shoulder rehabilitation | pectorals rehabilitation

In the previous two issues, we have outlined the principles of bodyweight- only or minimal equipment strength training for rehabilitation and given specific exercises for quads, calves and back muscles. In this issue we look at the upper-body push-pull muscles: the shoulders, pectorals and latissimus dorsi.

This is perhaps the most difficult area of the body for which to devise a progressive resistance programme without the use of gym equipment or free weights. Recent articles in SIB have discussed how to devise balanced strength in the shoulder using machines such as the seated row, lat pulldown and chest press, plus dumbbell exercises. One minimal equipment option is to replace the machines and weights with resistance bands. You can perform lateral raises, bent-over row and even a lat pulldown of sorts with bands.

However, another option is to prescribe old-fashioned isometric exercises for shoulder rehabilitation. Isometric exercises have great benefits for shoulder rehabilitation programmes because by definition they involve no movement and so can be performed in joint positions that produce no pain or excessive stress, which avoids jeopardising the healing process of the injury. In addition, useful isometric exercises can be performed in any house without any equipment.

Some isometric exercises, of course, are extremely fashionable, such as the plank and the gluteal bridge. These core stability exercises involve sub-maximal contractions, which are usually held for long durations (30-plus seconds) until fatigue. This means that the main benefit will be improvements to local muscular endurance: increasing the fatigue resistance of the muscles being worked.

To develop strength, isometric exercises have to be performed in a certain manner. The research supports maximal or near-maximal voluntary contractions held for 3-10 seconds. Unlike with weights work, you can perform these exercises daily and the literature suggests that the average adult can improve their muscle force this way by 0.5-1% per day following this kind of regime of isometric contractions (well-trained athletes would not achieve the same rate of strength development). The development of strength is confined to the 20 degree arc either side of the joint angle at which the isometric contraction is performed⁽¹⁾.

The exercises described below cannot be considered a substitute for the specific rotator-cuff or scapula stabilising work that any shoulder rehabilitation programme will need – so you probably will have to get the resistance bands out as well. But as closed-chain isometric exercises, the stabilising muscles around the joint will be recruited to maintain good posture and joint position.

Exercise	Start sets x reps	Target sets x reps
Single arm isometric press 1. Elbow 90 degrees 2. Elbow 140 degrees	5 x 5 sec hold each arm, for each exercise	10 x 10 sec holds
Isometric lateral raise 1. Arms by side 2. Arms at 45 degrees	5 x 5 sec hold each arm, for each exercise	10 x 10 sec holds
Single arm isometric pull 1. Elbow 160 degrees 2. Elbow 90 degrees	5 x 5 sec hold each arm, for each exercise	10 x 10 sec holds

The limitation of using isometric exercises is that the strength gained during the static contraction does not promote dynamic function. Sports performers will have to add in dynamic functional movements before their rehabilitation is complete.

The exercises are also very safe. Performed against a wall or in a doorway, the shoulder joint is positioned so that joint compression forces are not high. The patient is fully in control of how much effort they apply, which determines how much force is generated in the muscles – so they are unlikely to over-strain.

As there is no eccentric component, there is less risk of delayed onset muscle soreness and it may be possible to perform the exercises most days of the week. If you try the exercises for yourself you will quickly realise, as you feel the tension, that it is possible to get excellent recruitment of the muscles and that the muscles will fatigue – and therefore gain a training benefit – quite quickly.

Upper body isometrics series

Main muscles trained:

deltoids
pectorals
latissimus dorsi
rhomboids.

Suitable for rehabilitation from:

Any upper-body injury that has resulted in loss of strength or atrophy of musculature

Progression

When you perform the isometric contractions always aim to pull or push against the wall or doorway with a big effort. Think 9 out of 10 push or pull. This high-level effort will ensure a near maximal voluntary contraction so the strength benefit can be gained. If you cannot recruit the muscles with high force it is a sign that the injury has inhibited the muscle, in which case the exercise will be very beneficial at reeducating the muscle.

When you start these exercises you will find 5 reps of 5 sec contractions will reduce your ability to produce the high level of force. Soon you will be able to maintain 10 reps of 10 secs of strong contraction. Increase one second at a time until you do 5 x 10 secs and then increase one rep at a time until you reach 10 x 10.

Technique and arm positions

Please pay attention to the details, particularly those defining the position of the arm and elbow angle. There are two different positions for each exercise, because isometric strength development is highly muscle-length specific, with a small carry-over benefit. By training the muscle at two positions, you will be able to develop strength more evenly throughout the range of motion.

1. Single arm isometric press – elbow 90 degrees

Stand in a doorway facing the threshold with one foot slightly in front of the other for stability.
Stand upright with good posture – tummy in, chest out and shoulders back.
Place one hand on the wooden frame, positioning yourself so your elbow is bent to 90 degrees.
The height of your hand will be the same as your shoulder, but keep your elbow below your shoulder to protect the shoulder joint.
Set your abs to control your body position, keep still when you push.
Push hard with your hand against the doorframe.
You will feel the chest and front shoulder muscles contracting. You will also feel the abs working hard to keep your body still.
Make sure your body is rigid, use your shoulder stabilisers to keep the joint in a good position. Avoid shrugging.
Breathe in just before each contraction and breathe out as you push.

2. Single arm isometric press – elbow 140 degrees (see illustration)

Same as above but position yourself a little further away from the frame, so that your elbow angle is about 140 degrees. Keep your hand at shoulder height.

3. Isometric lateral raise – arm by side

Stand next to a wall, sideways on, with one foot slightly in front of the other for stability.
Stand upright with good posture – tummy in, chest out and shoulders back.
Place the back of your hand against the wall.
Your hand will be a few inches from your side.
Set your abs to control your body position, keep still when you push.
Push hard with your hand against the wall.
You will feel the shoulder muscles contracting. You will also feel the abs working keep your body still.
Make sure your body is rigid, use your shoulder stabilisers to keep the joint in a good position. Avoid shrugging.
Breathe in just before each contraction and breathe out as you push.

4. Isometric lateral raise – arm at 45 degrees

Same as exercise 3 but position yourself a little farther away from the wall, bend your arm to 90 degrees and raise your arm to 45 degrees to the side so your forearm is against the wall.
As you push keep your forearm flat against the wall.

5. Single arm isometric pull – elbow 160 degrees (see illustration)

Stand facing the threshold and to the right of a doorway with one foot slightly in front of the other for stability.
Stand upright with good posture – tummy in, chest out and shoulders back.
Place your right hand on the wall to the side of the door – you will use this hand to stabilise your body.
Extend your left arm through the door to grip the frame on the other side of the threshold, hand just below shoulder height and elbow at about 160 degrees.
Set your abs and push your right hand into the wall a little for stability.
Pull left hand hard towards you on the doorframe.
You will feel the rear shoulder and latissimus muscles contracting. Focus on trying to pull the elbow back, so your shoulder muscles rather than your biceps create the most tension.
Make sure your body is rigid, use your shoulder stabilisers to keep the joint in a good position. Avoid shrugging.
Breathe in just before each contraction and breathe out as you push.
Swap to the left hand side of the doorway and repeat for the right hand.

6. Single arm isometric pull – elbow 90 degrees

Same as 5, but stand closer to the doorway and grip the frame so that your elbow is at 90 degrees.

References

Baechle 1994. Essentials of Strength and Conditioning Human Kinetics.