You know in Z-Health, we take a look at the entire body all the time whenever we're working with clients. However, there are very specific instances in where we say, "You know, if you have a shoulder issue, let's talk about potentially how to actually rehab that shoulder."
What I'm going to talk about today are combination movements that can improve shoulder range of motion and shoulder strength, if you have had a prior injury. What I want to really look at today is your ability to do what's called AB-duction, or abduction, where we're taking the arm up, out to the side, and trying to bring it up, touch the ear. One of the key components to make that happen is that as my arm is coming out, my shoulder needs to go into some external rotation, and then it's to make anatomical room for the movement to occur.
One of the things we sometimes run into is that people try to abduct, and they run into this block, and it's like, "Ah," and they get stuck every time. In essence what we look at is, is there a way that we can reprogram the brain and body to work together, so that that external rotation and some of the stabilization that's required for the shoulder, happens naturally.
In order to do that, what you really have to think about is, how can I do combination movements? Very often what we see in traditional shoulder rehab is people begin working on flexions, and extensions, and internal/external rotation, with little attention paid to the fact that the entire shoulder has to be stabilized.
Very often what we find is that in order to create good shoulder stabilization, we need to activate a muscle called the serratus anterior. Don't really need to know that, but it lays here along your ribs. One of the easiest ways to do that is to bring the shoulder blade, the entire shoulder, down toward the ground against resistance. If we say, "I have problems raising my arm," it could be because my shoulder is not stable, as it should be, based off the serratus anterior. It may also be that I'm lacking external rotation.
What we're going to do is, we're going to do a combination exercise, where we're using a rope to create some isometric resistance, making us really focus on that scapular depression, shoulder blade depression, while we work on our external rotation. Pretty simple idea.
Imagining that I've got a really problematic shoulder and that if I'm here, I'm very stuck in external rotation, or it's painful, or I have this painful abduction, what I can do is take a firm rope. You can do this with a band, but I actually recommend that you do it against something with less give or resistance than a band, so I like to use a rope.
What I'm going to do is I need to make sure that my body is low enough, based on the height of the rope. For me, I'm going to get into a little lunge position. Notice that my shoulder is directly by my side. My thumb is facing the ceiling. What I want is to get nice and tall, make sure that my shoulder's in a good position, as in I don't have it rounded forward and up here, but in a good neutral position.
What I'm going to focus on is driving my shoulder blade, my entire shoulder, toward the ground. I'm now getting a strong isometric resistance. Remember, I'm trying to feel activation of the muscles along my ribs here. Again, as I press down, press my shoulder blade down, I should feel some contraction.
Now, the exercise is to hold that as you do internal and external rotations. Particularly in our case, since we're focusing on the external component, I can begin in neutral, press my shoulder down toward the ground, externally rotate, return, and repeat. Press down, externally rotate.
Could I add a small band or a weight to this? Absolutely, that's always a possibility to emphasize the external rotation a little bit more. But very often, what you'll find is the addition of this isometric will make this a much more comfortable exercise, and you'll find out that you get a much greater range of motion when you're taking care of the rest of the shoulder.
Very easily at home, you can test your abduction. You can see where you stop, where it gets uncomfortable. Tie up your rope, belt, whatever you need. Go through maybe five to 15 reps of this depression, external rotation. Come out of it. Retest your shoulder, and if it improves, decreases pain, improves range of motion, awesome, it's an exercise that you want to focus on.
Normally in terms of volume, you want to be aiming at maybe 15 to 20 repetitions of that three times, three sets. You can do that either all at once, but very often, it's better to spread it out through the day, so that you're reminding your brain what you want to have happen within the stabilization component of the shoulder. That's exercise number one.
Exercise number two, we're going to take advantage of something called the crossover effect. It's been known since around 1894 that if we work one side of the body, it causes activation of the musculature on the opposite of the body. For instance, if my right shoulder is great in this movement, but my left shoulder has been problematic or painful for some time, and I feel like I've lost some strength and range of motion, one thing that we can do is we can take advantage of working the right shoulder at the same time that we're working the left shoulder.
The way that I recommend that you do this is to use asymmetric weighting. What I've got here is a five-pound plate, and this is a two-and-a-half pound plate. For instance, our base level exercise right now is to elevate the shoulder. If my right side's my good side, what I'm going to do is I'm going to elevate the right, and then follow it with the left. We're taking, again, advantage of this neurologic crossover effect, where working the right arm actually will help strengthen, or activate, the musculature of the left arm.
Very often, we find if we take advantage of this, especially if you're early in your stages of rehab, asymmetric weighting while we're performing similar actions, will make the side that you're trying to rehabilitate that much more safe, if you want to call it that, through additional muscle activation. Really easy idea, you can apply it across the board. If you ever have an injured area that you feel like needs some strengthening, you may find that weighting, performing the same movement with additional weight on the good side of the body, has a tremendous impact on the amount of pain and discomfort you are experiencing on the side you're rehabbing.
Two very, very simple concepts today. Use the isometric stabilization as you're working on improving that external rotation, and then asymmetric weighted exercises to strengthen yourself and hopefully improve range of motion, taking advantage of that cool crossover effect.
If you have any questions about this, let us know. Otherwise, good luck. I hope it helps.