Shoulder Rehab is more than just Strength and Range of Motion!
Updated: Mar 30, 2022
Have you been thinking, "I've finished my rehab, but my shoulder still doesn't feel right"? Although the shoulder joint allows for a large range of motion in a variety of directions, this mobility inherently leads to a less stable joint. From an anatomy stand point, the shoulder is surrounded by large muscles such as the pectorals, biceps and deltoids that produce large movements. But the muscles of the rotator cuff which act to stabilize the joint are small and to some degree, easy to damage.
So you've done some strengthening and you have full range of motion. Acts of daily living go just fine, but when you return to your sport, things still don't feel right. Your shoulder feels unstable. You're scared to take contact or to fall because it feels like your shoulder is going to "pop out". But you've been cleared by your therapist, so what gives?
What is Proprioception?
Sport specific exercise and exercises that train proprioception (your body's ability to recognize a joint's position in space) are crucial for long term results, prevention of reinjury and optimal performance. Any shoulder injury which has damaged soft-tissue structures such as muscles, tendons, or ligaments also implicates damage to nerve structures. In order to re-train the brain's awareness of safe joint positioning, we must repetitively challenge the joint to remain in an ideal postural position while enduring outside forces. If our brain cannot react to outside stimulus to reposition the joint, we lack the ability to self-protect.
How do I train Proprioception?
Even if the muscles that move the joint are strong, it is still necessary to retrain the connection between the joint and brain, to establish the ability to involuntarily maintain a safe joint position. So how do we train this? Unstable surfaces are a great way to challenge the joint as the body is required to react to unprecedented changes. A great example of this for the shoulder is a plank hold with arms on a swiss ball or bosu. Just make sure you can hold a pain-free plank on solid ground before progressing to this option!
A ball plank is a great place to start, as it is a closed kinetic chain exercise. But most sports involved open kinetic chain shoulder movements, so we can't ignore them! My favorite way to train proprioception for open kinetic chain movements, is to place my client in a position specific to their sport or activity and to apply perturbations (moving the limb out of its normal position or path by applying an outside force) while they attempt to remain in a safe and controlled position. Let's say you play hockey. At home with a partner, adopt your skate stance as if you were about to receive a pass. Pull the shoulder blades down and back, or into a position that feels stable, and have your partner gently push on different areas of your body so that the joint is required to respond to outside force.
Proprioception, perturbations, performance, posture and positioning! Although basic strengthening is important in terms of injury rehabilitation and return to sport, we cannot forget to retrain stability and involuntary recognition of safe joint positioning. This is only one of several reasons that your shoulder may not feel right following injury. If you don't feel back to 100% even after your strength has returned, check in with your athletic therapist to see what else you can do to return to your peak.
Kristen Huber BaKin, CAT(C)
Owner, The Gentle Athletic Therapist