Shoulder Post-Rehab

Recently Anthony Renna interviewed me about our collaboration on a recent client of his.  At the time, she was several months post-surgical left rotator cuff repair.  I don’t know if there were any special factors or unique characteristics of her surgery.  She was discharged from physical therapy and cleared from her physician to return to Anthony with no restrictions.  No restrictions as in, this client had a list of exercises to read to the physician who as I understand it, okay’d every one.

The specifics to this case are all in the interview which can be found at StrengthCoachPodcast.com, Episode 62.

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So as Anthony and I discussed my impressions after I saw this client, I described how I felt that she was in need of some manual therapy and how I viewed progressing her to the exercises she wanted to do.  Often we speak of progression in terms of exercise continuums such as split squat to RFE split squat

Below are the variables that can apply to all types of progressions, but the unique biomechanics of the shoulder joint lends to the non-provocative to provocative positioning that may not exist with other joints.

The choices below are hardly all-inclusive, and there is no reason that you must clear dynamic of a lesser provocative position before going to static on the next position.   For instance, I am very comfortable getting to the 1/4 Get-Up

Static to Dynamic
Slow to Fast
Unloaded to Loaded
Sagittal to Frontal to Rotational
Non-Provocative to Provocative

Non-Provocative Static (Arm @ side)
Deadlift variations
Farmer’s Walk
Gripping

Non-Provactive Dynamic
Dips
Low Rows

Middle-Provocative Static (Arm 80-120 degrees)
Rolling Shoulders (Supine T-Spine Rotation w/Hip Flexion)
KB Armbars
Plank variations
EQI
KB Swings
KB Clean Walks
Inverted Row Pack
Body Pull

Middle-Provocative Dynamic
Bench Press variations
Inverted Rows
Chest-Supported Rows
TWYL
Push-Up Rows (Renegade Rows)
KB Cleans

Provocative Static (Arm overhead)
Turkish Getup
Overhead KB Walk
Pull-Up or OH Pack

Provocative Transitional
KB Snatches
Olympic lifting variations
–Dynamic through Provocative range followed by Static deceleration

Provocative Dynamic
Pull-Up variations
OH Pressing
–Narrow grip before wide grip Pull-Ups before Push Pressing before Strict Pressing

Med Ball Progressions
Short Amplitude to Large Amplitude
–Limiting range through overhead position or across body
OH Slam to OH Granny Toss to Soccer Throw
Low Rotational Throw to Middle/Upper Rotational Throw to Shot Put
Chop to Lift
Kneeling to Standing to Stepping to Footwork

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16 Responses to “Shoulder Post-Rehab”

  1. Chris says:

    Have one questions: Dips are non provacative? I agree with the rest.

  2. Charlie says:

    Chris – When we look at dips, the arm is closer to the zero ABD position. I hate dips, and I do not use them, as there is not a risk reward there, but I am classifying these movements by position, not potential end result.

  3. Tomas says:

    Thanks Charlie for those progresions. I agree completely except dips,also thx for explanation about them.
    I just would like to ask you about inverted row pack (do you mean moving just from scapulae?) and also don’t know what is body pull?
    and last one :) do you use in programing ,,0abd,, bent over arm extensions? I found them quite good tolerated and great for lats when overhead puling is problematic.

    Thanks for your time

  4. Dan Bilotti says:

    Charlie,

    Is the unfavorable risk-reward from dips related more so to sloppy performance by most trainees, or is it essentially par for the course by the exercises very mechanics and the injury/postural history of most people?

    I’ve used them for a long time and never had shoulder issues (knock on wood, and I absolutely recognize that my lack of problems in this area could be in spite of my use of dips), but your statement on their unfavorable risk:reward makes me wonder if dropping them and sticking with other routes of training the same type of qualities would be a better bet. Oftentimes I will sub out dips for weeks at a time in favor if board presses.

  5. Hal Starks says:

    Hi, Charlie. I’m just curious what your own approximate definitions of wide and narrow grip pull-ups are, since I know that this can vary a bit between coaches. Do you have any rules of thumb in this regard?

  6. Charlie says:

    Tomas – Good call with the straight arm extensions. I would put them in middle-provocative dynamic, but they would be more remedial as the direction is returning to non-provocative.
    I have not used them in rehab or athletes, but I highly recommend them for bench press specific training.

  7. Charlie says:

    Dan – I think when you do dips even correctly, there a very limited base of support for the entire body going through the anterior shoulder. There is nothing wrong with it in terms of the Joint by Joint, but I think the load and potential to rely on the shoulder capsule and very elongated pectoral muscles is not worth what you get out of it vs. alternatives.

    If it’s working for you, and it’s something you enjoy, the worst of it may be something down the road. I am not ready to tell you never do dips again, especially if you like doing them. I would say they should be the first to go if you start running into any shoulder or neck issues.

  8. Charlie says:

    Hal – Via hand grips for pull-ups, I would go with the below. These are just arbitrary and relative to what kind of bar you have to pull to.

    Neutral shoulder width to wide
    Supinated shoulder width (can’t really go much wider for chin-ups)
    Pronated grip
    –Narrow = shoulder width
    –Moderate = arms @ ~135 ABD
    –Wide = as far as the bar would allow
    –Super Wide = as far as angled bar would allow

  9. Kelvin says:

    Charlie – Great podcast! I am working with wrestlers, however I have this particular wrestler who injured his shoulder during the previous wrestling season and doing MMA. I am aware in wrestlers or MMA Athletes shoulder injuries are pretty normal. I took him through the FMS to see the various imbalances, etc… I noticed he had good shoulder mobility, however when he squatted I noticed he moved to the injured shoulder side. Therefore, I gave him some progessions to try and balance both sides when he squats. As a wrestler they need to tumble, etc… So is it not wide to have him do tumbling? He was able to do the tumbling forward and backward, however I told him do not do the side tumbling because of his shoulder. Its been two weeks and the shoulder has not bothered him. So, what steps should I take? Should I actually have a highschool athlete see a corrective specialist/physical therapist? It isnt recommended by the physician, however I would like to know how to handle this particular wrestler and others that may have the same injury (past or present).

  10. Charlie says:

    Kelvin – Thank you for the good words.

    Rule of thumb is that if what you are seeing is honestly non-painful, go in and try to correct it with bands, exercises, etc.

    As far as tumbling, I think 2 weeks of pain-free function is a fair allowance to get back into some progression. Pain-free dysfunction is about risk. If you still see the squat problem, you have increased risk. It may not be the worst idea to get another set of eyes to help this young man out.

    If your intuition and Screen smells smoke, and this sounds like the case, tread lightly.

  11. Coach Len Kuhn says:

    Charlie; Thanks for all your insight and assistance, even an old coach like myself can partake of your knowledge and enthusiasm

    Thanks

  12. Ray McCarthy says:

    A little late to hear this one but it was a GREAT ONE.

    As always Thanks Charlie!

  13. Chris S says:

    Charlie, super late here – curious for an explanation of your recommendation of push press before strict press?

    Thanks for the great stuff!

  14. Charlie says:

    Push Press requires ownership of a static stabilization strategy from a faster moving bell. I want you to stabilize a bell heavier than you can push on your own.

  15. Jari says:

    Charlie, one question.

    What’s your opinion for how long it usually takes after RC impingement/tear surgery to perform non-provocative static exercise like kb deadlift?

  16. Charlie says:

    Always depends. Maybe immediately if it doesn’t hurt and no compensation.

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