by Albert Salopek, ATC and Steven Ryan, PT
		Current Concepts in Shoulder Rehabilitation The asymptomatic shoulder is the perfect balance between mobility and stability. The shoulder joint demonstrates extreme ranges of motion in a multi-directional fashion. When the physical demands overcome the physiological stability, several injuries can occur. This article will concentrate on the stability of the shoulder joint. It will briefly discuss the anatomy of the shoulder complex and a few fundamental exercises to create a more stable and functional complex. Anatomy The anatomy of the shoulder is complex. The humerus connects to the scapula, which is virtually freely floating on the thoracic spine, by means of a ball and socket articulation. It is similar to a golf ball sitting on top of a tee. Except the glenoid cavity of the scapula has a labrum. The labrum is a bowl like cartilage structure that deepens the socket in attempt to keep the humeral head in place. Unfortunately this type of articulation allows for greater multi-directional movements at the expense to the stability of the joint. Therefore most of the stability of the shoulder complex comes from the musculature of the scapulo-thoracic region along with the musculature of the shoulder joint.
	Skeleton Shoulder in Glenoid Cavity Shoulder with Labrum Since the scapula is virtually floating on the thoracic spine it is extremely important for the musculature around the scapula to be strong, enduring, and neurologically firing in a coordinated pattern along with the rest of the scapular stabilizers, shoulder stabilizers and prime movers. The scapulo-thoracic muscular stabilizers consist of the three sections of the trapezius (upper, middle, lower), rhomboids and serratus anterior. The main shoulder muscular stabilizers consist of the rotator cuff. The rotator cuff includes the supraspinatus, infraspinatus, teres minor and subscapularis muscles. The rotator cuff is responsible for holding the humeral head within the glenoid cavity. These muscles are responsible for the dynamic stability of the shoulder joint. Rehabilitation & Prevention When the physical demands of an activity overcome the physiological stability of the joint, injury may occur. This will have significant bearing on the initiation of your rehabilitation program and the progression. These exercises should only be performed if one has the adequate range of motion along with the required strength. If one has shoulder pain, it is extremely important to have your medical professional evaluate the significance and severity of your injury prior to performing these exercises. 1 Full Can in Scaption S: Standing with feet about shoulder width apart and knees slightly bent. Draw in belly button to engage deep core musculature and keeping lumbar in neutral spine. Let arms rest at sides with palms facing eachother. M: Keeping elbows straight, raise arms upward at a 45o angle. Keep shoulders down and raise arms as high as you can without pain up to 120o. Lower arms back to starting position. 2 Prone Single Arm Y S: Lying on your stomach at the edge of a table, place a pillow under your forehead to keep your cervical spine in neutral. Let single arm hang over the edge with the palm of your hand facing toward head. M: Squeeze scapula down and back and keep scapula “locked down”. Raise arm up at a 45o angle. Only raise arm up to a feeling of tension. (It is a very small motion) Lower arm back to starting position and relax scapula. 3 Prone Single Arm T S: Lying on your stomach at the edge of a table, place a pillow under your forehead to keep your cervical spine in neutral. Let single arm hang over the edge with the palm of your hand facing toward head. M: Squeeze scapula toward spine and lift arm level with shoulder. So arm with the body makes a “T”. Lower arm back to starting position and relax scapula. 4 Prone Row into External Rotation S: Lying on your stomach at the edge of a table, place a pillow under your forehead to keep your cervical spine in neutral. Let single arm hang over the edge with the palm of your hand facing toward feet. M: Squeeze shoulder blade toward spine and lift arm level with shoulder with elbow bent. Keeping elbow in place, rotate shoulder into external rotation. Lower shoulder out of external rotation and return arm back to starting position and relax scapula. 5 Serratus Anterior Punch S: Lying on back with shoulders down, arms raised to 90o and palms facing eachother. M: Keeping elbows straight, reach hands up toward ceiling. Return to starting position. These exercises are a fundamental base to achieve a more stable shoulder complex. As previously mentioned, a detailed evaluation of each individual injury is imperative to a fast and full recovery. That way a more detailed look at strength and endurance deficits or increases can be fully incorporated into your program. Perry MD J: Anatomy and Biomechanics of the Shoulder in Throwing, Swimming, Gymnastics, and Tennis. Clinics in Sports Medicine Vol 2 No 2, July 1983 Townsend H, Jobe F et al: Electromyographic analysis of the glenohumeral muscles during a baseball rehabilitation program. T American J Sports Medicine 19: 264-272, 1991 Wilk K, Meister MD K, et al: Current Concepts in the Rehabilitation of the Overhead Throwing Athlete. T American J Sports Medicine 30: 136-151, 2002