As we discussed in last week’s article, hypermobility (joints that are too mobile/flexible)—as demonstrated by the ability to perform tasks such as bending forward and placing your palms flat on the floor without bending your knees—can lead to joint injury, pain and possibly arthritis pain caused by excessive joint movement. This week’s article will discuss how you can improve your stability and strength to protect your shoulder joint, which is commonly injured by excessive motion. If you are not a hypermobile individual, this program can also help improve shoulder function and prevent injury.
The shoulder joint is designed to allow tremendous freedom of movement in order to allow the dexterous hand to reach as many objects as possible. In addition to being mobile, the shoulder must also provide strength and stability for the hand to perform intricate tasks, whether that is throwing a 90-mile-per-hour curve ball for the New York Yankees or playing Rimsky-Korsakov’s “Flight of the Bumblebee” on the violin. However, somtimes the shoulder is too flexible and unstable. This leads to pain, weakness and loss of function. There are several causes of hypermobility or instability in the shoulder.
In some people’s shoulders, the socket of the “ball and socket joint” is too shallow or is shaped in a direction that allows it to move excessively. For other people, the ligaments or the outer layer cartilage (labrum) of the joint are too loose or insufficient. And for some people, the rotator cuff muscles lack tone and strength. Those with shoulder instability often have one or more of these issues, and are vulnerable to problems from excessive motion.
The origin of these problems can be congential – hypermobile joints, like we discussed in the past two weeks, can be something we have since birth. Or, it may come when the joint forced out of place by traumatic event, such as bike, motor vehicle, or sports accident. Many people have shoulder instability from chronic microtraumas that occurred over years of wear and tear from overuse. Professional baseball pitcher Ron Chiavacci is such an example—he suffered a torn labrum and rotator cuff tear from excessive movement from multiple microtraumas that occurred over years of throwing high-velocity baseballs.
Sometimes an unstable shoulder feels like it is loose and wants “come out of joint.” This is called subluxation and is associated with a feeling of the shoulder dislocating. This often causes sudden onset of pain, muscle spasm, and weakness. However, the shoulder never actually comes out of the socket. A more serious and painful problem associated with shoulder instability is shoulder dislocation. This occurs when the head of the humerus in the shoulder comes out of joint from the socket. It is painful, often requires an emergency room visit to put the shoulder back into the joint, and reoccurrence is common. Muscles and ligaments are often stretched or torn during dislocation.
For those who have experienced a sensation of subluxation or instability or for those engaged in high-velocity throwing sports, improving shoulder stability is essential, and the following exercises can assist in this goal. For those with a recent history of dislocation, consult your physician or physical therapist before you attempt these exercises.
For each of these exercises, tie a Theraband® to a fixed surface, such as a door-handle. With your arm in the position described with each exercise, stand far enough from the door that the Theraband® has no slack but is not stretched tightly. Then, without moving your arm, take two steps away from the door, stretching the Theraband®. Hold for a count of 10. Keeping arm still, return to your starting position by taking two steps toward the door. This is one repetition. For each exercise, complete 1 set of 10-20 repetitions.
1. Hold your arm at your side with your elbow bent 90-degrees with the band pulling “in,” across your body. Take two steps away from the door, stretching the Theraband®. Hold for a count of 10. Keeping your arm still, take two steps toward the door. This is one repetition.
2. Hold your arm at your side with your elbow bent 90-degrees. This time, stand with the Theraband® pulling “out,” away from your body. Complete the exercise by taking two steps, as above.
3. Stand with your arm down by your side, elbow locked straight, and the Theraband® pulling back, behind you. Complete the exercise by taking two steps, as above.
4. Stand with your arm down by your side, elbow locked straight, and the Theraband® pulling forward, in front of you. Complete the exercise by taking two steps, as above.
5. Stand with your arm down by your side, elbow locked straight, and the Theraband® pulling “in”, across your body. Complete the exercise by taking two steps, as above.
6. Stand with your arm down by your side, elbow locked straight, and the Theraband® pulling “out”, away from your body. Complete the exercise by taking two steps, as above.
Photos: Gary Mattingly, PT, PhD; Model: Brian Connor
Read “Health & Exercise Forum” – Every Monday. This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: firstname.lastname@example.org. Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an affiliate faculty member at the University of Scranton, PT Dept.