SHOULDER INSTABILITY: EXERCISES

Anatomy

The shoulder or glenohumeral joint is a complex joint and is made up of different bone structures, including the clavicle, sternum, ribs, scapula or shoulder blade, and the humerus.

All these bone structures make up different joints that will give rise, together, to the shoulder joint complex.

- Acromioclavicular joint

- Sternoclavicular joint

- Thoracic scapular joint

- Glenohumeral joint

Shoulder Anatomy

Regarding the musculature, we have different muscles that make up the shoulder joint complex, among which the rotator cuff group, which constitutes the deepest muscle group, should be highlighted.

- Supraspinatus muscle

- Infraspinatus muscle

- Teres minor muscle

- Subscapularis muscle

All these joints that we have mentioned, allow together with the muscles a wide range of movement to the shoulder.

However, this great motor skills also produces repeated friction and overloading, in many cases reproducing the symptoms known as painful shoulder.

The painful shoulder is a fairly common reason for consultation, being the third most frequent cause of musculoskeletal consultation in Primary Care, behind lumbar and cervical pathology.

Shoulder pain is a symptom that concerns a multitude of pathologies, of which the vast majority are due to disorders of the periarticular soft tissues. There are other possible reasons for shoulder pain, such as injury, joint instability, or arthritis.

SHOULDER INSTABILITY

Shoulder instability is excessive movement of the humeral head relative to the glenoid. It is a common abnormality that is often seen in medicine and physical therapy. An appropriate rehabilitation program plays a vital role in the successful outcome after an episode of shoulder instability. The glenohumeral joint allows a great amount of movement, which makes it inherently unstable, being the most frequently dislocated joint in the human body, being more frequent to find dislocations or subluxations of the shoulder.

Due to poor bone congruence and joint capsular laxity, it relies heavily on dynamic stabilizers and the neuromuscular system to provide functional stability. Therefore, the differentiation between normal movement and pathological instability is often difficult to determine. There is a wide range of shoulder instabilities, from subtle subluxations (as seen in head athletes) to major instabilities.

Dynamic joint stabilizers are the rotator cuff muscles (supraspinatus, infraspinatus, teres minor, major round, and subscapularis), the deltoid, the long head of the biceps, and the scapular musculature. These muscles are capable of generating compressive or coaptating forces in the joint, mainly in ranges of movement where the capsule and ligaments are loose.

In subjects with shoulder instability, muscle strength and neuromuscular control is impaired. They have scapulae that rest in downward rotation and have poor upward rotation, which reduces the area of ​​contact between the humeral head and the glenoid. Symptoms range from mild reports of pain to apprehension, compression, rotator cuff pain, and neuropathic symptoms.

The most commonly recommended initial treatment for shoulder instability is a rehabilitation program. This article tries to create an exercise program to help the shoulder to obtain a correct operation in subjects with instability.

EXERCISES

All included exercises are specific to the shoulder muscles and are designed to improve strength, power and endurance. They should be done with the chest open and the shoulder away from the ears. We will do 3 sets of 12 repetitions, 3 times a week for a minimum of 4 weeks. The initial shoulder position should be relaxed, away from the ear and without being rolled forward.

1. Diagonal: Extension + Adduction

With an elastic band attached above the subject, pull the resistance down and through your body to the opposite side of the leg. During the return movement, you should end with your palm up and your thumb facing up.

Extension + Adduction

2. Diagonal: Flexion + Abduction

Elastic band held at the bottom, start with the arm extended in a 45º position and the palm down. After turning the palm forward, proceed to flex the elbow and raise the arm up and over the affected shoulder. Rotate the palm down and back to bring the arm to the starting position. The opposite movement of the exercise 1.

Flexion + Abduction

3. External rotation

Elastic band attached to one side. Stand with the affected elbow fixed to the side, the elbow at 90º, and the affected arm through the front of the body. Grab the resistance and perform an external arm rotation, keeping the elbow resting on the side. Return to the starting position slowly and controlled.

External Rotation

4. Internal rotation

Elastic band attached to one side. Stand with your elbow fixed at your side at 90º, grasp the resistance and do an internal shoulder rotation. Return to the starting position slowly and controlled.

Internal Rotation

5. External rotation with 90º abduction

Shoulder abducted at 90º. Keeping the shoulder abducted, turn the shoulder back keeping the elbow at 90º. Slowly return to the starting position.

External Rotation with 90 degrees Abduction

6. Abduction

With a dumbbell, your elbow straight and your thumb up, raise your arm to shoulder level at a 30º angle in front of your body. Do not exceed shoulder height. Hold 2 seconds and lower slowly.

Abduction

7. 90º abduction in prone position

Lie on the table, face down, with the involved arm hanging directly to the floor and palm down. Raise your arm to one side, parallel to the ground. Hold 2 seconds and lower slowly.

Abduction in Prone Position

8. Abduction to 100º in prone position

Same as exercise number 7 but with the arm slightly in front of the shoulder (hitchhiker).

100 degrees Abduction in Prone Position

9. Ball

After those exercises, it is interesting continuing the progression with the help of a ball. You can put it in a wall or in the floor and support your weight generating a job of instability and balance for your shoulder.

Exercise with ball

The benefits of this type of exercise in the stability and strengthening of the shoulder have been verified in the current scientific literature, becoming the treatment of first choice for all those shoulder pathologies that are unstable.