Hi guys, I’m Mai-Linh Dovan, Certified Athletic Therapist and Founder of Rehab-U Movement and Performance Therapy.

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In this week’s video, we’re going to talk about late phase shoulder instability rehab.

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So I’ve decided to do it a little bit differently this week and I’m going to go through a couple of slides of content for you guys. Now, don’t worry, I always want you guys to get a practical application out of these videos, so we are going to go into the gym and look at some exercises after this, but I just thought I would share some content and have you guys be able to follow along visually.

Let me know in the comments below if you like this format and if you do then certainly we will listen to your feedback and have more of this.

So late stage, late phase shoulder instability rehab programming. What I always want to do when I get to late stage rehab is, and you’ve probably heard me say this before, is expose clients and athletes to vulnerable positions. So as much as early in the rehab process, we’re working in more neutral planes, unaffected planes, we’re more protecting the injury, we want to expose them more and more to end ranges and vulnerable ranges and key positions, right? Which will change depending on the different sports.

Now the shoulder, you know, obviously the overhead position is always a vulnerable position and again, where overhead and how will depend on the athlete that you’re working with.  So, in late-phase shoulder instability rehab, you want to progress into those vulnerable ranges of motion in your mobilization sequence. So you have rid yourself of any restrictions, you may have had and now you’re wanting to have control in those end ranges, so active range of motion, anti-movement in vulnerable positions in your activation sequence, you want to move the torso underneath the shoulder. So when you get to this late phase rehab your mobilization activation is kind of a bit of a continuum, right? You’re working through an active range of motion, so there’s a motor control element there.  You also want to be able to create rigidity to avoid excessive movement and then you also want to be able to react to joint perturbations.  Once you get into your integration sequence, your strengthening work, obviously, you’re going to want to have some throwing or striking drills. If you’re working with a throwing or striking athlete and you’re working on that hip-shoulder separation, you’re going to want to do some plyometric work and in strengthening, strengthening key positions, right?

So in your regular strengthening exercises, where are you going to have pauses? Where are you going to have a dead start? Where are you focused on generating strength from? And usually, that should be in either the key position or the most vulnerable position. So that if an athlete gets into that position, they’re able to generate strength in that position. Obviously, you do also want to initiate multiplanar and rotational exercises there.

So, here’s a sample of a late phase shoulder, instability rehab program. I’m going to go in the gym in a couple of seconds and show you some of these exercises.

In the Mobilization sequence, I’ve got an exercise where the athlete will be in an overhead position and we’re actually moving the torso underneath the shoulder. The Activation sequence is going to be about creating a rigid lever, so anti-movement, we’re going to show you an anti-movement exercise. We’re going to show you a plyometric with a landing in a vulnerable position. So again there, think vulnerable positions and key positions, and we’re going to show you in the Integration how we use the Savickas press with a dead start to say, well we’re creating strength now from a position that’s more difficult to generate strength from.

So let’s go in the gym with our supermodel Virginie, and look at all of these exercises.

So, starting with the half kneeling windmill in the mobilization sequence, Virginie is in a half kneeling position, arm is up overhead with a weight, and you can challenge yourself with the weight here, and then she’s going to come down onto the hand and then down onto the forearm. So she’s moving and turning that torso, underneath the shoulder underneath load. So its range of motion, torso moving under the shoulder and there’s a stability component to it, right? We’re in late phase. We’re not ridding ourselves of restrictions. We’ve rid ourselves of range of motion issues. Now we’re in that motor control, stability and strength.

In the activation sequence we’ll show you guys an open arm bar. Now, what’s interesting about this exercise is it looks quite a bit, it is quite a bit harder, I should say than it looks. So it looks quite a bit easier than it is. So what she wants to do is she wants to create a very rigid lever here where that shoulder that arm is going to stay in line with the torso, as she starts to come up and want to lean over onto that left arm.  So see how there was no lag there: as she lifted the torso up that arm stayed in position. What we don’t want to see is the torso starts to come up and the shoulder lags behind, right? So we see this nice rigid lever, that stiffness that she created to keep that shoulder in line with the torso. And you can do refs here, and she hold that top position, hold that, rigid position.

In the plyo, push-up to one arm overhead, Virginie is just going to get into a quad position and she’s going to do an explosive push up, and she’s going to land on the one hand in a slightly overhead position.

Now, you can progress this to move a little bit further back so that the landing is a little bit more overhead. So you can see how that’s creating that stiffness landing in a vulnerable position.

Then we all have our Savickas press or our strengthening exercise, and we’re getting her in a deadstart position. So in that bottom position where she has that stability requirement, she’s having to generate strength to overcome inertia, pushing up and then slowly down and she’s going to bring the barbell all the way back down to a dead start.

And then every time she’s got to overcome inertia from that bottom position. Now you could play with range here where we could increase the range of motion, so bring the bar down closer to underneath the chin and she’d be even in an even more vulnerable position for even lower where she has to generate strength.

And then, guys, even within that phase, there are progressions as well. So I mentioned in the individual exercises, for example, the plyo push-up, you could progress, so move further away from the box and land in a more overhead position.  With the Savickas press, you could progress the depth of that range of motion and be in a more vulnerable position, but there are also regular progressions that you would expect to see in a program as far as repetitions changing. So decreasing the reps and then increasing the load or sometimes when there’s time, your time will change as well. So when you’re holding things for 15 seconds, initially by the fourth week, you get to 30 seconds for example. So they’re all also progressions there within the parameters.

So hopefully that give you guys some ideas on how to work with late-stage shoulder instability rehab. Again, what I want to reiterate is: identify with a vulnerable positions are for your athlete and then work on creating everything you need to create in those vulnerable position. So, having the control of the range of motion, being able to limit movement, so anti-movement exercises, perturbation exercises and then in your strengthening exercises, how can you manipulate your methods and your reps to make sure that they’re having to generate strength from those vulnerable positions.

So that pretty much sums up what we want to be doing or where we want to be headed in late phase shoulder instability rehab program.

Again, let me know how you guys feel about this format in the comments below and we’ll see you guys in the next video.