Dr. Colin Butler, DPT, ATC

The foremost principle that guides rehabilitation is the SAID Principle – or “Specific Adaptations to Imposed Demands”. 

Simply put, this principle of physiology tells us that our body adapts to the specific demands that are placed upon it. 

Perform enough aerobic exercise and your heart adapts by increasing the size of the muscles in your left ventricle. This increases the amount of blood your heart can pump with every contraction, and your resting heart rate drops. The same adaptations effect the hormonal function of the nervous system and tend to decrease your resting blood pressure as well.1

The tendons of sprinters become increasingly stiffer as they train to be faster and faster. This is a positive adaptation – think of the last time you struggled to change the roll of bathroom tissue because the spring was stiff and kept snapping back quickly. A stiffer spring (tendon) releases more energy when it is deformed (stretched) and makes the sprinter more likely to win his race. 

When an injury is present, either to a muscle, or a tendon, or another part of the structure of the joint, this has happened because that area was applied a stress, or repeatedly more stress, than it could positively adapt to. 

When you trip over something and roll your ankle in the classic position shown below in Image 1, you sprain the ligaments and strain the muscles on the outside of your ankle because you loaded them at a speed and magnitude in which they were not adapted for. Meanwhile, in the Far East, there are historical truths about mixed martial artist practitioners being able to break stone with their shins without hurting themselves, because they have repeatedly exposed their shins to those compressive forces by kicking trees and harder objects for years. 

How does this relate to a shoulder injury though? 

If we want to restore the function of someone’s shoulder to being able to tolerate more and more physical stress and use without a negative adaptation like injury, we must now follow the Goldilocks Principle of rehabilitation (image 2) and find a dose of stress that is “just right”: not so much to drive a negative adaptation, but enough of a stress to start to drive a positive adaptation. 

When it comes to our ability to produce force or restore freedom of motion in a joint following injury, this chart below is a useful illustration of that Goldilocks principle. 

Image 2:  Volume vs intensity threshold for gaining an adaptation. (Joel Jamieson’s “Ultimate MMA Conditioning”) 

Resistance tubing, often used by the commercial brand name of “Theraband”, is one of the most common images conjured up when folks are asked what they think of physical therapy. 

And despite the title of the article, I am not against the use of Theraband or tubing. 

For people in the early stages of rehabilitation from a shoulder injury, resistance tubing can be a very useful tool for giving a low dose of resistance that may be enough of a challenge to recapture strength, or to give enough resistance through a range of motion to help someone improve their ability to control their arm in challenging positions. 

Tubing can also be very useful for helping to give you external resistance so you can feel your body and shoulder getting into different positions to help you restore range of motion (link to an article about “position restoring range of motion”). 

If our goal is to build a shoulder capable of producing and absorbing significant forces, we need more force than just the band can provide, so that we can find the right dose of “volume and intensity” to help us get stronger. 

Sidelying Kettlebell Arm Bar

Activities like the kettlebell or dumbbell arm bar, shown above, are a great entrance point to retraining rotation at the shoulder with greater loads. They are also effective at retraining the ability for the shoulder blade to turn to accommodate improving smooth total movement of the arm. 

Hooklying Dumbbell Pullover

The hooklying dumbbell pullover is another way to improve range of motion, and strength across a whole range of motion. This is a way that I commonly help clients improve their ability to go overhead without using a substitution from their lower back, and to get them confident in keeping heavier objects overhead. 

Staggered Stance Landmine Press

Landmine pressing, shown above, is a great way to load all the muscles that work around the shoulder, and eventually with a substantial amount of load. Landmine pressing is easy to modify to train the timing of rotation of the ribcage with rotation of the shoulder and shoulder blade to improve different aspects of upper body performance. 

If you’re returning from a shoulder injury, make sure that you’re aware of what you’re trying to accomplish with the exercises that you choose to do. Not all rehab has to look like bands and two-pound weights. It should be intense enough to prepare you above and beyond what you need your shoulder to do. Make sure you’re getting the adaptations your shoulder needs with the time you are investing in your rehab.

References

1. Farrell C, Turgeon DR. Normal Versus Chronic Adaptations To Aerobic Exercise. [Updated 2021 Jul 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK572066/