My 5 Least Favourite Shoulder Rehab Exercises

Following on from my previous piece 'My 5 Favourite Shoulder Rehab Exercises' which I honestly thought would cause more controversy and gnashing of teeth than it did, I thought I would write another piece looking at my five least favourite shoulder rehab exercises. This again will be heavily based on my own personal opinion and experience with some supporting evidence, and as before I'm hoping it will create some debate and discussion, so please leave your comments below or on Twitter

I need to thank Matt Croger aka @PTPain for giving me the idea for this post in a conversation we had, so please go follow him as a thank you from me!

Now, before I go any further I need to put a disclaimer in here and say that really I don't think there are many 'bad' exercises, just bad choices and recommendations by therapists and bad execution and compliance by patients. Most of the time its not the exercise that should be blamed, rather the therapist giving them out or the patient doing them poorly, if at all, however, these exercises I've chosen are arguably either ineffectual, problematic or at worst dangerous!

So here we go, my 5 least favorite shoulder rehab exercises!

No 1: Scapular Setting

This exercise easily gets my No 1 as my least favourite, ineffectual, shoulder rehab exercise, even it's name winds me up, scapular setting, setting for what?

Scapular setting is regularly given to patients who are seen to have rounded or slouched shoulders, or when a 'winging scapular' is noted (see images below).

Winged Scapular

The patient is instructed to sit or stand and asked to pull/squeeze their shoulder blades back together and down (see image below), it is commonly given out in an attempt to correct and improve the resting position and static posture of the shoulder girdle, it is also thought to strengthening the lower trapezius muscle and so given out on the premise of improving posture, reducing scapular winging and relieving pain!

Scapular Setting Exercise

However, in my experience it does none of these, if anything it often makes matters worse and increases pains and problems by asking people to hold themselves in braced, stiff, awkward and strained positions sometimes for extended periods of time.

The notion that there is a preferred or correct way to hold your shoulders, or any other part of your body for that matter, is in my opinion. nonsense! Anatomical, environmental and activity variability make this so, we are all different, we all look different and we all move different, if we weren't the world would be a very boring place. There is no robust evidence that one posture is any better than another, yet we insist as therapists on advising and instructing our patients to adopt 'textbook' postures and positions, based on ideals that are false and misleading.

Variability of position is far more important in my opinion, an ability for an individual to change positions and postures is far more useful than being able to maintain just one, and above all else, all positions of posture should be comfortable and pulling your shoulders back and down just isn't for most!

The notion that scapular setting will reduce a winging scapular by strengthening the lower trapezius muscle is also flawed, we know that a winged scapular is an issue due to a weakend Serratus Anterior and scapular setting does not target the Serratus Anterior, it's more targeted towards the lower trapezius muscle

But the reasoning to use scapular setting to 'strengthen' the lower trapezius is also a flawed one, the low force of contraction produced in this position will not produce the required tension to effect a change in its strength, there are far better exercises for achieving this goal, such as the 'prone Y lift' as mentioned in my 5 favourite shoulder rehab exercises (source).

Finally is scapular winging really that much of an issue? There is no clear association with scapular winging and shoulder dysfunction (source), so should we even worry about it, although I do attempt to 'improve' it in most I see with it, and we know that there is no association with a shoulders static resting posture and its dynamic ability (source), so just beacuse a scapular is winged or sits anteriorly titled or downward rotated does not mean it will say this way when it begins to move.

No 2: The Barbell Upright Row

This next exercise almost got my No 1 spot as I loathe it with a passion, but as there are some variations of it that I do think can be useful for some so it was downgraded to No 2! But the standard weighted barbell upright row is just a horrible and potentially dangerous exercise that has no place in shoulder rehab, nor in strength training for that matter!

This exercise is performed by holding a barbell and lifting it up the front of your body until the bar is under your chin (see image below).

Upright Row

Not only does this make you look like a demented chicken, flapping your elbows up and down, but the end position of the shoulder joint is in combined abduction and internal rotation! Now does this position look familiar? Yep it's the same position as one of our most common sub acrominal pain povocation tests, the good old Hawkins Kennedy Test, when we try to push the humeral head up against the acromial arch squeezing the structures beneath it to see if they cause pain, but I. The upright row we are doing it repeatedly, with speed and with weight, can you begin to see a potential issue here!

Hawkins Kennedy Test

However, there are modifications of the upright row that I do like, as this exercise does create high forces in the upper trapezius and a stack load of other muscles which can be desirable. The modification I like is in a single arm snatch movement (see image below), where you pull a weight up from the floor infront of you and end up with it above your head, doing it this way and doing it with a single arm produces much less force and less time in the 'danger zone' of combined abduction and internal rotation and incorporates a whole body movement, so giving more 'bang for your buck' per rep.

Single Arm Snatch

No 3 & 4: Theraband Rotations in Neutral

Now those that know me, will not be surprised that these two exercises are in my least favourite catergory, with me often criticising (some say whinging and moaning) on there over use and application, not just beacuse the exercises have issues, but also for some other reasons.

These exercises are performed by pulling a theraband either across the body for internal rotation bias, or away from the body for external rotation bias, with the elbow bent at 90 degrees and the upper arm down by the side of the trunk (see images below).

Theraband Rotations in Neutral

The main reason I don't like these exercises is simply due to their lazy, over prescribed use by so many therapists for every shoulder pain they encounter, giving them out routinely to all patients with any shoulder issue, no matter the condition or the diagnosis, not thinking, not fully assessing, not clinically reasoning.

Many argue that these exercises do have a role with many shoulder issues as they are simple to do and easy to teach and as they get some force into the rotator cuff muscles and tendons and so strengthening them, but what most don't know is they don't get as much force into the cuff as they do in the deltoid and pecs. Studies have show high EMG activity in the delt and pec during neutral rotational exercises, so they get your delts and pecs strong, but not really your rotator cuff (source)

Another reason I don't like or use these exercises is they lack the co contraction of the cuff needed to dynamically stabilise the humeral head as they target all the torque producing muscles of the shoulder in one direction so creating potential shearing forces in the joint (source)

There are, in my opinion, far better alternatives than doing rotational movements in neutral positions, for example, simply elevating the arm into unsupported elevated position targets the cuff more specifically (source) although again they don't produce much better cuff co contraction which is often needed!

Finally another reason I'm not a fan of these exercises is they could compound some shoulder problems rather than help solve them, for example the external rotation exercises in neutral also targets the rhombiods heavily and this muscle acts as a strong scapular downward rotator, usually not advantageous in sub acromial pain

So in summary I don't like shoulder rotation rubber band exercises in a neutral postion and when I see a therapist giving out both internal and external exercises to the same patient at the same time a little piece of me starts to cry quietly inside as I see our profession losing its credibility, one rubber band exercise at a time… please stop!

No 5: Anything on a Bosu, Swiss Ball or Wobble Board

Finally the idiocy that is unstable surface training gets my last spot. When it comes to shoulder rehab (and most other rehab) training on unstable surfaces is just bonkers and a gigantic waste of time and energy, it's usually done more for the therapists benefit than the patients, giving an illusion of complexity and 'thinking out side the box'

Bonkers…

There is absolutely no sound clinical reason to do any shoulder rehab exercises on an unstable surface, unless perhaps you are thinking of doing over head weights standing in on a rowing boat in the middle of the open sea.

Studies have shown that there is no increased muscle activation in any muscle groups so no gains in strength by exercising shoulders on unstable surfaces (source) (source), as for the argument that it improves 'core' activation, that also has been shown to be not true (source).

However if in closed chain positions then perhaps, the role of unstable thingys could be useful in some instances, such as a press ups action on Swiss balls, as this does show in some research increased muscle activation (source) but then in others it doesn't (source) and the reasoning and functionality of doing such exercises again has to be questioned strongly (source).

So there you go, my five least favorite shoulder rehab exercises, please let me hear your comments and opinions and if you have any others you would of like to have seen added to the list.

As always, thanks for reading

Enjoy your sport

Adam

 

7 thoughts on “My 5 Least Favourite Shoulder Rehab Exercises

  1. The single-arm snatch is a nice movement to add to a routine of scapula elevations.
    I do all three rotator-cuff exercises with dbs while side-lying: ER and IR (4 – 5 kgs), and supraspinatus exercise by lifting the db at about 20ΒΊ-30ΒΊ off the horizontal hip, 10″ holds, 10-12 reps. The difference of supraspinatus strength between right-arm (5 kg db) and left-arm (4 kg db only) is noticeable.

    The picture of the monstrous strong man on his unstable board is cool β€” an impressive masterpiece. Too bad (for my taste, that is) he’s marred by all those tattoos on his arms. His kbs seem pretty light for his formidable strength.
    I wonder what happens if he should lose his equilibrium. Where do the kbs end up smashing into? Still, I add him to my collection of pictures of motions to avoid.

  2. Do you think there is anything to be said for closed-chain stability exercises to improve proprioception in patients with joint instability? This is my only use for ‘stability’ exercises in the shoulder.

    • Hi Ali, I think there is a lot to be said for closed kinetic chain exercises for shoulder in general, I like them not only for shoulder instability issues but a host of other conditions, cheers Adam

  3. Damn i love you articles. Ive read all of them! It’s so good, funny and very learning full reading. Keep up the good work, can’t wait for your next article πŸ™‚

    Can you recommend any other blogs similar to yours?

  4. I had a lot of issues with shoulder injuries over a period of several years (both my own and with others) – I’ve found two things out from personal experience.
    1) Natural movement – if a person is doing a movement (especially weighted) that looks awkward and that causes pain or sensations of instability then they probably shouldn’t be – especially as part of rehab.
    2) Kettlebells can work the shoulder in a lot of beneficial ways, the same goes for weighted clubs, but each person varies – barbells/machines/bands/kettles/clubs/dumbbells – find what works in each case and try not to care which, just learn from similarities and successes/failures

  5. Perhaps not strengthening the shoulder on an unstable surface, but what about doing the exercise and pairing it with a one leg squat or balance? We know that for throwers, the contralateral leg needs to be strong and weakness on the contralateral leg can result in an inefficient throw. So would it be practical to pair throwing with a single leg squat or a row with a single leg bent over row? There are some research showing that even decrease hip flexor flexibility can contribute to excessive stress on the shoulder , I think it is important to involve the kinetic chain but not so much on an unstable surface (unless they need to be on an uneven surface for their sport, would you then utilize the bosu?!). I don’t have the references, but if you want them, I can find them. Thanks! love the blog

    • Hi Linda

      Yes involving the rest of the kinetic chain in shoulder rehab exercise is essential especially in sports, especially in overhead and throwing sports, only 10% of throwing force comes from the shoulder the rest from trunk, legs etc so its very important!

      I do use contra lateral leg work with high level end stage rehab drills trying to mimic the functional movements as close as possible, and I mention a few examples in my other blog on my 5 favourite exercises

      Thanks for your kind comments and taking the time to write

      Regards

      Adam

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