9 months ago I started working a with a client who had experienced multiple shoulder dislocations. The main issue was that the dislocations had all occurred on the same shoulder and without major trauma! As a result, the whole area had become unstable due to limited movement. It’s important to note that I am not a physio, however the client had been cleared to work with me by a professional. Below is a brief look at how we approached the training.
Where to start?
The very first place we started was to find out “unhappy” or “risky” movements and positions. Not an exact science, just a look into how the injuries affected movement. These limitations could be both mental and physical such as impingement or lack of confidence in a position.
The next step was to start loading these positions very gradually and in a manageable way. Whenever you experience an injury you will discover both physical and mental blocks to progression. Don’t shy away, discover what happens and why then you can formulate a plan of attack!
Start simple, then build
After taking a look into various positions and movements we decided the place to start was to build confidence supporting a load, whilst improving stability and positioning. Basically, hold stuff in varying positions to make sure all the relevant musculature was recruited.
Whilst this was happening we also wanted to improve vernal fitness, health and wellbeing. As a result, the warm up became a time to get specific work done in every single session. This way we wouldn’t waste time and could gradually build volume and load. So, every single session, the warm up looked something like this.
- 2-4 rounds of quality movement
- 2-3 specific single limb exercises
- 1-2 full body dynamic movements
For example:
- 3 Rounds for quality
- 20m walk with dumbbell held overhead in one hand
Focus on full lockout and bracing of the shoulder - Repeat 20m walk with other hand.
- 5 perfect inch worms
- 20m single arm farmer walk (DB held to side of the body in one hand)
Focus on upright horse and engagement of the shoulder - 10 perfect air squats
- 20m walk with dumbbell held overhead in one hand
Where to go next?
Initially, progression was to gradually increase the load in various positions. From here we could increase the number of reps or rounds as and when to keep things moving forward. As confidence and strength improved we added in large movements that required the shoulder to work in unison with other joints.
In addition to this, each session would have certain exercises that concentrated on strengthening the musculature around the shoulder. To start with, this was mainly done on machines in order to reduce instability. Moving forward we have started introducing free weight various to challenge new ranges of movement and control.
The future is bright (and hopefully without shoulder dislocations!)
We are now at the stage where we are moving into variations of pull ups and supporting bodyweight in unstable positions. In addition we are adding increasingly dynamic exercises to continue progression.
I believe one of the most important factors that has contributed to progression is the clients patience. The understanding that there is no quick fix, simply the task of chipping away session by session has been essential.
Working as a personal trainer in Twickenham, many clients come to me with big goals and even bigger limitations. The knowledge and understanding of gradual and steady progression is one of the most important factors to grasp. Once this is accepted progression can easily be seen and tracked!