Shoulder Pain Rehabilitation: How to Progress Exercises For Shoulder Pain in Athletes Part 1: Closed Chain

shoulder-painI’ve been working with a lot of students lately in my clinical practice as a physical therapist lately.  In my experience most students tend to have pretty good clinical decision making skills, a fairly sound evidence based approach as well as some solid evaluation and treatment ideas.

When it comes time for program directors to visit their students at our clinic they usually ask about ways to improve their physical therapy curriculum.  Far and away the biggest comment I give is the lack of experience with exercise selection.

I also feel that as a profession overall we lack a bit in this area.  We do a good job of finding evidence based EMG exercises for specific conditions but sometimes drop the ball when it comes to finding great exercises that are specific to getting back to sport.  Those basic exercises are of extreme importance but what do we do once our athletes reach their maximum benefit from these exercises and aren’t yet back to their activities.  I work with a decent number of weightlifters and crossfit athletes.  Besides a lack of knowledge of their sport, the second biggest reason for failed previous treatment is a lack of specific exercise progression to get them back to their activities.  Getting someone back to their ADLs pain free and getting them back to high level performance are two different things.

I wanted to put together a series of exercises I use with my athletes to get them back to their sport.  These exercises are specific to strengthening and conditioning an athlete along their rehab/physical therapy process. The first example will be a series of closed chain exercises.  Populations that would benefit from these exercises would be a gymnast or crossfit athlete that wants to return to handstands, handstand walking or any other closed chain pressing activity.  Phase 1 and 2 of the video contains a heavy dosage of exercises that target the serratus anterior, rhomboids, mid trap and phase 3 provides several exercises to utilize as your athletes continue to progress through the end stages of rehabilitation.  I wanted to help people get an idea of how to progress patients by showing progressively harder exercises.  They all get harder as the video progresses.  Hopefully this will help some students and clinicians gather some more ideas for their higher level athletes.

This exercise progression is by no means a replacement to a thorough evaluation with specific emphasis on correcting deficits and potential causes of injury.  However, I think it provides several ideas on how to progress your athletes adequately while keeping them entertained in the process.  Hopefully both seasoned clinicians and students alike can glean some new exercises from this video:

There it is.  Please let me know if you liked any of these exercises or have some great ideas of your own by leaving a comment below.  Next week I’ll show a progression of my favorite exercises to return back to open chain activities like weightlifting (overhead press, bench press, push press and jerk variations).

Stay tuned,

Dan Pope DPT, CSCS

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