Rehabilitation for the Shoulders Shoulder injuries can occur both in and out of the gym yet they are often preventable. Discover how to keep your shoulders healthy and pain free. Whether you are a competitive athlete or weekend warrior, shoulder pain can get in the way of
your life. Yet regardless of the specific pathology, many shoulder injuries are preventable. There
are several common factors that contribute to shoulder injury, and addressing them will help to
protect your shoulder.
Thoracic spine mobility With thoracic extension accounting for the last 10-15 degrees of shoulder flexion, t-spine
mobility is critical to ensure normal shoulder movement especially during overhead activities.
Insufficient t-spine extension (a.k.a., mid-back backward bending) increases the risk of shoulder
impingement.
Two exercises that promote thoracic extension include:

Cat/Camel – In an all‐fours position, tuck your chin into your chest as you round your back up like a cat. Next, slowly reverse this position, looking up focusing on a point in the distance and allowing your back to arch or sag into extension. Repeat 10‐15 times. 
Hook‐lying Thoracic Extension – Lying on your back with your knees bent and feet flat, place a soccer/basketball under the apex of your mid‐back curve. With your hands supporting your head, gently extend back over the ball. You can perform tiny, pain‐free oscillations at the end of your comfortable range. You can also substitute a foam roll or half‐foam roll for the ball. Emphasizing good posture both in and out of the gym Whether the result of too many hours at the computer or muscle imbalances exaggerated by poor
training techniques, poor posture interferes with normal shoulder function. A common postural
deviation like a forward-head and rounded-shoulder posture will lead to forward migration of the
humeral head. This poor alignment adversely affects normal shoulder biomechanics.
Over time, a forward-head, rounded - shoulder posture can lead to shortening of chest muscles,
overstretching and functional weakening of the upper back muscles, and decreased thoracic
mobility further increasing your risk of shoulder pathology.
For good posture, think ears over the shoulders over the hips. In addition to increasing postural
awareness 24/7, addressing any long-term tightness and weakness associated with bad postures
will help to keep your shoulders healthy.
Addressing your core The phrase "core training" is often used synonymously with "functional ab training." However,
when discussing the shoulder, we are talking about the rotator cuff musculature as well as the
scapular stabilizers.
Located close to the axis of rotation, these muscles are in a unique position to control
arthrokinematic motion. This control is critical in maintaining proper shoulder mechanics during
activity. Think of the core stabilizing muscles as supporting the base from which larger, more
powerful muscles function. Without a strong base, the shoulder is unable to function at its peak.
There are an endless number of exercises that emphasize core muscles in the shoulder. If you are
training for a particular sport or task, consulting an exercise specialist like a physical therapist or
trainer may be beneficial. Below are two examples of core shoulder training exercises.

Wax on/wax off – With your arm at approximately 120 degrees of shoulder flexion and in the scapular plane (about 60 degrees out from the mid‐line), place your hand against a smooth surface like a door and perform a wax‐on/wax‐off motion. You can vary the amplitude and speed of movements as well as the degree of shoulder flexion as long as your remain in a pain‐
free range. Perform the activity for 2‐5 minutes, switching directions as needed to manage fatigue. 
Plank ‐ With the popularity of yoga, you may already be familiar with the plank position. However, most individuals overlook the scapular position during this activity. Emphasis should be on setting and maintaining the scapula in a neutral position while engaging in the pose. Warming up Whether playing baseball, shoveling snow, or getting ready to lift at the gym, performing an
adequate warm-up is helpful in preventing injury. The warm-up activity should be long enough
and specific enough to activate muscles to be used. The generic core shoulder exercises
mentioned above can certainly be incorporated into a warm-up program.
For sport's specific training, a warm-up should include movements relevant to the activity. Not
only does a warm-up increase blood flow and activate specific muscles and motor patterns, it
prepares you mentally for the required task thus reducing risk of injury.
Balance push with pull Because of the nature of most postural biases, many individuals tend to have tight chest muscles
and lax upper and mid-back muscles. What further exacerbates this imbalance is training that
emphasizes too many heavy push exercises and too few pull exercises.
So how do you fix this? You should focus more on your back and less on you chest. This applies
even if you aren't an athlete in the gym. For example, someone who spends their day at a desk
hunched over the computer (primarily a flexed-biased position) needs to spend more time in
extended positions out of the office.
Incorporate diagonal patterns and functional movements into your training program Bodies generally don't function in single planes, yet many exercise programs focus on nothing
but single-plane movements. In reality, a good shoulder program will include activities that
attempt to incorporate functional patterns of movement.
The chopping motion is a perfect example. These diagonal patterns can be performed using
weights or tubing. There are many benefits to this type of training, most importantly is that it
prepares your shoulder for real life function.
Avoid overload Even the healthiest shoulders can be vulnerable to prolonged overload. Simply put, too much of
anything can be bad for you. In competitive athletes, proper training and awareness is key. Yet
the same is true for an assembly-line worker. Many companies now routinely rotate people on
the line to different positions as a way to help reduce repetitive stress injuries.
Likewise, if you sit flexed forward all day and then come to the gym and spend two hours, three
times a week working chest and occasionally get a little back in, realize that you may be setting
yourself up for an injury.
Conclusion In the end, a body is like any other well-built machine. Proper alignment, good posture, and
balanced muscle function are necessary to achieve normal biomechanics and joint stability.
Many shoulder injuries can be prevented if individuals focus on keeping the shoulder in a
preferred physiologic position so that it can function properly.
Disclaimer: The information contained in this article is for educational purposes only and should
not be used for diagnosis or to guide treatment without the opinion of a health professional. Any
reader who is concerned about his or her health should contact a doctor for advice.