendon reaction, not to mention working proprioception. The other benefit of the bottoms up press is you need to have a much stronger grip and there is a correlation to grip strength and rotator cuff strength (source) and using strong gripping when perfoming all exercises is something I encourage!

Bottoms Up Kettlebell Press

No 5: Press Up

My final favourite shoulder rehab exercise for this piece, is the good old press up, for a number of reasons. First it's a great all round upper limb strengthener, and not just of thr anterior shoulder and chest as known, but its also good for producing high levels of activity in the posterior rotator cuff (source) which is commonly lacking. Next it's a closed chain exercise so has adavantages in providing increased joint proprioception, cuff co-contraction as well as reducing joint shearing forces. And finally it has multiple variations and simp,e adaptations to change and progress and it is a great all round body exercise.

Press Ups

As I said variations of press ups are almost limitless and restricted by only your own imagination, they can be done standing, kneeling, inclined, declined, hands wide apart, close together, asymmetrical, explosive, static, weighted, assisted etc etc etc, I have my 45 year old housewife with superior cuff tendinopathy doing them, I have my 80 year old post op shoulder replacements doing them, I have my 23 year old type II anterior shoulder instability patient doing them, I even eventually have my rarer posterior shoulder dislocators doing them, obviously with caution and only when ready to do so!

Simply put if you haven't got some form of a press up type exercise into your shoulder rehab programs you are missing a trick!

So there you go, my top five shoulder rehab exercises!

However….

With all of that just said I need to spend a little time in the summary to discuss the non specific effects of all rehab exercises! It does occasionally pain me to admit this as a so called experienced, educated and well informed, physiotherapist blah, blah, blah, that sometimes it doesn't matter WHAT exercises we give people, they get better regardless!

Time and graded exposure to any movement is all that it needs sometimes to reduce pain. It can be the easiest and simplist way to rehab a painful shoulder, or any other joint for that matter. Simoly getting your patient to do a movement that aggravates their symptoms a little bit and by reassuring them they aren't doing any harm and encouraging them to gradually increasing their exposure and tolerance to that movement, it can reduce their sensitivity and pain to that movement… it can be that simple!

So let me know what you think of my favourite rehab exercises, good? bad? All constructive comments gladly received!

As always thanks for reading

Adam

 

 

37 thoughts on “My Top 5 Shoulder Rehab Exercises

  1. Thoughts on SLERS? Inner range i.e. not provocative, great EMG activity for posterior cuff, easy to teach. Of course not functional etc etc but great exercise for building strength initially.

    • Hi Chris

      Not sure I know the ancronym SLERS I’m assuming it’s Side Lying External Rotation?

      If so then yes it’s a good exercise for building resistance, capacity and overload in the posterior cuff, I know Mike Reinolds study found good high MVIC on his EMG study, but it’s not that much different than doing in standing

      As all things exercise selection is based on lots of variables and choosing SLER has a place if goal is simply to build resistance of posterior cuff

      Cheers

      Adam

  2. In your description of the Arnold overhead dumbbell press, why not use the more precise terms for wrist position: prone at the start (palm in towards shoulder), related to internal rotation of the shoulder, and supine at the end (palm out), related to external rotation of the shoulder.
    The intermediary wrist position is often described as “neutral” or “hammer”, which is good too. Those three wrist positions are fundamental and the terms very useful for precise descriptions.

    This kind of description comes back in a huge multitude of exercises involving description of hand grip, and it is good education when therapists and patients add those terms to their vocabulary. They are precise, and more easy to remember than the convoluted way of describing every time which way the palm is facing, which quickly becomes confusing.

    This is no more difficult than using the terms eccentric and concentric, and makes the whole description of any movement involving hands and grips sharper, clearer, and more memorable.

    For instance, even though this is not therapy, in the tennis serve, the racket is launched upwards with the wrist in neutral position, and just before impact, the wrist rotates towards the supine position (same as in top of the Arnold overhead press), which allows to launch the ball forward, and the nice follow-through also in extreme supine position.
    I have found very few tennis coaches able to explain this fundamental pointer about wrist position and rotation in the serve hit to their students.
    A clear grasp of the three terms, prone, supine, and neutral, makes for a crisp explanation of motions and facilitates teaching and learning.

    • Thanks for your comments, in my opinion the choice of terminology used depends on who you are taking to, this article is intended for both therapists and the general public so I didn’t want to be filling it with to many technical terms.

      I disagree with you that using technical terms helps patients, I find most patients prefer simple cues for exercises rather than using medicalised anatomy terms and jargon, I also feel to much jargon and biomechanical terms produces a more internalised sensation to the exercise and think this should be reduced as much as possible as over complicated, technical internal descriptions take away the natural feel of an exercise. Individual variability is also important, movement shouldn’t be exact, and reproduced the same every time it just doesn’t work this way!

      I tend not even to use the terms eccentric / concentric / isometric with my patients most dont understand or really want to, unless they have some anatomy or physiology education so why confuse them!

      However there are some that do want to know or when talking with other professionals then yes I guess your descriptions maybe helpful.

      Thanks again for your comments

      Regards

      Adam

  3. Dear Adam:

    By the way, I think I made a real error in my description of the wrist positions in the Arnold overhead press. At the start, with palms facing in to shoulders, the wrist is supine, with ER (external rotation), and at the top of the motion, the palms are facing out, in prone position with IR (internal rotation). I don’t know where the confusion came from in my mind. The shoulder moves from ER to IR. With your system (palms in, palms out) no confusion is possible!

    However, I think you are correct with respect to the average public and its ignorance of the basic fitness vocabulary.

    But I have a suspicion that this reflects a general lack of education in physical anatomy and sports training among European populations.
    Once in Europe I asked a doctor about the terms “prone” and “supine”, and he answered (exactly like you) that nobody in the street would ever understand what they mean. Only students in medical schools would have some knowledge.

    This is not the case in the US, where we are inundated with magazines, videos, articles on sports and athletics, an immense quantity of new gear, and the fine points of training. Everybody I know owns some fitness training manuals.
    Here fitness is nearly a national religion, and is a cult for a huge membership of a wide “3-F club” (physical fitness fanatics).
    If you walk along the famous Venice Beach Boardwalk, you’ll get the idea that life in California is dedicated to the cultivation of body fitness.
    Any stroll through Central Park in Manhattan will give the impression that the whole city is obsessed with sports and fitness, with everybody equipped with all kinds of gear, bands, dumbbells, etc. with all kind of gym apparatus already installed in the Park, all of them attending classes, many with their own personal trainers (carrying kettlebells of 9 and 16 kg!).

    In my circles, I have never met anybody who would not understand the term “isometric”, or “dynamic”. The description of isometric exercises for the neck can be found in any ordinary newspaper or magazine.
    It’s a difference of cultural obsessions, but in the US, a soon as you want to perform and stand out a bit from the anonymous crowd and strike some kind of figure, in any field, business, entertainment, media (especially media!) good looks are primordial, and they go with youth and fitness. Most newspapers are fascinated with the beauty and fitness regimens of aging people, from age 60 to 100!
    As a result the basic vocabulary of fitness training and kinesiology is far better known than in Europe.

    However, if you go to any Walmart, you might wonder whether all those grotesquely overweight shoppers have ever heard of fitness…

  4. Well I thought it was really good however you put it!
    I’ve just moved from a small NHS GP clinic environment with little to no equipment/space into a senior physio role at a major gym chain so keen to get into later stage rehab for shoulders etc with some of the exs and equipment shown so cheers!

  5. I also like to do the “Lat Pullddown with Resisted Return” (No. 3) and the “Arnold Overhead Shoulder Press” (No. 4) with both arms, but in an alternating mode.
    One arm is reaching up while the other one is coming down. In both cases the mental focus is on the arm moving up and being stretched along the ear (maximum lever).
    While recognizing that the single-arm movement is more efficient, it’s just a matter of saving time during a long workout session (I try to do mine at home every day).

    Also, in the case of the kettlebell version of the Arnold Press, I have bought a 4 kg kettelbell (a bit reluctantly, just for the fun of variety and a new toy) , but I am wary of using it for too many exercises, as I have read too many accounts of horrific accidents.
    It takes a very strong grip to control this animal, because, once the ball is up in the air, it develops an inertia and a life of its own, not controlled by the hand, which does not directly control the center of mass as it does with a dumbbell. The dumbbell moves with your hand and wrist, not so the kettlebell.

    I do notice that your model looks extremely fit and extremely strong, and perfectly able to control his kettlebell, which to me looks like a 9kg, or 12 kg, perhaps even the monstrous 16 kg. Most patients with shoulder weakness and problems do not have the athletic build of this man.

    My personal feeling about using kettlebells is the same as Stuart McGill’s about Olympic lifts: They are better left to the professionals of this special sport. Kettlebells require a very precise technique in handling, safety is a major concern, and learning all the important details requires lengthy and precise instruction from professionals.
    Practically any kettlebell exercise can be done, much more safely, with a dumbbell, as demonstrated in this article.
    And there are many specific hand exercises to develop one’s hand grip that does not involve lifting this dangerous iron ball in the air.

    • Hi again Roo

      You are obviously very passionate about movement and exercise and I applaud you for that and I agree safety is always paramount when getting a patient or client to do any rehab exercise, and the kettlebell press as you say won’t be suitable for everyone, I was merely using it as one example of a progression of the over head press

      I don’t think kettlebells are dangerous nor do I think they should only be used by professionals, I think they have a lot to offer in rehab, the unstableness is one of the key factors I like about it.

      I do think however you need to be less worried about exact and perfect technique when giving rehab exercises as I don’t agree in getting someone to move exactly how YOU want them to move and to move the same way all the time, is not good practice, every individual is just that individual and they will have their own preferred way of moving, and variation is vital for a health adaptable and flexible biomechanical system

      Thanks again

      Adam

  6. Nice write up Adam. I just started checking out your work and blog. Impressive and quite detailed (perfect for a laymen like me:)). Thank you for what you do. I think what often goes overlooked in most shoulder protocols unfortunately is the entire lower body itself. I’ve found the reason why a scapula will be floating or forced ‘out of position’ in the first place has a lot to do/more to do with what’s run amock through the pelvic axis (which can be endless, I know. But I digress…). The brain and nervous system have a great way of trying to normalize weight distribution by positioning ‘bony structure’ above somewhere else via fascial loosening or tightening. Like it or not maintaining center of gravity is what we do apriori to everything else. The head is the easiest and first for us to change (the eyes lead the way for us here). The scap then secondary. The poor shoulder and all the internal workings of dysfunction as you’ve described are the end link in the chain unless we are looking at some blunt forced trauma. When we reverse the order of protocol for these shoulders don’t be surprised that when we finally get to the shoulder ‘Impingement’ (ahhh, the ‘Impingement’!) this issue has already been cleared. I’ve found that approaching things in this way also helps the patient. It takes some of the metaphorical weight and emphasis on their shoulders ‘off their shoulders’. This helps then to loosen the neural pain pathway at the level of the brain and helps the entire system recover from whatever/wherever the trauma is. Oftentimes in a span of under two hours from start to finish.

    • Hi Rob

      Firstly thanks for your kind comments and your excellent thoughts here. I do like you refer to sometimes look at the shoulder from a top down or bottom up perspective and see the interaction and effects the other bodies systems have on it and it can again as you say take the emphasis and focus of the painful part. The issue I have with this is that it’s all very subjective and ‘arty’ going on nothing but observation and intuition can sometimes mislead us and direct us down wrong pathways and miss the glaring obvious issue, a painful, weak or stiff shoulder.

      However I’m also a fan of the saying if you look less hard you can see a lot more

      Thanks again

      Cheers

      Adam

  7. Great article Adam. I use most of these ( less the kettle bells but will add those in) I agree the use of push ups are overlooked. I use variations more than the traditional push up position with golfers in order for them to feel the connection with the scapula as they tend to have so many compensations in this area due to poor swing mechanics. My experience with golfers is that they are given training programs that start at too advanced a level for their ability & they get nowhere but injured, fast. Choosing the entry point of the exercise is as important as the correct exercise itself.
    Likewise, I agree with you regarding descriptive choices. I have worked with players from around the world & although some are up to date with lingo, many like to think they are & are actually very confused. For me simple language that illicits the response & feel they need is best. They want a result & care not a jot if you explain it in english or double dutch, as long as they “Get It”
    I also add a simple figure 8 exercise (with arm relaxed by the side, elbow extended- to improve joint propreoception, in an acute, painful shoulder (taught to me by Paula Deacon) A great exercise along with the isometrics to build confidence and break the protracted, IR position of the gaurded, painful shoulder.
    Love your work, keep it coming #groupie

    • Orlaith:

      You see, your posting did elicit an answer from me.

      Excellent point about the vital importance of choosing the right point of entry, including the initial load. And the fact that athletes may easily delude themselves into believing they can handle heavier loads that are in fact at a level too advanced for them. Testosterone plays a bit in this common error.
      This is where an objective trainer or therapist can be invaluable with his experience, as it allows him to see immediately that the trainee is working with a load beyond his level of fitness.
      I have read a huge amount of literature and watched many videos about kettlebell use, and very rarely is the weight of the kettlebell ever discussed, certainly not the weight used by the master, who is shown swinging his monster for endless reps.
      Only in the case of accidents, say in kb competitions, it is reported that the competitor smashed his skull with a 64-kg kb. Then the amount of the load seems to be a vital ingredient of the presentation.

      I find your allusion to the figure of 8 very enigmatic. If, as you say, this is a valuable exercise, any chance you could give us a clearer description so that we could immediately get it?

      If I may make a comment.
      Here, in this blog, we are conversing with Adam. We are not patients running short of time, or international golfers always on the go. We are not in a hurry to get it over with and rush to our next appointment. So, here, we are not in a position comparable to those patient golfers of yours, who probably don’t read too many books or articles, and with whom the key for you is to dumb down your knowledge so that they can absorb it like baby food.

      So, here, at our level of discussing ideas and communication (not treatment), we have a bit more time and are able to digest more solid food,. And so, I don’t think that we should be so afraid of using more technical language such as eccentric, concentric, ER (external rotation), IR (internal rotation), proprioceptive, stability, etc., even including, if I dare say so, prone and supine..

      Now, when back to handling your patients, of course you’re the only judge to decide whichever language you feel is best suited. Still, I find English very flexible and versatile, and see no need to use double Dutch, ever. Single Dutch seems already incomprehensible enough.

    • Thanks Orlaith for your very kind comments, I don’t work much with golfers, not any good ones anyway so my experience with these types of shoulders is limited, but you’re right getting the right exercise, at the right level, at the right intensity and with the right progression is the key to successful rehab, progress etc

      Thanks again

      Adam

  8. Hey Adam

    Great blog (and twitter-profile)!! I hope it is okay if I hijack your article with a question.
    What is your take on serrarus press, push up plus etc. – do they show too much m. pectoralis minor activity? And if so, should they be used cautionally around patients with subacromial impingement?

    • Hi Martin

      Thanks for comments, yes a press up obviously does incorporate the pec muscles and yes this maybe an issue for some impingement type shoulder pains, but the Serratus anterior is a key muscle in scapular upward rotation and so this exercise can really help increase its strength

      If u want to avoid pec but maximise the Serratus anterior then just focus on the push plus bit ie keep elbows straight would achieve this

      Thanks

      Adam

  9. Brilliant clear and thought provoking , always learning cheers lesley

    Ps can I request an a Achilles tend one ? Obv when u got 5 mins bit cheeky but u know me

  10. Thanks for this great article. I’ve been suffering with RC problems for about six months now and it’s getting me down. That said, I didn’t realise how bad it was at the beginning and have only been seriously rehabbing thus for about 3-4 months.

    I have noticed that although I certainly seem to be getting better (on a weekly basis), I do feel a little sorer the following day, only to sort of feel better than what I did previously after a couple of days rest from that point. If I simply do nothing, I don’t feel sore (obviously) but I don’t really seem to get better. Is this sort of thing normal?

    I’m trying to stay positive by looking at the progress I’ve made. I find that the final bit of pain that I need to get rid of is when performing the “back of hand wall press”. It’s more pain on release but it is starting to go…just taking so long.

    Anyway, thanks again :-).

  11. Hi Adam

    I am an MSc (pre-reg) Physiotherapy Student at Queen Margaret University in my final year.

    For my dissertation I have been fortunate enough to be given the opportunity to analyse the data of professional Scottish Rugby Union players. In particular I will be looking into the relationship between upper limb Y Balance Test performance and subsequent risk of shoulder injury based on the last 2 seasons worth of data collection.

    Given your expertise in this area I was wondering if you had any thoughts regarding the test and/or any interesting literature you could point me in the direction of.

    Cheers

    • Hi Stuart

      What a great study that will be… let me know when its done, I would love a read.

      Yes I know the UQYBT well, I use it and teach it on my courses. I think its a nice simple tool to monitor progress of a lot of things, such as strength, proprioception, fear, anxiety, kinetic chain ability etc etc.

      However does it give us any clues as to what we should be working on or any indication of risk of injury… hmmmmm… I doubt it… Its just a test and doing tests tells us how good the subject is doing the test, nothing else.

      There is some normative data on the UQYBT by Gorman 2012 here http://www.ncbi.nlm.nih.gov/pubmed/?term=gorman+2012+upper+quarter which is helpful, but only applicable to that population of course, those in pain or with injury are going to be different.

      Hope this helps, and as I said please keep me posted

      Kind regards

      Adam

  12. i understand what you mean. write “” functional exercise fanatics NOT “‘functional exercise nazis”.

    To remind you: the actual Nazis concscientiously, and cruelly condemned to death millions of ordinary people; to be murdered ; the Nazis ingeniuosly caused suffering to women, children, old men ,
    FALSELY called “undermenschen” meaning biologically lower class people.

    While I am pretty sure that Adam Meakins only meant to underline the concepts of
    ” functional exercise fanatics ” …let’s drop the word “nazis” unless we mean… NAZIS.

    marty

  13. Hey adam, great post as always; really enjoy all that you have to say…thought provoking in a constructive manner backed up with evidence.

    I have a little problem myself with bilateral shoulder pain; worse on the right, insidious onset and the only causative factor is that I do alot of pushing pulling etc; never had any previous problems before with my shoulders . I’m a physio myself so I do need my arms so to speak and I’m in considerable pain; dull achey…anyway’s, I’ve seen a well renowned physio and he was excellent; given me exercises to do but I’m not finding an improvement…SH flexion with my arm ER caused pain in the anterior part of my shoulder, however when he performed the scapular assistance test, the discomfort eased and I could achieve full flexion; I’ve been given bilateral prone Y-lifts, scapular setting ( I know what you will say) scapular protraction on all fours maintaining a neutral spine whilst keeping my knees of the ground in that prone position, a seriously hard exercise that involves a press up against the wall, keeping my elbows tucked in and my wrists flat against wall! ( bloody hard) and one more exercise by where I’m side lying, using a dumb bell and I protract and then retract where the arm is fully extended above me and a progression of that is rotating my scapula laterally and bringing the weight up towards my head with the arm extended; that causes discomfort!! anyways; I initially localise the pain to anterior part of my shoulder, in or around the bicpital groove and the usual pain provacation tests caused some discomfort. however I am now feeling it somewhere in or around my pec minor/major and if I poke/prod in the area…there is considerable discomfort!! I am the type of person who needs to know exactly whats going on and I’m at a loss right now…is it pec minor dysfunction with an associated serratus anterior problem or are we talking a biceps tendonopathy and while I’m not as experienced as yourself in all matters of the shoulder ( annoyed I missed your course in dublin) I am always keen to learn and I find the shoulder interesting especially now I seem to have a fecking problem with it!! To me exercise is medicine and that’s why I’ve wrote to you asking for your opinion if that is possible over social media when it come’s cases like this.

    Thanks again,

    Lisa

  14. Hi Adam, fantastic write up and suggestions. I have suffered with shoulder problems since my early 20’s (I’m 29 now) mostly from playing rugby and thai boxing something which I continue to do. I had a Bankart repair on my should a just over a year ago and everything was going amazing, I was even training to get back in the ring at the end of the year, but last week I stupidly decided to play in a rugby 7’s tournament after 5 years away from playing and I dislocated my shoulder :-/. It’s been a week now and my shoulder actually feels pretty good, I almost have a full range of movement but I know that it’s totally unstable. This, my question is do you have or recommend any kind of 8- 10 week plan for regaining shoulder stability so that I can start training in full contact again?

    Also, I’m thinking of taking up swimming to help stabilise my shoulder is that a good idea?

    Kindest Regards
    Gary

  15. Thanks a lot for the exercises! I’ve already felt better in my shoulder from the isometric exercises after two days… That’s incredible to me. My shoulder only hurts in the 90 degree neutral press, with no pain in the 30 degree abduction press. Would you say I’m more likely to have antero-superior cuff tendinopathy?

Please leave your comments here...

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s