The shoulder is a complex and beautiful joint in the human body. For the same reasons of being a beautifully functioning articulation, we are faced with added challenges such as stability. Having a such a vast range of motion, the shoulder is able to move in all movement planes, leading to an increased demand for dynamic support of the joint. This means an elevated requirement from the shoulder musculature to provide support during joint movements, that are not met by the joint structure.
I can tell you from personally experiencing rotator cuff tears, broken clavicles (yes, multiple) and shoulder separations that maintaining shoulder muscle strength is imperative for keeping and improving shoulder function but also to help reduce risk of re-injury of your shoulder.
This blog will cover the following points on the shoulder and strengthening programs:
Anatomy and Function of the Shoulder
The shoulder is a complex joint that allows for a wide range of motion. It plays a vital role in the movement and function of the upper limb. It consists of several bones, muscles, tendons, ligaments, and other tissues.
- Humerus: This is the upper arm bone and forms the main connection between the shoulder and the elbow.
- Scapula: Commonly known as the shoulder blade, the scapula is a flat, triangular bone that rests on the back of the rib cage. It provides attachment points for various muscles.
- Clavicle: Also known as the collarbone, the clavicle is a long, slender bone that connects the sternum (breastbone) to the scapula. It helps stabilize the shoulder joint.
- Glenohumeral Joint: This is the primary joint of the shoulder and connects the head of the humerus with the shoulder socket – the glenoid cavity of the scapula. It is a ball-and-socket joint, allowing a wide range of movement.
- Acromioclavicular Joint: Located where the clavicle (collar bone) meets the acromion (a bony projection of the scapula – shoulder blade). This joint provides stability and allows limited motion.
- Rotator Cuff Muscles: These four muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) are responsible for stabilising the shoulder joint and initiating various movements.
- Deltoid: The deltoid is a large, triangular muscle covering the shoulder joint. It helps with shoulder abduction (moving the arm to the side), flexion (moving the arm forwards), and extension (moving the arm backwards).
- Biceps Brachii: This muscle is located on the front of the upper arm and assists with shoulder and elbow flexion (bending) and forearm supination (turning the hand upwards).
Tendons & Ligaments
- Rotator Cuff Tendons: These tendons connect the rotator cuff muscles to the humerus, providing stability and controlling the movements of the shoulder.
- Glenoid Labrum: This is a ring of fibrous cartilage that surrounds the glenoid cavity (shoulder socket), deepening the socket and enhancing joint stability.
- Acromioclavicular Ligament: This ligament connects the acromion and the clavicle, reinforcing the acromioclavicular joint.
- Coracoclavicular Ligaments: These ligaments connect the coracoid process of the scapula to the clavicle, providing additional stability to the acromioclavicular joint.
- Synovial Membrane: The synovial membrane lines the joint capsule and secretes synovial fluid, which lubricates the joint and nourishes the articular cartilage.
This is a simplified overview of the anatomy of the shoulder. Each component works together to facilitate the wide range of motions performed by the shoulder joint.
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The role of muscles in shoulder mobility and stability
There is a complex synchronicity that takes place between these structures when moving the shoulder. The balancing act between stability and mobility is constant. The muscles play roles on both sides of this balancing act (Cools et al, 2014).
“An exercise program that encourages joint control as well as strength through range of motion is critical for optimal shoulder function.”
My journey through shoulder rehab began at 17 years of age. I was playing competitive baseball in Canada which led to an overuse injury and tear in the rotator cuff. I was offered surgical repair on first examination but was told physiotherapy could help as a first option towards recovery.
I chose physio!
Prior to this point, I had no strength training knowledge but was fortunate to have a physio that was very exercise oriented. Over the next 9 months, I was able to regain full range of motion and improved my shoulder strength to be throwing as well as before the injury. And I avoided any surgery!
Not only did I learn of the importance of strength training to compliment my athletics, but the experience also inspired me to follow my current career path.
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Key components of a shoulder strengthening program
Some key components to a balanced shoulder strengthening programme are:
- Balance between Internal shoulder rotators and External shoulder rotators:
- Internal rotators: Subscapularis, Teres Major, Latissimus dorsi, Pectoralis Major,
- External rotators: Infraspinatus, Teres Minor, Supraspinatus,
- Balance of training open chain and closed chain mechanisms:
- Open chain exercise: hand moving freely through space (e.g., dumbbell weights and cables or exercise bands)
- Closed chain exercise: hand in fixed position while body moves (e.g., push ups or planks)
- Balanced eccentric and concentric loading exercises:
- Eccentric load: tension in a muscle while increasing muscle length
- Concentric load: tension in a muscle while shortening muscle length
These are important for balanced control of acceleration and deceleration of the arm in a throwing motion.
How physiotherapy can help the throwing athlete with a shoulder injury
Throwing athlete expose their shoulders to extremes of motion, in order to increase velocity in the throw (Wilk et al. 2009). This high exposure to greater angles in joints gives rise to greater forces working on the tissues and increasing risk of injury.
If you have sustained a shoulder injury (or multiple shoulder injuries like me!), a comprehensive assessment of strength and range of motion deficits will be required.
Your PhysioTec physiotherapists can provide:
- Biomechanical observation with available video analysis,
- Real-Time Ultrasound for deep muscle neuromuscular coordination training of the shoulder,
- Range of motion assessment, and
- Strength testing using dynamometers - for real-time objective measures to direct your treatment and strength program for best outcomes, and to meet your specific needs and goals.
These methods are also applicable to athletes wanting to improve performance, through analysis of strength balances and range of motion deficits that may be impacting sporting function.
If you have a sporting injury, visit us at PhysioTec and let one of our sports physios assess you and provide you with a personalised program for recovery and to get you performing your best!
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Cools AM, De Wilde L, Van Tongel A et al. Measuring shoulder external and internal rotation strength and range of motion: comprehensive intra-rater and inter-rater reliability study of several testing protocols. J Shoulder Elbow Surg 2014;23(10):1454–61.
Cools AM, Vanderstukken F, Vereecken F et al. Eccentric and isometric shoulder rotator cuff strength testing using a hand-held dynamometer: reference values for overhead athletes. Knee Surg Sports Traumatol Arthrosc 2015 Aug 21
Wilk KE, Obma P, Simpson CD et al. Shoulder injuries in the overhead athlete. J Orthop Sports Phys Ther 2009;39(2):38–54.