A client recently experienced a shoulder separation. It was "mild" in terms of severity (no need for surgery. Doctor's advice is to rest and use anti-inflammatory medications). Interestingly enough, the injury didn't occur as a result of a fall or any impact. It appears to be a result of a combination of resistance training and daily life (client is 30 years old, sedentary and with no previous injuries to the shoulder girdle). The most "severe" training done with the client consisted of woodchoppers with rotation and lat pull down at approximately 70 percent of max, three sets of 12. Can you give any advice on what kinds of exercises might be appropriate during the this recovery period (over two weeks after the separation occurred), which would be beneficial in terms of keeping functional levels up and hopefully avoiding this injury again? What would be a good approach to take for strengthening the integrity of the AC ligament and increasing the stability of the clavicle?
The shoulder is the junction of three bones: the clavicle (collarbone), the scapula (shoulder blade) and the humerus (upper arm bone). A shoulder separation involves the first two bones: the clavicle and the scapula. The tip of the scapula is known as the acromion and forms the roof of the shoulder. The acromion and clavicle meet in a joint known as the acromioclavicular (AC) joint and are held fast by ligaments. Ligaments exist in two places in the joint: one group surrounds the joint and another holds the clavicle down, anchoring it to a knob on the scapula known as the coracoid process. Mild sprain of the AC joint capsule – where the ligaments surrounding the joint suffer a minor sprain – results in pain and stiffness. Treatment is RICE and rehabilitation.
Johnson suggests that unless your doctor tells you otherwise, perform the following exercises two or three times a week. Both Saidoff et al and Johnson recommend that the client perform between 12 to 18 repetitions per set, and do two to three sets of each. Start by using one or two pound hand weights, and increase the weight as your client is able. It is always important to consult your client’s doctor if your client experiences more than mild discomfort when doing any of these exercises. The first two exercises increase strength and flexibility. In addition, two exercises help stabilize the scapula. Another exercise that will work is a slightly exaggerated, full length push up. As you push up, emphasize pushing your back toward the ceiling as high as possible (like you would do for a cat stretch). This exercise will also help improve scapular stabilization and add variety. It appears that bent-knee push ups do not work as well for this exercise. The seated press up is another way to increase scapular stabilizer.
Start with arms along side the body. With thumbs pointing up and elbows straight lift arms straight up in front of you.
Lift arms to the side and about 30 degrees forward. Perform three sets with your thumbs point up and three sets with your thumbs pointing down.
Lie on the non-injured side with the injured shoulder on top. Keep elbow bent at 90 degrees and fixed to the side of the body. Lift weight from the floor to elbow height.
Sit in a chair that has arms (you could use a step as well). Place hands on the chair arms with your elbows bent. Without using your legs push your body up out of the chair until your elbows are almost straight.
I hope this helps!
- D.C. Saidoff & A.L. McDonough. Critical Pathways in Therapeutic Intervention: Extremities and Spine. 2002. Mosby, Inc. St. Louis, Missouri.
- R. J. Johnson. What to Do About AC Joint Injuries. The Physician and Sports Medicine; (2001)29(11): online edition.