Shoulder Stability

Dear Tracie,    I have dislocated my shoulder many times over the last 20 years and I was wondering if you had any exercises that I could do to strengthen my shoulder and prevent further injury? Thank you, Steven

Dear Steven,

I am happy to make some suggestions.

A dislocated shoulder occurs when the humerus separates from the scapula at the glenohumeral joint. The shoulder joint has the greatest range of motion of any joint in the body and as a result is particularly susceptible to subluxation and dislocation.[1] Approximately half of major joint dislocations seen in emergency departments involve the shoulder. Partial dislocation of the shoulder is referred to as subluxation.’ Wikipedia 2016.

I suspect that you have been told to strengthen your rotator cuff and be cautious when performing loaded rotational movements.  The rotator cuff muscles [Teres minor, infraspinatus, supraspinatus, subscapularis] are a quartet of muscles that function to stabilize the shoulder during movement.  If you have injured your shoulder and/or stretched out the ligaments it can become susceptible to dislocation.  If your external rotators are weak it is particularly easy to dislocate your shoulder.

Seek advice from a medical professional immediately following a dislocation.  Wear a support/sling to help stabilize at this stage.  Two to four weeks into rehab start to work on joint mobility and isometric [non-moving] strength. Use only limb weight no weights and avoid abduction [lifting to the side] and external rotation [rotating your arm outward] as these are the riskiest movements early on. 

It is also important to work on your scapular [shoulder blade] stability too.  If your scapula is unstable it in turn affects your shoulder stability.  Four sets of seated scapular retraction [shoulder blade squeezes] focusing on squeezing down and back and holding for 30 – 60 seconds at a time, work well to improve scapular strength.    

Once you have established good range of motion [ROM] in the shoulder it is time to work on stabilization strength for all key shoulder movements. Use a wall for resistance to work on isometric strength.

Shoulder isometric contraction challenge: Hold each exercise for 15-30 seconds.

Engage your core and stabilize your scapula before performing each exercise.

  • Shoulder flexion; face the wall, make a fist, straighten your arm but do not hyperextend the elbow, push forward and up on the wall
  • Shoulder extension; put your back to the wall, knees slightly bent, imprint you shoulder blades and lower back against the wall, keeping your thumbs forward and arms straight press your fists and arms against the wall.  Open your chest.   
  • Shoulder abduction; Turn perpendicular to the wall, right shoulder to wall.  Stand tall, posture neutral, scapular stable and core engaged.  Make a fist and keeping your arm straight and thumb forward and press your arm against the wall.  Repeat on the left side.
  • Shoulder external rotation; Turn perpendicular to the wall, right shoulder to wall.  Stand tall, posture neutral, scapular stable and core engaged.  Make a fist thumb up, bend your elbow to 90 degrees, hold your upper arm against your side, rotate your lower arm out and against the wall.  Turn the other way and repeat on the left side.
  • Shoulder internal rotation; face the wall and make a right hand fist thumb up, bend your elbow to 90 degrees, hold your upper arm against your side, push inward against the wall. Keep your shoulder blade stabilized. Repeat on the left side.

Perform 2-3 sets back to back paying particular attention to your core and scapular stability.  You should not experience pain during these exercises but should feel muscle fatigue.  This set can be nicely paired with lat rows, tricep extension, long arm plank and reverse flyes.

Isometric exercises can be expanded to moving with load around 4-6 weeks.  Once that is mastered, complex motions like loaded abduction with external rotation can be gradually performed.  Progress slowly and seek help if unsure.

Continued dislocation does indicate followup or consult with an orthopaedic surgeon or physiotherapist.  Surgical intervention is sometimes the only solution to stabilize the joint and avoid circulatory and/or nerve damage.  There are always options, so stick to your guns and pursue a solution that allows your to do the things you love.  Good luck!

What will you conquer in Summer 2016?    Set your fitness goals & conquer them. 

Kind regards, Tracie

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