A friend of mine was a professional bodybuilder who performed not only in competitions but also on TV every week for many years. About 10 years ago, he had surgery on the supraspinatus and had part of his acromion process removed. He cannot remember anymore information than that. I have been doing some general sports massage, integrating myofacial release, PNF and trigger pointing. I am working with an upper body that hardly moves, and I feel at last we are making progress. He cannot raise his arms over his head. His elbows are bent (however, it is getting better with therapy). There is no medial and lateral rotation of the glenohumeral joint (again, it is improving). My challenge is not only to get movement to a very muscle bound body but also help him strengthen his serratus anterior, mid/lower traps (very winged scapula) and work on strengthening his rotator cuff as his shoulder complex hardly moves. He has just started training again and is becoming very positive. I do not want him to get bored, and I realize he is lifting very heavy weights. Do you have any suggestions of some good gym-based exercises that will strengthen the shoulder complex? Also, with the surgery he had, will the supraspinatus ever kick in while doing abduction? At the moment, the traps are doing all the work!! He has seen many specialists and physiotherapists, and he is finding massage very positive. I could really use some guidance.
Thank you for your question and client concern. There is no way to tell what exactly happened in surgery. Every procedure will have a name, but the actual application varies based on the trauma, etc. In addition, the process of rehabilitation is usually very different therapist to therapist. At this point, I would strongly recommend a full functional analysis of his current function to identify his current threshold, taking into consideration his structural anomalies. Here is the process to follow and “tweak” to fit your client’s needs.
- Understand Individual and Task(s) - This is key! What motions MUST your client perform day to day? Use these motions as your motion assessment. Ask how efficient is he? There is a difference between effective and efficient! Be sure not to run into the trap of trying to isolate muscles. Many exercises are too isolated to a muscle region when in FACT muscles never work alone unless forced to (like many gym, rehab exercises). For example, if his right scapula is winged because of post traumatic stress to his GHJ, analyze how he loads his left hip joint while performing a left leg anterior lunge with a right arm anterior left lateral reach to knee height. This reach will test not only his ability to load the left gluteal complex but also his right scapula/thoracic joint.
- Identify Transformational Zones Associated with Task - A transformational zone is the zone at which we change direction and move into the next intended direction. In other words, load to unload, stretch to shorten. As for your client, if he can’t externally rotate, think of how you can load internal rotation FIRST so he can externally rotate. A functional paradox: we must lengthen before we shorten to be movement efficient.
- Appreciate Chain Reaction Linkages - As mentioned above, the shoulder doesn’t work alone. Analyze what motion he needs to perform. Once identified, assess his efficiency, compare side to side, develop a plan that improves his ability.
- Realize Authentic Drivers - The body is constantly using drivers to facilitate necessary reactions. The example above uses a lunge where gravity, ground reaction forces, mass and momentum become drivers to “turn on” the right shoulder. Realize you have many natural drivers within each client to help facilitate normal motion.
- Layer for Success - What shoulder chain motions CAN your client perform without gross compensation, pain and/or discomfort? Once identified, use these motions in his program to “feed” dysfunctional zones.
I realize this may be a new approach, especially compared with traditional literature of how to strengthen specific muscles. I urge you to study principles of functional movement before searching for techniques as the techniques are application tools that must be derived from fundamental truths (principles). A great reference is Gary Gray’s Functional Video Digest on The Mostability Shoulder.