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Postrehabilitation strength and conditioning of the shoulder: an interdisciplinary Approach

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Title: Postrehabilitation strength and conditioning of the shoulder: an interdisciplinary Approach


1
Postrehabilitation strength and conditioning of
the shoulder an interdisciplinary Approach
  • By Marisa Schoepflin and Katie Griffis
  • Kinesiology

2
Objective
  • To educate readers on the more common shoulder
    injuries and provide a framework to link
    rehabilitation principles to postrehabilitation
    strength and conditioning program design

3
Principles of the postrehabilitation design
  • OVERARCHING PRINCIPLES
  • Themes of postrehabilitation management that need
    to be addressed
  • Rotator cuff strength
  • Scapular strength
  • Stability
  • Rhythm
  • GH joint mobility

4
UPPER EXTREMITY WEIGHT-TRAINING MODIFICATIONS
  • 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

5
CONSIDERATIONS OF PROGRAM DESIGN
  • 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

6
Program design
  • 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

7
3 main Pathologies and Rehab techniques
  • Rotator cuff
  • Glenohumeral joint instability
  • Labral

8
Rotator Cuff pathologies
  • 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

9
ROTATOR CUFF PATHOLOGY (Postrehabilitation)
  • 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.

10
Surgical intervention
  • Goal is to restore the normal anatomy
  • Arthroscopic or open surgical techniques
  • Success is measured through
  • Subjective functional outcome scales
  • Range of motion
  • Healing of the repair site

11
Rehabilitation
  • 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

12
Rehab techniques
  • Sleeper stretch
  • http//www.youtube.com/watch?vHU6bdtdDess
  • Used to improve internal rotation mobility
  • Cross arm stretch with internal rotation over
    pressure

13
Strengthening of rotator cuff and Scapular
muscles
  • 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_Kkwplaynex
    t1listPLDFwhc5-T0K8UreU9t_C5kaoC3Pu3_s8jfeatur
    eresults_video
  • Full can elevations
  • http//www.youtube.com/watch?vnwMFih5BABA

14
Glenohumeral Joint Instability
  • 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 theglenoid and the
    humeral head
  • Proprioception loss
  • Neural mechanisms.

15
GLENOHUMERAL INSTABILITY (Postrehabilitation)
  • 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 weight-training program to
    avoid positions of stress to the joint capsule.

16
Surgical intervention
  • 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

17
Rehabilitation
  • 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

18
Strengthening
  • 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

19
Labral Pathology
  • Glenoid labrum is a fibrocartilaginous ring
    that serves as a static stabilizer of the
    glenohumeral joint
  • The long head of the bicep tendon attachesto
    the superior labrum concern to rehab
  • Causes extreme tension of the labrum during
    external rotation

20
LABRAL PATHPOLOGY (Postrehabilitation)
  • 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.

21
Surgical Intervention
  • 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.

22
Rehabilitation
  • 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.

23
Strengthening
  • 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

24
In Conclusion
  • 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.

25
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26
Works Cited
  • 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), 42-55.
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