I recently found out that I tore my labrum in my right arm. I was wondering if you could give me tips on how to strengthen my rhomboids and other muscles so that I can compensate with those muscles until I have surgery to repair my SLAP tear.
Thank you for your question, and I will answer it to the best of my ability without knowing more specifics such as:
- The type and extent of the labral tear
- The associated muscle inhibition/weakness
- The related neuromuscular compensations
As you are aware, the shoulder is a ball and socket articulation relying mainly on the soft tissues of the scapular stabilizers as well as the rotator cuff for dynamic support. The labrum of the shoulder is a fibrocartilage rim that essentially deepens the rather shallow glenoid fossa. Both the long head of the biceps brachii and triceps brachii blend with the labrum adding dynamic support to the shoulder joint.
Labral tears are becoming increasingly common with the increased participation in overhead sports such as tennis and swimming, intense workouts such as kettle bells and plyometrics and the overall general de-conditioning of our society. Naturally many labral tears will result secondary to traumatic shoulder injuries such as dislocations.
The symptoms of a labral tear can be obvious such as severe shoulder pain that is associated with a “gapping” between the head of the humerus and the glenoid fossa indicating separation or tearing of the labrum from the glenoid fossa. Symptoms can also be more subtle such as deep aching and pain with overhead motion or with sleeping with the arm underneath the head. The pain accompanied by the tear itself often results in altered mechanics of the shoulder complex. These altered biomechanics results in atrophy of several muscles, most commonly the anterior deltoid, supraspinatus, upper pectoralis, upper, middle and lower trapezius and resultant spasm of the levator scapula, rhomboids, infraspinatus, lower pectoralis, pectoralis minor and posterior deltoid. Therefore, stability and upward rotation of the scapula in addition to internal rotation of the shoulder will be comprised, necessitating pre-habilitation prior to surgery and rehabilitation after surgery.
Please note: These suggestions are based upon my experience and being able to properly monitor and manage my patients. They may or may not apply to your individual case, and you should consult with a health care professional prior to instituting any exercise. Most of the exercises below can be found in the three-part article series on Improving Shoulder Function (see "related articles" at right).
I chose isometrics as the first choice of exercises because they place the least stress on the injured tissues. The position used would be to activate the aforementioned inhibited muscles and always in a pain free range. The positions are held five to 10 seconds beginning with 25 percent of the individual’s max contraction and working up in intensity to the individual’s tolerance. These may look very similar to the traditional “Y” and “T” exercises. However, they are performed in a supine position. I never recommend “squeezing the shoulder together” or “pulling the shoulder blades down and back,” as these cues encourage and perpetuate the original scapular dysfunction. Recall that the function of the scapular stabilizers is not to pull the scapulae together. Rather, they are meant to support and stabilize against motion of the arm. Therefore, isometrics are an excellent way to encourage this function without adding stress to already injured tissues.
Once the individual demonstrated proficiency in these positions, I will perform arm slides facing the wall to encourage scapular stabilization and upward rotation. Again it is important the individual trains in the pain free range. This exercise is performed facing a wall with the pinky side of the hand positioned against the wall at 90 degrees of shoulder flexion. The arms are slid up the wall focusing on serratus anterior activation and upward rotation. Depending on the individual ability, this may be almost full range motion and for others it may only be a short range motion. Once they develop improved scapulae stability and motion, light resistance band exercises can be performed. Both internal and external rotation can be trained again focusing on quality over quantity and resistance. Perform these in pain free range of motion and not at extreme ranges. Stick with mid-range movements. Remember the goal is not to “feel the burn” but rather re-educate the motor system, increase blood flow and diminish further deterioration of the labrum and shoulder muscles.
Again, I must stress, as with any exercise, it must be individualized. What works for one person will not always work for the next person. However, the general template that should be followed is to stabilize the scapulae first with isometrics and follow up with exercises that the individual can tolerate to enhance upward rotation and gleno-humeral stability.