So right now there’s a weird trend going on in regard to shoulder rehabilitation. For some reason I think it’s become unpopular to train the shoulder and more specifically the rotator cuff when you have shoulder pain. Here are some trends I’m seeing going on in the blogosphere and podcastland.
- “You need fix your breathing to get your shoulder better”
- “The neck is the major issue and if you don’t address it your shoulder will always hurt”
- “Your problem is obviously based in your core”
- “Your shoulder isn’t doing it’s job because something down the chain isn’t working”
I get it, I’m a big fan of regional interdependence (How joints further from the painful area can be the cause of pain) but come on. There is an enormous plethora of research to show that training the cuff (with basic boring exercises) is effective for rehabilitating shoulder issues.
Besides that, I think we’re confusing people. People already have a tough time finding good therapists who can help them with their specific needs. Now they’re looking for therapists who address breathing as a first line treatment for subacromial impingement syndrome. I have patients coming in who have come up with all sorts of weird treatment ideas for their pain problems.
In a lot of ways I agree and I’ve probably created part of this issue myself. Of course the core, spine, and shoulder blade is important from a rehab perspective. In many cases a seemingly unrelated joint like the ankle can be related to someone’s pain. Yes we need to be aware of this, but we can’t overlook the obvious. If you’ve got a painful shoulder we can’t ignore this joint. It’s perfectly reasonable to prescribe specific exercises for the rotator cuff and scapular stabilizers. Honestly you could make the statement that it’s malpractice not to. If your therapist gives you basic rotator cuff strengthening, please do it, especially if you want to get better.
Of course you’ll need to progress to harder exercises after the basic rotator cuff and scapular protocol. You’ll also have to address any underlying movement, programming and periodization issues that are leading to continued pain. I just think too many people are skipping the basic phase 1 exercises in favor of sexier correctives and popular trends.
Sorry for the rant but I wanted to make sure people are getting this information. Yes, good therapists should still prescribe shoulder strengthening exercises. If your therapist treats the shoulder directly it doesn’t mean they’re a bad therapist. Treating local joints and looking at things like breathing and movement are definitely important still. Just please don’t get carried away.
I’m in the process of putting together 2 big projects for the shoulder. One is catered towards clinicians showing you exactly how I like to do shoulder rehab to get your athletes back to high level training. The second product is a do-it-yourself style book to help you fix your own shoulder. If you’re interested in updates and a discount when it comes out the fill out the form below:
Mad about rotator cuffs,
Daniel Pope DPT, OCS, CSCS, CF L1