1/4 Hour Neuro #15: "What About External Shoulder Rotations for Shoulder Pain?"

Introduction

Welcome to the Neuro quarter-hour, where we address your questions about sports and neurology. Today, we delve into a question regarding the effectiveness of external shoulder rotation exercises for preventing pain in handball players, following a recently shared study.

A listener shares their experience: despite years of external rotations prescribed by coaches and therapists, their shoulder mobility remains limited and tensions persist. This situation raises questions about the current approach and suggests exploring more comprehensive avenues for shoulder health in athletes, particularly handball players.

The Study on External Rotations in Young Handball Players

The study in question, titled "Nordic No Benefits of 8 Weeks of External Rotation Strength Training for Youth Handball Players," examined the strength of external rotators and the external/internal rotator ratio. It looked into the effectiveness of 5 to 10 minutes of resistance band training in 16-year-old adolescents.

The results suggest that targeting only the external rotators may not be sufficient. It is likely that other elements, such as scapular stabilizers, are also crucial and should be targeted beforehand.

It is important to note that the study does not conclude the total ineffectiveness of these exercises for everyone, but rather that an isolated approach is not the cure-all. The protocol involved two exercises, three times a week after handball training, over a period of eight weeks, with a control group not performing these exercises.

Beyond Isolated External Rotations: A Holistic Approach

Limiting oneself to external rotation movements to improve shoulder health is an overly simplistic view. In physical preparation, a holistic approach is essential. While external rotations target one aspect of the structural balance of the shoulder, they represent only a third of the three main exercises relevant to upper body strength.

The forces generated during a handball throw are very different from those involved in small isolation exercises. Therefore, it is relevant to combine these isolation exercises with more significant strength movements.

As for pain, it is a survival mechanism. If the system is imbalanced and perceived as threatening, it will trigger protective mechanisms against stresses like a powerful throw. Working on sensory foundations and the prediction of the nervous system is an important line of thought.

The rotator cuff can be better engaged through more global movements like "ramping," which establishes complex shoulder movements and develops overall strength.

The Integration of Mobility and Strengthening

When joint mobility is regained, it is imperative to strengthen it, which involves strength exercises. Tools like isometric bands can be helpful for working within limited ranges.

It is also crucial not just to replace external rotation exercises but rather to complement them with new approaches.

The Importance of Sensory and Reflex Factors

Shoulder issues often have other origins, including ocular dysfunctions or sensory problems in the hands (reflexes, hand-mouth axis). The shoulder is there to serve the needs of the hand. If the hand encounters tactile or visual issues, this can reflect on the shoulder and elbow.

Eye or sensory exercises for the hands can therefore be very beneficial. Additionally, it is essential to consider the tone of the extensors, often overlooked in shoulder work. Rather than limiting oneself to "pull/push" ratios, it is interesting to explore more neurological approaches.

Reflex Stabilization and Posture

Physical preparation often emphasizes movement production but neglects reflexive strength, which is mediated by the brainstem. This reflexive strength is essential for postural maintenance, regulating the tone of extensors and flexors.

Specific exercises can target extension or extensors or lower flexors by acting on different structures of the brainstem.

The body first seeks to stabilize before moving. Thus, reflex stabilization is crucial. It is recommended to conduct a complete assessment, including archaic reflexes and posture, with a competent professional.

If current methods do not yield satisfaction, other possibilities, such as strengthening around the scapulae (crossover symmetry), should be considered.

Insanity is doing the same thing over and over again and expecting different results. It is also essential to account for injury history, imbalances between sides of the body, as well as issues of ocular convergence and other postural aspects that may lead to shoulder limitations.

Finally, reviewing training load and programming if pain persists is essential.