I have a 59 year old male client who has had a "snapped" medial deltoid muscle. It was repaired surgically, but the surgeon was only able to re-attach about a third of the muscle. He cannot abduct the humerous without pain. He would specifically like to build up the affected area. Can you suggest exercises to help?
Thanks for your question and client concern! I will start the answer by stating that form feeds function and function feeds form. In applied terms, this means his structural deficit is affecting his function. Therefore, the first place I would start is assessing his current function, starting with the question: what planes of motion ARE successful? As you mentioned, he cannot abduct without pain. Can he extend TO flex, flex TO extend, externally rotate TO internally rotate, internally rotate TO externally rotate and adduct TO abduct (you already said he has trouble abducting to adducting)? Please note: The word “TO” defines the lengthening phase BEFORE shortening. In addition, the whole body should be used to create this reaction as opposed to an isolated contraction assessment of motion.
Hypothetically, if he can perform even one of the transformational movements, this is where you START your conditioning. In parallel (depending on your background), we would start soft tissue therapy in hopes to realign the scar tissue formation that has developed not only because of the injury but also the surgery. Yes, soft tissues remodel with proper techniques. By applying a hands-on therapy to the affected region (structures) in combination to conditioning in the successful planes of motion, you should see immediate improvements. If pain continues, a more in depth assessment of pain should take place to rule out a nerve entrapment. The axillary nerve is often a problem when clients report posterior, lateral shoulder pain. The axillary nerve passes through the quadrangular space formed by the teres minor, teres major, triceps and humerus (see Netter’s anatomy book for a detailed view). If your exercise results do not come within one to two weeks, I suggest you refer your client to an Active Release Therapist (www.activerelease.com). This therapy specializes in soft tissue adhesions and nerve entrapments.
With respect to “building up,” train the patterns of movement that are successful while staying away from isolated exercises that will overstress the injured area. Pain means the area is not working correctly, therefore “building” exercises will only exacerbate the problem. Clear the runway before you take off!