Session 1

A client of mine came in recently who had dislocated his shoulder. The dislocation happened 9 days prior and he had already been to the ER to have it “popped” back into place. The shoulder was still very sore, did not take load well, and was extremely guarded (shoulder elevated towards the ear, elbow flexed, and arm hugged into the body).

Letting pain be our guide, we used shoulder CARs (controlled articular rotations) to explore the full range of the shoulder in all movements (external rotation, internal rotation, abduction, adduction, flexion and extension). This gave us a baseline of his current movement capacity, allowed him to explore his pain-free range, and displayed where the “weakest links” resided.

After the CARs, we moved onto some capsular work for the shoulder. Again, letting pain be are guide, we explored the range of motion in shoulder external rotation. We used PAILs (progressive angular isometric loading) to establish if the reason for the lack of motion was neurological tension (guarding) or mechanical (something injured). This allowed my client to gain range in a safe way without further injuring his shoulder.

Once we created more range in the shoulder (most of his loss was due to guarding), we gently moved the shoulder through the full, pain-free range of shoulder external rotation and internal rotation to “upload” to the nervous system the availability of this new range.

This may not seem like much, but it is a safe and easy way for this client to learn where he can move his shoulder safely. It connects our mind and body (via the nervous system) so we are less likely to guard and compensate. This expedites the healing process and gives us a roadmap of what we can train during this time so there is no “waiting” between rehab and fitness. We have identified where there is a lack of range, where there is a lack of control or strength, and we can use those perimeters to adjust the workouts so he can keep getting strong while protecting his shoulder from further injury.

Session 2

When we met again, and we went over his shoulder CARs, his range had much improved. We could see there was still limited motion in his internal rotation and his flexion, so we addressed that lack of range of motion first by adding a PAILs (progressive angular isometric loading) for shoulder internal rotation.

After creating that space, we repeated our shoulder CARs movement and then moved on to some strengthening for the shoulder capsule.

We started with shoulder external rotation since he had been working on that at home for the last week. We also started with eccentric loads (loading as the muscles elongates rather than shortens) in both shoulder external rotation and internal rotation because it has the ability to train the tissue as if it wasn’t injured. Eccentric exercises can override the reflex to guard the joint and lets the nervous system know that it is okay to move and load that area. This is the path back to full range strength.

This is the beginning of the strength phase. Again, loading in the eccentrics allows us to strengthen the shoulder, in full-range, while avoiding any unnecessary re-injury or pain. He will be sore from this exercise, but in a normal, muscle-sore capacity.

Stay tuned for more updates as we continue to progress.

Want to know more of have questions? Reach out Brenna@koafitusa.com