WEST HILLS, Calif. - May 22, 2020 - Locally at the shoulder, the major rehabilitation concerns are the balance between mobility and stability. The balance between these two allows for normal shoulder function. Mobility is the key that allows shoulder activities. Wide ranges of motion are needed in different athletic activities, ranging from 180° of abduction in swimming to 120° of external rotation in baseball to 80° of internal rotation in tennis. In addition, over 1,600 different positions in three-dimensional space can be assumed by the shoulder(9,14). To achieve these motions and positions, the joint has to be relatively unconstrained. This means that a certain amount of glenohumeral translation is necessary for normal activities.
Stability of the glenohumeral joint is also important in shoulder function. Stability for the glenohumeral joint means that the instant center of rotation of the humerus remains in a specific path throughout the full spectrum of motion. In the mid ranges of motion, there is minimal or no movement of the instant center, indicating a true ball and socket arrangement. At the end ranges, anterior-posterior and superior-inferior translations of 4-10 mm do occur (3,15). These translations are coupled with specific motions of internal or external rotation.
(This is where the ASHR can help improve the motions inherent within the glenohumeral joint within the shoulder joint capsule as well as to improve both internal and external rotation of the shoulder which is crucial for putting on a coat, combing one's hair or simple raising your hands to get something out of a cupboard.)
Rotator cuff activation is coupled with and follows scapular muscle activation, so that the rotator different muscles work off of a stabilized and optimally positioned base, are physiologically activated, and are mechanically placed in an optimal length-tension arrangement to create maximum rotator cuff strength development requires tissue healing, minimal pain, and no external or internal impingement. Joint range of motion, muscle flexibility, and adequate tissue healing are necessary so that the glenohumeral rehabilitation program will generate minimal substitute patterns. Proximal segment and scapular control are necessary for glenohumeral motion and facilitation. These controls are accomplished in the acute and recovery stages. Glenohumeral emphasis in rehabilitation of "shoulder problems" such as impingement, tendinitis, or mild instability is toward the end of the rehabilitation stages, rather than the beginning .
Isolated rotator cuff exercises do not integrate muscle activation, potentially create shear across the joint, and are usually performed in non physiologic positions.
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*Shoulder rehabilitation: principles and practice" (modified)
Author Citation & Information
Shoulder rehabilitation: principles and practice
By: KIBLER, W. BEN (Contributed & reformatted by Arlen Minassian)
Medicine & Science in Sports & Exercise: April 1998 - Volume 30 - Issue 4 - p 40-50
Contact
The ASHR
arlenminassian@gmail.com
