An old client of mine hit me up again after having some shoulder issues. They had dislocated their shoulder three times. The most recent was from a trampoline incident in April of 2015. In May 2015 they had a Latarjet procedure. Video with some fantastic opera music if interested:
-> By the way, a good way to get injured is to get on a trampoline. More so if you’re female. Even more so if you’re jumping on it with someone else.
After the surgery they were in a sling for about seven weeks.
They were seeing a physio until September 2015. By late December 2015 they email me (they’re in Australia, so not an in person client) looking for help. He’s still significantly limited into external rotation and hasn’t been making any progress. When he lifts his arm, this happens:
Notice how much the left elbow is facing the side.
The right arm isn’t a whole lot better. He’s had issues with that arm too.
How the arm is bent.
Subsequently the hand can’t get as high:
And then because he can’t get his shoulder higher, rather than bring his shoulder to his neck, he’s having to bring his neck to his shoulder:
His head is tilted and his shoulder blade is shrugging inward.
This is a very limited arm. Not just into external rotation, but into elevation and upward rotation too.
After a few weeks of exercising together things weren’t budging much, so we needed to get more aggressive. We had been doing this exercise:
On the way back is external rotation; on the way forward is internal. Angus was really limited into external.
Internal rotation on left; external rotation on right:
Notice again when the elbow is pointed out is internal rotation. When Angus was raising his arm his elbow was pointing out. He was too *good* at internal rotation, and not good enough at external.
Backing up a step, why might Angus have been so limited? Notice what a sling does- place you in internal rotation:
After a couple months of that, you’re going to be stiff getting out of it. Then, more than likely, his physical therapist just wasn’t doing as good of a job as they could have been.
So we get more aggressive and I instruct Angus to use a weight, and gently let his arm get pushed by the weight into external rotation:
You can see him grimacing due to how tight he is. Note this was NOT painful. I made sure repeatedly it wasn’t by asking him. He repeatedly told me it was just really tight at times. Still, I told him to see if he could lessen the weight / stretch enough to where he didn’t have to grimace. (For many with an athletic background though, that’s not the easiest instruction to follow!)
The idea here is when stretching you want to relax an area. Being tense, or facial grimacing, is a sure sign you’re not relaxed. This is similar to getting a massage. When someone is beating the shit out of you, it’s not relaxing, and some of us call that S/M. When you feel like you want to fall asleep, that’s relaxing.
A few weeks later, he looks like this:
How much better does that look??? Still some grimacing, but much less, and the range of motion improvement is obvious.
Then we get back into raising his arm:
A few more weeks and Angus would be good as new.
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Need help like Angus? Become a remote client. He’s in Australia! If he can make this type of improvement from that far away, surely you can too.
Alex
June 21, 2016
Awesome work Brian, can u let us know, how often is he doing the exercises, how many sets/reps on daily basis ?
reddyb
June 21, 2016
Monday, Thursday, Saturday he did the weight hold for 1 set of 2 minutes to start his workout.
Tuesday, Friday, Sunday he did three sets for as long as desired. Angus knows his body better than the average client. I give these types some more leeway and autonomy.
This was hardly all he was doing though. The various exercises he was working on were 6 days per week, along with some changes as to how he went about his day (activities of daily living).
Jason.p.clement@gmail.com
June 23, 2016
Thank you for this Brian. I do have a question – Why does his head move toward his shoulder in the first video?
I’m guessing that its because shoulder elevation reduces the distance from the shoulders to the head – and when that’s limited – the body falls back on achieving a similar end state by bringing the head to the shoulder. I sure would like to know! Thanks for the interesting post.
Jason.p.clement@gmail.com
June 23, 2016
After re-reading the post I guess you basically stated that, and I just didn’t recall reading it.
reddyb
June 23, 2016
The other way to view this is the levator scapula is too active in elevation relative to the upper trapezius. The levator downwardly rotates while the upper trapezius upwardly rotates. He is lacking upward rotation in the first video.
jameson
July 27, 2016
i have a similar problem to this not quite as noticeable and extreme since my torn labrum bankart repair surgery.i seem to run into a little instability when i go into the fully externally rotated overhead position. i was wondering if in your opinion this sounds like something i could work on or this is a natural result of the trauma i suffered and my bodys way of protecting itself id be happy to show you pictures or videos if you believe you could help me thank you.
reddyb
July 29, 2016
Hey Jameson (great name!),
It sounds like all the above.
-When externally rotating the arm at 90 degrees abduction (like shown in the videos), the humeral head glides anteriorly *some*. A bankart lesion is a tear in the anterior labrum. So in this position you’re moving into the direction of your injury. You could 1) be worried about this as you’re sensitive that direction from your past trauma (understandable) 2) Still have some instability, based on how the surgery and recovery went, and or…
-However, at least during slow exercise, like illustrated in the post, humeral anterior glide can largely be prevented through concentration / being careful with ROM (at least until it improves). In other words, this may be more a strict movement impairment. For instance, if the back of your shoulder -the posterior side- has gotten stiff, you’re more likely to have excessive anterior glide, where you end up moving towards the path of least resistance. Where that posterior side needs to be loosened up. This could have been a movement issue before you ever injured the area, but now you’re just more aware of it.
Relevant articles- https://b-reddy.org/2011/06/19/best-exercises-for-the-subscapularis/
https://b-reddy.org/2015/03/06/humeral-anterior-glide-video-with-animation/
And you can see the focus on preventing anterior glide in this exercise:
Could likely help you out with all this through the remote client process, if you want to take a look and let me know more- https://b-reddy.org/2013/06/20/the-remote-client-process/
jameson
August 3, 2016
hey brian thank you very much for getting back to me with this personalized response. ive begun doing those supine humeral rotations for about a week now and they do seem to be helping only time will tell but i just wanted you to know im looking into the literature you gave me and wanted to extend my gratitude for you taking the time to get back to me
reddyb
August 4, 2016
You’re very welcome!
Marc Brown
October 13, 2016
AMAZING! I’ve lost 15degrees of external rotation after my latarjet so when at the gym it can be a nightmare not being able to get a bar on my traps and hold it safely for squats, not being able to position my arm correctly for wide grip pull ups.
I’m going to be trying this from tonight… starting with tins, jars and work my way up to dumbbells. I’m just over a year post op and it’s tight as hell. So thank you for this.
reddyb
October 14, 2016
You’re welcome! Remember to start out slow. Stretching should always have an element of relaxation to it. You sound like you have the right mindset with tins, jars, etc. Good luck.