21 Apr Avoiding Shoulder Pain: 7 Unconventional Exercises To Prevent Injury.
When I was an orthopedic physical therapist, I can’t tell you how many shoulder patients I treated through the years.
The shoulder was my gig, my speciality.
And, for a period of time, I was fortunate to work directly under one of the top physical therapist’s in the country.
I can’t tell you how invaluable that experience was.
It was through that experience, I became was known as the “shoulder guy” in my clinic.
I saw almost every shoulder pathology you could think of.
Yes, I’ve seen and treated it all.
Lots of post-op rotator cuff (RTC) repairs, labral repairs, sub-acromial decompressions, and many other unique surgical cases.
I’ve seen a lot of RTC problems and shoulder instabilities, especially in the athletic population, not to mention all the “frozen shoulders” (adhesive capsulitis).
There’s a lot that can go on in the shoulder complex.
The shoulder complex is…complex.
There’s a lot that can go wrong in the shoulder, but a majority of problems are usually RTC related.
Believe me when I say, you want to avoid shoulder injuries because one problem can lead to another (ex. tendonitis to dysfunction to disuse to frozen shoulder).
And, many shoulder injuries are preventable by strengthening the RTC and scapular musculature, doing the right types of exercise, and avoiding poor techniques.
That’s where this information will help you.
You need to understand that the RTC’s primary function is to hold the ball (humoral head) in the socket (glenoid).
There are 4 muscles that compose the RTC, which are:
- and teres minor
The 4 muscles of the RTC are responsible for allowing a dynamic synchronization of muscle firing that allows for optimal joint biomechanics and function.
Here’s why this is important.
If the RTC musculature is imbalanced, weak, injured, or dysfunctional, the joint biomechanics will not function properly, which can lead to pain with motion.
It’s essential that these muscles work together in a synergistic manner to elevate the arm properly.
The key is to keep these muscle strong and healthy so that they do their job, which is to stabilize.
The question is, what are the best exercises to optimally strengthen the RTC?
When I was a PT, we used to do a lot of things with bands, tubing, and light dumbbells.
I’ll say that the methods I had the most success with were the “hands on” or manual techniques I used to do with my patients.
Things to promote strength, mobility, stability, and neuromuscular education (optimal muscle firing and movement patterns).
Today, I want to share with you what I now believe to be the best exercises to prevent shoulder dysfunction and improve or restore mobility, stability, and strength.
It comes down to just a few things.
Here they are:
1-THE TURKISH GET UP (TGU) and components of the get up.
I would say that the TGU is the most important of these exercises, and truth be told, it is.
The TGU is a wonderful shoulder exercise that enhances and optimizes RTC function by moving through a broad range of motion, while the RTC is firing and stabilizing the entire time.
The TGU and it’s component parts are what I consider to be the staple for maximizing shoulder joint function.
Not only does it fire the RTC the entire time, but the weight bearing positions are outstanding for scapular stability.
It’s critical to get this exercise right and not rush it as you’re moving through each transition.
As renowned physical therapist Gray Cook says, “It’s important that we honor this movement.”
Again, I would probably consider this the single most important exercise to optimize shoulder health.
The windmill (with a kettlebell) is another similar type exercise for the shoulder because it requires a dynamic range of motion, mobility, and stability to perform.
As you move throughout the windmill, the RTC must constantly fire and stabilize the humoral head through the wide range of motion.
Again, similar in effect to the TGU. It promotes strength, stability, and mobility.
The armbar is very interesting and I debate a little whether to include it here.
It’s really a drill and not an exercise, but it has similar benefits to the exercises above and I believe it should be included in this list.
There are some differences though.
The shoulder mobility is not as great as with the TGU and windmill, but the stability and proprioceptive (knowing where your arm is in space) benefits are outstanding, which is why I like it for total shoulder health.
And, it really opens up the anterior portions of the shoulder complex (anterior glenohumoral joint, pecs, and rib cage).
So, for tight pectorals, this is a fantastic stretch.
There are some variations on how to perform this drill, but to see exactly how I do armbars, check out this video tutorial.
The armbar is also outstanding for thoracic mobility, which is something we all can improve.
4-THE PROPERLY PERFORMED MILITARY PRESS.
The military press is excellent for total shoulder strength, but it has the mobility and stability elements to it, as well.
The key here is to perform the shoulder press in the plane of the scapula, which is approximately 30 to 45 degrees anterior to the frontal plane.
This is a little tricky to explain, but basically your arm is not positioned straight out to the side and it’s not straight out in front of you, instead it’s between 30 to 45 degrees.
(See the picture for the visual representation of the plane of the scapula).
Keeping the press in the plane of the scapula is not only safe, but is the most functional and biomechanically efficient position for the shoulder to effectively press the kettlebell.
The military press is excellent for the shoulder complex and incorporates not only the RTC, but all shoulder musculature for stability and mobility.
5-THE KETTLEBELL SWING.
This exercise may come as a surprise for you, but the kettlebell swing is fantastic for the RTC.
Because the entire time you are swinging the kettlebell, the RTC is firing to stabilize the shoulder joint and maintain the humoral head in the glenoid.
Remember, in the Russian style swing, the shoulders (especially the deltoids) aren’t really active, but the load on the upper extremities for the RTC muscles to contract continuously and hold the shoulder in place.
So, from a standpoint of strengthening the RTC in a dynamic, non stressful way, the kettlebell swing is surprisingly excellent.
6-PLANKS AND PLANK VARIATIONS.
The plank (and it’s variations) are also wonderful for shoulder joint strength and scapular stability.
When you are holding a weight bearing plank position, again, the RTC is firing to maintain shoulder stability.
And, you’re also recruiting other shoulder and scapular stabilization muscles here, as well (trapezius, rhomboids, serratus anterior, lats, and teres major).
While the plank is typically used for abdominal and trunk stabilization, the plank is a phenomenal shoulder stability exercise that does not stress the shoulder.
Planks for optimizing shoulder strength?
7-OVERHEAD STATIC HOLDS (WAITER’S WALK).
And, finally, the overhead static hold is great for the same reasons I continue to mention.
The overhead hold (such as with a waiter’s walk or overhead squat) forces continuous firing of the RTC muscles to promote shoulder stability.
Again, it’s the continuous firing of the RTC with dynamic movement that is so effective for the shoulder joint and the prevention of injury.
I’ve found these types of exercises to be the best, least stressful ways to optimize shoulder function, improve RTC strength, and minimize risk for injury.
I could go on with more great examples, but this list serves as a solid program for the shoulder.
I should note that I would also add more scapular stabilization work to the exercises listed above.
Things such as various scapular retraction exercises, bat wings, and push ups with scap protraction are just a few examples.
And, this would be highly necessary if scapular weakness or dysfunction was evident.
Here’s the bottom line to all this.
To minimize the risk of injury, you need to keep your RTC strong and healthy.
I’ve provided 7 examples of what I consider to be the best in shoulder stability and mobility training to reduce the risk of injury.
And, I would consider the TGU as the mother of all shoulder exercises because of the unique benefits and it addresses all the things I have mentioned in this article.
This article really just scratches the surface on optimizing the function of the shoulder joint.
I’ll have more to come on maximizing strength and preventing injury in the shoulder, including training videos on these methods.
Stronger shoulders and reducing the risk of injury are keys to getting better results and elevating your training to the next level.
Keep that in mind.
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Brian Bochette, PT, MSPT, CSCSPosted at 19:33h, 29 April
Great post Scott,
It is unfortunate that many practicing PT’s do not know the benefits of these fantastic exercises. I went to a continuing education course last year where the presenter mentioned TGU’s and you could tell by the blank stares that no one knew what he was talking about (the audience included PT’s and OT’s). Gray Cook and some others have really helped to bring awareness to the importance of proprioception and reflex stabilization in exercises like the TGU, but many therapists are still in the mindset of training the RTC using isolation exercises. Keep spreading the good word.
Brian Bochette, PT, MSPT, CSCS
ScottPosted at 13:49h, 01 May
Thanks a lot Brian, I really appreciate that!
I think slowly, but surely, the great, progressive PT’s (like yourself) will rise to the top and spread the message.
Eventually, the “old” thinking and methods will fade and the more progressive, effective methods will become more known and utilized by the mavericks and the pioneers out there.
Yes, Gray Cook and now Kelly Starrett will hopefully help the shift the “conventional” mindset of the PT and OT.
It’s unfortunate that many PT’s don’t have the exercise or strength training background at all. That’s a big piece that’s missing (glad to see you’re CSCS) I think that’s one of the key reasons why rehab professionals are still stuck with the common isolation exercises that I learned in PT school many years ago.
Thanks again for the feedback and you are a “Maverick.”