This research examined the advantages of scapula training workouts on shoulder performance following rotator cuff surgery.
Material/Methods
Forty-six individuals who experienced rotator cuff injuries following an operation were selected at random to participate in either the experimental group or the control group. The two groups underwent traditional physical therapy and rehabilitation exercises, while the experimental gathering was given an additional scapular training exercise. The Constant-Murley scale (CMS), visual analog scale (VAS), and active range of motion (ROM) of the shoulder were all assessed in the patient both prior to and after a period of six and twelve weeks of treatment.
Results
Evaluations of the two groups improved significantly after 6 and 12 weeks of treatment when compared to their prior conditions (P<0.05). Furthermore, following the administration of treatment for 6 weeks, the CMS (measures of ache, lifestyle, the scope of movement, and overall ratings), VAS, and ROM (anteflexion) of the experimental group had significantly increased over that of the control group (P<0.05). No measurable distinction was found between CMS (muscular power trial) and ROM (abduction, rear stretch) (P > 0.05). After 3 months of treatment, a marked enhancement in the experimental group was noted compared to the control group (P<0.05).
Background
The shoulders are easily injured by external forces. Rotator cuff damage is a frequent shoulder injury. For rotator cuff injury (RCI), traditional restoration techniques are regularly used on the shoulder joint, known as the glenohumeral joint. Many countries around the world have produced manuals focusing on scapula workouts for people with shoulder issues such as the USA’s HSS’s manual that highlights the importance of scapula movement in regards to shoulder operation. Medical advancements have allowed for less intrusive shoulder surgery and specialized prostheses that can aid those with rotator cuff injuries in returning to the workplace, decreasing economic and social stressors. Rehabilitation procedures at an earlier stage are also beneficial. Various methods of treatment, including radial shockwave therapy, have been demonstrated to help with the rehabilitation of those with RCI. This research measured the impact of traditional rehabilitation treatment along with supplemental scapular exercise on individuals who were affected by rotator cuff injury.
Discussion
The four components making up the rotator cuff – supraspinatus muscle, infraspinatus muscle, teres minor, and tendon of subscapularis muscle – form a sleeve-like shape and secure the glenohumeral joint by connecting to the tops of the larger and smaller humerus bones. Moreover, the rotator cuff is essential for maintaining the stability and operation of the shoulder joint. The rotator cuff’s tautness can put pressure on the glenohumeral joint activity and lead to pushing strain on its surface. The shoulder joint’s stability is maintained by the concavity-compression mechanism, and the rotator cuff muscles work in tune together actively while the shoulder is moving to remain the alignment between the joint surfaces the same. RCI is the most common shoulder joint degenerative disease. Among the population, 17 to 41 percent of individuals have RCI, thus resulting in an enhanced possibility of facing a disability. The scapulothoracic joint essentially lacks any real anatomical features, yet the arrangement and positioning of the scapula in the chest wall serve as the basis that enables mobility of the glenohumeral joint. This has an important impact on aiding patients with RCI to regain the usage of the shoulder joint. The goal of this research was to look into the rehabilitation of individuals suffering from shoulder dysfunctions due to rotator cuff trauma. We looked into whether exercise focusing on the scapula, such as movement and muscle strength exercises, as well as increasing stability in this area could effectively reduce shoulder pain associated with RCI and enhance shoulder joint health.
The shoulder blade’s mobility and placement are critical to the shoulder joint’s operation. Researchers such as Solem-Bertoft looked into the posture of study participants while seated and the positioning of their scapulae before they were examined by doctors. For example, poor positioning of the shoulder blade could be amplified by the forward-leaning of the chest, head, and neck due to discomfort, which could worsen the stenosis and irritation of the rotator cuff muscles below the shoulder blade and consequently worsen the pain. In 2009 and 2010, Ludewig and a number of other researchers undertook an inquiry into the scapulothoracic mobility in healthy people, primarily regarding the upward and downward rotation of the scapula. Through this study, it was highlighted that the proper positioning and movement of the scapula are critical to ensuring should joint function. It was discovered that the shoulder range of motion among the experimental group was substantially enhanced following 12 weeks of therapy, which was more so than the control group, showing a significance at p < 0.05.
Scholars like Liu Xiaohua proposed that patients who went through surgery for a shoulder injury two weeks after the operation should partake in isometric strength training, with conditioning exercises to be incorporated 6 weeks post-operation, so long as the exercises do not worsen the shoulder pain. Many scholars, including Escamilla and Horsley, recommended strength exercises focusing on scapulohumeral muscles, particularly rotator cuff muscles, to enhance glenohumeral joint stability, widen shoulder range of motion, and optimize the recovery of patients with scapulae glenoid labrum tears.
Research conducted by Tsuruike as well as a number of other academics demonstrated that sustained immobilization of the shoulders may cause the serratus anterior muscle to become exhausted, thereby diminishing the scapula’s range of motion for extension and rotation. This can lead to the head of the humerus slouching forward and raising, possibly contributing to secondary trauma of the acromion and the tearing of rotator cuff muscle fibers. Furthermore, the mid to lower region of the serratus anterior muscle serves to sustain the usual space of the subacromial joint with arm elevation, thus promoting arm elevation of the shoulder joint, making post-immobilization physical therapy focused on the muscles in the vicinity of the scapula, particularly the serratus anterior muscle, indispensable. The participants of the trial experienced power training of the muscles close to their scapulae and executed a stability-focused program derived from a common rehabilitation technique. The investigation established that individuals in the experimental set exhibited higher quality outcomes when it comes to shoulder joint pain, daily operations, and strength testing than those in the control set, and the variations were quantitatively noteworthy (P<0.05).
When evaluating the results of post-operative rehab treatment six weeks later, there was no considerable distinction between the two groups concerning strength measurements and range-of-motion (ROM) for shoulder abduction and extension according to the CMS score (P>0.05). Potential causes for why the evaluation of the strength test failed to reflect muscle strength change might be: for starters, the protective immobilization rehabilitation which was primarily done following early RCI surgery didn’t have muscle strength training as a part of it; secondly, the grading criteria of the strength test focused on 0-5 ratings, making it challenging to detect slight changes in muscle strength; lastly, most patients with RCI had issues with their supraspinatus, requiring cautious application of exercise as part of the outreach activity.
At the end of it all, physiotherapists need to scrutinize the root of shoulder joint issues before they begin with the recuperation and treatment process. Afterwards, they will be able to come up with a customized recovery and cure program based on the cause of the ailment. Many doctors did not pay attention to the movement of the scapula in their daily rehabilitation and treatment, so the outcome was not very successful. Thus, physiotherapists needed to assess the scapula movement in order to set up a plan for people with shoulder joint malfunctions. In shoulders that have experienced an injury early on, the position and activity of the scapula are very significant with regards to the normal functioning of the joint. It’s necessary to keep the scapula in motion during the initial stages of treatment, and extending the range of movements of the scapula will have an impact on increasing the range of motion for the shoulder joint. The findings of this investigation demonstrate that physiotherapists would benefit from a greater focus on scapular exercises when treating individuals who have undergone RCI surgery to guarantee the highest level of treatment success.
Corrective and Strengthening Exercises
A committed method of shoulder motion sequencing and muscular conditioning will result in a general enhancement and immunity from damage. Mishandled training regimens, inconsistencies in body structure and strength, and doing too much too soon can contribute to minor and major physical problems. Here are some usual exercises to help with shoulder movement and optimize shoulder ability.
1. Retraction Rows
For most exercises involving pulling, squatting, and pressing, the shoulder blades must be drawn back. This does not apply to pullers who utilize thoracic rounding techniques. Retracting the shoulder complex to create steadiness enhances performance and minimizes the chance of harm.
In this activity, the shoulder is first brought down before being retracted. This is an important configuration that should not be misconstrued to mean merely pushing the shoulder downwards. Extend your arm in a straight line and have a firm hold on the resistance band with your palm facing the floor. Visualize the attempt to reach your wrist to the floor without moving your arm. If your lat is activated, you need to keep it that way by lowering your shoulder. While maintaining that tension, retract the shoulder. This exercise is not extensive in terms of scale, yet it necessitates a lot of concentration and coordination in order to execute it correctly if you are new to it.
2. Y-T-W Drills
Often observed in baseball and football players who are experienced in throwing, these drills should be included in weightlifting, powerlifting, and shoulder injury preventative programs. Enhancing flexibility, power, durability, and accurate control of the back side of the shoulder will boost steadiness during snatching, jerking, heaving, and any other motions that involve hauling or pushing over the head.
Before you raise your hands, draw your shoulders downward, just as you would in a retraction row. Your hands should not reach up beyond your shoulders if you have your shoulder blades pulled back. It’s all right if you still need to improve your flexibility and your arms won’t go up very far. You can tell that you are pushing yourself too hard if your elbows stick out or your shoulder blades come apart. This movement should not involve excessive joint articulation and is mainly concentrated on the shoulder joints. If your body moves in any way or your center stops working so your spine will take up the slack, you are overdoing it.
3. Multi-Directional Pull Aparts
Pulling apart the shoulder blades encourages steadiness of the scapula, fortifies the back part of the shoulder and inside muscle segments of the upper back, and helps to equalize the process of pressing with variable pulling angles. By using an underhand grip on the resistance band and concentrating on the outward turn, you can ensure that your shoulder blades stay in their retracted position. This motion needs to be regulated at every level — it is not a momentum-driven action. Watching the video below makes it obvious that the lats have been activated and the shoulders have been drawn down by the shadow of the instructor’s attire. Beginning here, targeting the rear deltoids can be achieved efficiently by performing pull-aparts.
It may be advantageous to envision oneself hauling with the elbows rather than the hands, possibly aiding in retaining the shoulder blades activated. Your elbows and hands should not move back any further than your shoulders. If they do, the tension moves off the shoulders. Imagine an imaginary ring around you that is level with your shoulders, running through your waist. When executing the pull-aparts in any route, the hands should brush the circumference but not traverse it.
4. Seated Strict Press
This exercise includes sitting on a bench with two weights and doing an overhead press with a neutral clasp. Observe the way your shoulder blades are held in a downward and backward position and your core stays tight for the entire exercise. This adjustment increases the difficulty of controlling the abdominal muscles and maintaining a neutral stance, which prevents the torso from altering the vertical line. If it’s difficult for you to move, move a bit forward on the bench so your hips are more forward than what is 90 degrees.
At the summit of this exercise, maintaining the shoulders drawn back and down should be the primary aim. Should they back out, you should recruit a lot more of your strength and lessen the maneuver’s importance. You can picture yourself with your back stuck flat against a wall and your shoulder blades wedged in place. Execute the motion from this position.
5. Snatch
The rear shoulder, trapezius muscles, and shoulder blades work to avoid crumbling. To properly snatch, it is necessary for the various components to collaborate in order to steady the load. The activity of weightlifting which appears to be bizarre is really connected to the retraction of the shoulder blades and is sometimes referred to as “placing” the back. In other words, the muscles must be contracted and held tightly during the whole activity. Making sure that your body is balanced will not only aid in preventing damage, but also make it simpler to hold your weight without toppling on your face.
Pull-Ups
Jamie Da Silva, a top-level gymnast, guides viewers through a correct sequence of pull-ups to help optimize the development of the shoulders. The key factor to a successful strict pull-up is that the power should originate from the back muscles, rather than the arms. Do not trick yourself into thinking pull-ups are intended to exercise the biceps, as they do not serve this purpose if you perform them with the wrong form. While hanging from the pull-up bar, activate the lats by pushing the palms away from the body. From that point, use just your shoulder blades to bring your hips toward the bar – this should put your shoulders in a drawn-in configuration with the lats activated. Once in that position, perform the pull-up.
This could give the impression that the pull-up is more challenging than usual. Well done – this implies that you managed to do the task correctly, relying on your own strength rather than having to depend on your arms to do the majority of the work. Do this kind of pull-ups regularly and you should soon start to observe the gains made in those other major exercises.
