Why We Can’t Get Corrective Exercise For The Shoulder Right!
2024-02-29
Jessica Bento, Physical Therapist (Creator DVRT Restoration Certification, DVRT Rx Shoulder, Knees, Pelvic Control, & Gait Courses)
Some people don’t like the idea of corrective exercise, they think the term is unnecessary and believe all forms of strength training are corrective exercise. Admittedly, I like the idea that all exercise improves how our body feels and performs, but the reality is as being a physical therapist of over 20 years, there is a distinct difference from the intent of many strength training and corrective exercises.
One of the biggest misconceptions is that all movement issues, especially as we look at the shoulder, are strength related. In fact, the truth is that most injuries are not due to lack of strength of a particular muscle, but inappropriate motor control. Trust me, I get no one goes to the gym and thinks “I’m going to work hard on my motor control today and people on social media are going to be really hyped about it!”
Maybe we should, but most people don’t really even know what motor control means. While it can get complicated, the idea basically is, do muscles work at the appropriate time in the right sequence with other structures to produce movement. For example, when I see a shoulder injury in a throwing athlete, most assume it was a strength issue of the shoulder. However, we know from research that over 50% of the force created in throwing something occurs in the lower body and core, therefore, if something went wrong with the foot, ankle, hip, or core, this could have exposed the shoulder to WAY more forces than it could reasonably absorb.
The more and more we just keep thinking that a shoulder injury is just from a weak shoulder then our attempts even at corrective exercise will be largely futile. Of course there are those that don’t like what I am saying because it means we have to be more thoughtful about what we are doing, but the benefits are clearly there. The question is “how do we use corrective exercise smarter to help shoulder issues?”
Diagonal Patterns
I know that most people think of corrective exercise for the shoulder being external rotations and wall slides (while we can do those better too), the truth is that the most beneficial may be diagonal patterns originally found in classic therapeutic systems like PNF.
A 2017 study found PNF was helpful to rather significant shoulder issues, “Single-session therapy with the use of the techniques and patterns of proprioceptive neuromuscular facilitation can improve both the active and passive range of shoulder movement. Physiotherapy based on the PNF concept is positively perceived by patients.”
Some may be aware of our lifts/chops, but we see people miss how to do them well many times so I wanted to explain how to use them correctly in training to help corrective exercise for the shoulder.
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Integrate The Whole Body
I am not against using exercises like external rotations and wall slides, but if we do so, we want to incorporate the WHOLE body when doing so. Lying on benches or taking out the rest of the body is a HUGE mistake so examples like below help show how we can do so in a meaningful ways.
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Use Breath Work, Relaxation Techniques, & Myofascial Stretches
Breath work can be another helpful tool we use when develop a better corrective exercise program for the shoulders. Many people with pain will alter their breathing patterns that both takes away from their deep core stabilizers that can help their shoulders as well as create excessive use in muscles around the neck that can make those shoulder issues worse. People in pain often guard a lot of movement as well, so using movements that can be fluid can help take off the brakes of all that movement guarding and muscle tension.
Finally, myofascial stretches can really help as well. What is a myofasical stretch? It is one that integrates multiple segments at once to acknowledge the fact that fascia (not just muscle) can restrict movement and force transmission in the body. Combining all three elements can also do wonders to reduce pain perception that can help us in having more success in our corrective exercise program and provide greater overall well-being to the person. Sometimes these movements are foundational to what I do with people because many people with pain are afraid of movement and these can be incredible valuable in setting the proper foundation.
You see that corrective exercise can and should be seen differently than strength exercises because our intent is different. Hopefully you can implement these strategies to help people overcome some great challenges in their quality of life!
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