Therapeutic Exercise for the Shoulder
Original Editor - Rachael Lowe
Top Contributors - Rachael Lowe, Naomi O'Reilly, Shreya Pavaskar, Kim Jackson, Claire Knott and Wanda van Niekerk
Introduction[edit | edit source]
Central to the practice of physical therapy is the prevention of movement dysfunction and rehabilitation through restoration and maintenance of active movement – in other words, therapeutic exercise. Therapeutic exercise is commonly used in the treatment and management of a range of shoulder disorders and is supported by much research.
Muscle activity during shoulder movements[edit | edit source]
Recent EMG studies have indicated that rotator cuff muscles are recruited in a reciprocal, direction-specific pattern during shoulder flexion and extension exercises. Wattanaprakornkul et al[1][2] demonstrated that during flexion, the posterior externally rotating cuff muscles (supraspinatus and infraspinatus) were activated at significantly higher levels than the anterior internally rotating cuff muscle (subscapularis), while during extension the reverse occurs. This knowledge gives us more information to specifically target the rotator cuff muscles in different positions and ranges of movement.
This muscle contraction in a reciprocal direction-specific manner supports the role of the rotator cuff as shoulder joint dynamic stabilizers to counterbalance antero-posterior translation forces and that the rotator cuff provides shoulder joint support by preventing flexion and extension prime movers of the humerus e.g. the deltoid, from translating the humeral head on the glenoid fossa.
The Evidence[edit | edit source]
Exercise in the management of rotator cuff tendinopathy, has a useful role to play and incorporating loaded exercises is safe and not detrimental to outcome[3]. Both home and supervised exercise programmes have been found to be more effective than no intervention or placebo and as effective as minimal comparators, e.g. functional brace, or active comparators, e.g. multimodal physiotherapy, surgery[3].
However, optimal parameters of exercise and load have yet to be determined as has the mechanism by which therapeutic response occurs[3].
References[edit | edit source]
- ↑ Wattanaprakornkul D, Halaki M, Cathers I, Ginn KA. Direction-specific recruitment of rotator cuff muscles during bench press and row. Journal of Electromyography and Kinesiology. 2011 Dec 1;21(6):1041-9.
- ↑ Wattanaprakornkul D, Halaki M, Boettcher C, Cathers I, Ginn KA. A comprehensive analysis of muscle recruitment patterns during shoulder flexion: An electromyographic study. Clinical Anatomy 2011;24:619–26.
- ↑ 3.0 3.1 3.2 Littlewood C, Ashton J, Chance-Larsen K, May S, Sturrock B. Exercise for rotator cuff tendinopathy: a systematic review. Physiotherapy. 2012 Jun 1;98(2):101-9.
