Wednesday, February 28, 2007

Isolate to Activate and Integrate

This question came up recently on JP Fitness and I wanted to expand on it a little:

Q: I went to a a PT this summer for my shoulder. Their was little to no isolated exercises and very little static stretching...The program consisted of a warmup with dynamic stretches (lunge variations : front, side, reverse), single leg squat touchdowns, jumping jacks or 3 dimensional jumps, shoulder activation exercises (shoulder dump, internal/external rotator cuff movements with movement in the hips, punches thrown at different levels with some hip movement, similar exercises to the above link), this was followed by a strengthing circuit section...There is no exercises like pushup pluses, face pulls, Y's, T's, etc. that we see in many rehab programs....I enjoyed this program, but I don't know if I need to include traditional exercises like Y's T's to get better. The PR [I'm assuming he meant PT here] actually advises against these type exercises I think becauuse it isn't using more of the kinetic chain. Any opinions?

There are many components to an effective shoulder rehab program. I question whether a PT would actually advise against upper extremity weight bearing exericses (push-up plus, closed chain weight shifting, tripod exercises), isolated strengthening of the rotator cuff and scapular muscles, or range of motion and stretching. Each serves an important ingredient at specific stages of the rehab program.

The programming that you refer to involving the whole body exercises is primarily designed to restore normal intengration of shoulder function with the rest of the body. Certainly, this is important to recovery and general shoulder health.

When Mike Robertson and I put together Inside-Out, we designed it as such to emphasize the principles of how the body produces upper extremity movements from proximal (trunk and hips) to distal (scapula, shoulder, and arm) much like the exercises you describe. Just to show you how other parts of the body influence shoulder function, in almost half of all rotator cuff tears, you'll find a mobility issue in the opposite hip. In 100% of all cases of acquired shoulder instability, the scapula is also found to be unstable (cause and effect?).

Keep in mind that in most cases, you'll still need to address range of motion and strength in isolation on some level as the body is still able to compensate around movement restrictions or substitute for weakened muscle.

In other words, isolate to activate and integrate. That being said, all these processes can take place at the same time. Even in some situations where the shoulder may be immobilized, you can work on hip mobility, thoracic spine mobility, scapular mobility, and their integration.

Later

27 comments:

Anonymous said...

Dear Mr. Hartman,

I understood everything you mentioned in your response to this individual's question. In particular, I thought the connection between unstable scapula and unstable shoulder made sense. I am confused about the relationship between the hip and injured rotator cuffs. Could you elaborate on this? Thanks for your time.

Sincerely,
Matt Tentis
Athletic Training Student

Bill Hartman said...

Do a pubmed search for Kibler and scapular dyskinesis and you'll find what you're looking for

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