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The Best Way to Exercise the Shoulder--Hands Down!

If you've hurt your shoulder and you're seeing a physical therapist, expect to get down--on your hands and knees. Putting weight through the shoulder is a common way to do exercises when rehabilitating shoulder injuries.

Physical therapists plan rehab programs for each patient. They make sure the exercises target the right muscles. Studies like this one help therapists make these decisions. It's important to know which muscles are working in each position. Therapists also need to know when and in what order to do each exercise.

Therapists at the University of Kentucky tested 18 healthy adults in seven different weight-bearing positions. These exercises where the hands are placed on a stable surface are called closed kinetic chain (CKC) exercises. They improve joint position sense and strength. During CKC activities, muscles on both sides of the joint work at the same time.

The authors found that of all the positions used, being on hands and knees is the easiest for the shoulder. It's probably the best exercise form to start with. The "prayer position" (sitting back on the heels with hands on the floor) is the next step. Raising one arm or one leg while on hands and knees puts more force on the muscles. The one-arm push-up is an example of how challenging these exercises can get.

Therapists still don't know the best time to start CKC exercises. Studies that test normal muscles are helping answer this question. Other studies are needed to compare damaged tissue to normal in these same seven positions. Measuring muscle activity while the tissues are in various stages of healing may be a part of future studies.

This study shows the demand on shoulder muscles for weight-bearing exercises used in shoulder rehab. The information can help physical therapists know what muscles are working and how strongly these muscles contract with each exercise. This will guide clinicians in finding the best programs for each shoulder patient.

References: Tim L. Uhl, PT, PhD, ATC, et al. Shoulder Musculature Activation During Upper Extremity Weight-Bearing Exercise. In Journal of Orthopaedic & Sports Physical Therapy. March 2003. Vol. 33. No. 3. Pp. 109-117.

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