Recently I had the opportunity while in India to work with a variety of people. In the video that follows, this person was well recovered from a fracture of the proximal humerus. They were still experiencing pain upon end range movement. Here we will look at only one of the functions that proved bothersome–overhead movements with the left arm. Their range of motion in this direction (shoulder flexion) was fairly good, though lacked the last 10 degrees–which were also a bit painful.
One thing to check is to see if the shoulder blade is participating sufficiently in these movements. Since stretching of the arm overhead proved painful and since her prior rehabilitation had taken her in this direction, I thought we would explore more approximation or pressure into the shoulder joint. (and this compressive movement was not painful and helped her to improve)
This concept of compressing the joint in these weight bearing positions that you will see in the video is a very good alternative for improving pain free terminal flexion. Often in hatha yoga where there is today and emphasis in stretching, the stability work that is needed is often marginalized. (This post is not about yoga but focuses on a case example of rehabilitation).
Another important aspect here is the emphasis on testing before and after exercises. This testing can be accomplished quickly and easily before and after your session. You will see it at the beginning of the video. It would be wonderful if people found out things that they could not do easily and then determine the exercises that would help them function better (i.e. less pain and more gain). In other words don’t just perform a bunch of exercises without seeing if they are appropriate and giving you the results that you want and need.
Also this is not a complete program, it is a first example of where one might start out in their journey of recovery.
Lets take a look at the video:
You can see there is not an emphasis on stretching out the shoulder at this point. The place that we try to increase mobility is at the thoracic spine or rib spine. This associated area of the middle back is often left out with rehabilitation of the shoulder. Of course one should test the ability of rotation to take place here before prescribing the exercise. Do note how much shoulder mobility is asked for in the down shoulder. For some people you will need to support the space between their armpit/rib area and the floor. For some people, without using the support–they will have too much stress on the bottom shoulder in flexion and abduction–they will not be able to relax or benefit from the spinal rotation.
It is interesting to note that in the side lying movement of reaching and rolling of the upper body–this person had difficulty in stabilizing the pelvis and lower trunk while accessing the middle spine area. Again this difficulty is fairly typical. We often over move from the lumbar and pelvic area especially in the side lying position.
There are many variations in sidelying that can be very helpful here. This is only one of them.
From the above instability of the pelvis and lower trunk, you can see that this area will need to be addressed in follow up routines.
Notice the weight bearing aspect of being on hands and knees and prone on elbows (supported cobra asana). These are just excellent positions to stimulate the shoulder complex and begin teaching stability. Always consider there to be 3-5 ways to regress and progress any exercise. That gives you a much wider appreciation of the functional relationships that are involved in rehabilitation. It is also quite a challenge to come up with this range of movement possibilities. This challenge is mainly for those who are teachers, trainers and therapists.
Do try out some of these movements. You will find out that working with the mini-bands in the prone on elbow position can be fairly challenging. Many people are quite weak in external rotation when the elbows are away from the body. This variation opens up so many more ways to activate the rotator cuff musculature and the scapular stabilizers than just the standard “cuff” exercises with the elbow fixed to ones side.
This routine is only a beginning. I hope it will be a continuation of the progress that has been made.
Best in Training–peter