After ten years of pain and recurrent injury I was sitting on the edge of an operating table scheduled to get a pin in my shoulder to which my supraspinatus was going to be hooked. The young assisting surgeon did a final check of my shoulder. And bless him forever, he refused to do the operation.
More than one friend now asks me about my shoulder. One friend ALWAYS asks. It seems programmed into her now and she asks me if I’m keeping up my exercises.
So now here’s my take on shoulder rehab.
The thing to know about shoulders is the 4 tiny muscles which hold them in place. If these muscles are weak (and even in muscle-bound people at 3.25 mins in this vid they can be weak) your shoulder is in danger.
The 4 muscles are subscapularis, teres minor, suraspinatus, and the infraspinatus.
Your shoulder rehab exercises target these tiny muscles (not the bigger ones such as biceps, triceps, pectoralis).
Before doing any exercises you MUST “set” your shoulder. This is the hard part and you need a good physio to teach you how.
So I found a good physio by a stroke of luck meeting that good young surgeon (Phillip Insull).
He said I needed a good physio who could teach me how to set my shoulder and strengthen my shoulder muscles (the 4 little ones). He said the massage I’d had in the past from a range of physios was utter bullshit. He gave me the name of a good physio. And enormous thanks here to the expertise and evidence-based attitude of UNISPORTS (they help with the NZ Olympic Team and top class rugby teams too).
The physio said I needed to retrain my mind and learn to “set” my shoulder/scapula. He said it was my mind that needed work first. Then and only then could I begin exercises. And then I could only exercise the small 4 muscles. Regaining muscle mass on the bigger muscles was a second priority and was a few months away. In my experience it takes about three months for new muscle to grow nicely.
Anyway, he said keeping my scapular “set” nicely and flat on my back needed to become a way of life. Making coffee in the morning, reaching to a cupboard, sitting at a keyboard, walking or running or cycling or swimming, reaching out to shake someone’s hand, pulling on a rope, using a screwdriver – all these need a properly set shoulder/ scapula. Sorta like sitting up straight and keeping your shoulders back like teachers used to tell me in school.
To give you an idea of how much mental retraining is needed, there are 17 muscles attached to the scapular. Fortunately your brain can automatically learn to program them all to keep them set in the right place. So unless you are really keen, there’s no point learning to control each of the 17 – though you’d be amazed at what’s possible (nauli stomach demo).
OK so how do you learn? My physio used tape which was left in place for a couple of days. My brain was a bit slow and it took me a couple of weeks to learn to set my scapular. So I had to go back a couple of times and get him to retape me. He watched me trying to get the “set” position and he taped me again.
There are 2 types of taping, only one is right.
1. Heavy tape which attempts to hold the shoulder in place and which you often see footballers strapped with. I was warned against this because you aren’t training your own muscles. This type of strapping is the only one bad physios know.
2. Smaller strips of tape which are placed on your back once your scapular is “set”. The tape is placed to that it slightly bunches the skin so if you slouch out of position, the tape tugs gently on your skin and gives you a signal to straighten up. The tape doesn’t hold you in position, your own muscles do. It’s strangely fatiguing at first, so don’t push yourself. I’ve found it impossible to find a decent picture of this on the internet. You only seem to get the heavy tape pictures.
(The photo above shows the two strips of tape holding a crease in the skin. If you slouch out of position, the tape pulls on your skin, reminding you to “set” your scapula, which sets your shoulder. After you learn it, you don’t need the tape. The photo at the top of the page shows pen marks on the edge of the trapezius. The marks follow the striations of the trapezius muscle attached to the scapula. This is where the tape needs to be put – your physio should know all about this – but many don’t.)
I never found a youtube video for the second type of taping, though here is a good video on “setting” your scapular.
Your physio, if they know their stuff, will emphasise that the issue is MIND CONTROL not muscle strength and that wrong exercise may set you up for shoulder damage.