Shoulder prehab exercises

Hello everyone i wanted you to tell me a good routine that can help me keep my shoulder strong.Firstly some things about my injury.I had 3-4 shoulder  subluxations in the previous 1 year mostly while training in mma.Visited the doc he told me to have an MRI and the a MRI showed hill sachs lesion and maybe a bankart lesion.I was prepared to have a surgery (when reading in then internet about the bankart lesion) but strangely the doc told me not to.He told me to rest for 1 month and then start strenghening my shoulder(he didnt tell me to go to a physical therapist) on my own.After 3-4 months i can now say that my shoulder is really strong and i can do everything without pain.Push ups, pull ups ,handstands everything.I am even working on back lever right now again with no pain(strangely my shoulder doesnt feel exactly like the other one during leisure time, cant really explain that).I am planning on buying rings and the foundation 1 to start GST from the beggining and i wanted you to tell me what you think are the best exercises  for a shoulder prehab routine in the end of the workout so i keep my shoulder healthy in the long run and never again have any subluxations. (i am 14 years old btw).

Thank you very much for your answers.

I really appreciate it:)

Brilliant, if the doctor says avoid the surgery, then do so! 

Check Ido Portals shoulder stabilization routine on Youtube, it's great stuff and worth spending money on a GOOD quality band or resistance tubing. I'd post my own but I can't find my adapter to save my life

Just found the routine on youtube.Thank you very much i will surely implement it.I also found ido portal's routine on scapula mobilization could i do both 3 days a week after f1 work or would that be too much?

Again thank you very much:)

I can only say listen to your shoulders for this one. Start off doing it once a week, and if your scapula muscles aren't sore, go for twice a week, then eventually you can do it after every workout Just take it slow as external rotation and retracting muscles can fatigue quite easily if untrained

Why did your doc say not to have surgery?  Was it an orthopedic surgeon?  Your Hill Sachs is likely from your initial dislocation or recurrent subluxations and you're young enough where surgery could be an effective option and you're likely going to continue to dislocate/sublux without it.  Beyond that your rehab would focus on countering anterior laxity... basically you need to find exercises that will keep your humeral head (top of your arm bone) centered in the glenoid (shoulder socket), which is going to likely mean determining your muscular imbalances, correcting them, and then also working on improving neuromuscular control and scapular stabilization.  A simple 'do this exercise, do that exercise' coming from someone on an online forum is not going to help.  So, first figure out why your doc things surgery is not the best option then go to a PT who actually knows what they're doing to work on the things mentioned above.  Stay away from isolation exercises on your rotator cuff.  Working on external rotation with a band or weight is what most people do when they think they're going to strengthen their rotator cuff and is just not effective.  Dynamic motion requires dynamic rehabilitation.

The research I am familiar with, regarding bankharts and labral issues in general, is that you need to be performing your rehab 5 days per week.If you do this, even high velocity overhead players like pitchers can perform at the top of their game, pain-free, injury free. The catch is that you really do have to do this nearly every day, forever.

This does not mean 3 work sets of internal rotation, external rotation, and supraspinatus raises: You should do stuff like that, but these higher volume episodes should really only be maybe twice per week, 3x at the most.

On the other 4-5 days you will typically do a few reps several times a day, and you should never feel tired or even really like you worked out.

This is what I do as of now:

1-3 times per day, depending on what I remember to do, I do 5-12 reps of internal rotation, external rotation, and slow lateral raises in the plane of the scapula. I use a band for the rotator work, and dumbbells for the lateral raises. I don't have any labral tears. If I did, I would be doing this 3x per day, every day, at least, for just a few reps each time.

The daily work is really about muscle activation, because the more often you use them the more active they stay during your free time! I don't want to get into the science on this, because I think that would get confusing. The important thing to take away from this section is that you will probably feel much better during your free time if you do a few reps of internal rotation, external rotation, and 2-3 lateral raises in the plane of the scapula (which is ~30 degrees forward from the iron cross position at the top of the lift. You move in a straight line from your hips to that position.

I also do Xiaopings, which are included in F1. These fall more into the dynamic rehabilitation that Nail is talking about. 

Thoughts on rehab in general:

What you have to realize about what Nail told you is that if ALL you do is isolation work, you should not expect it to have super awesome carryover to your daily life. It will help, and help immensely, but in order to stay injury free as you keep improving your physical performance you will ALSO need to take your time and re-learn how to use your shoulder in everything you do. That includes just walking around.

The isolation work will help you rebuild and maintain the stabilizing structures that you need for shoulder health, and the Xiaopings, your regular workouts, and postural awareness as you move throughout your day will all help translate that into healthy shoulders during movement as well.

Other comments:

Nail is a physical medicine specialist. Don't just toss what he's saying out the window.

I agree with Nail 100%... It is strange that your doctor is not doing surgery for this, especially at your age. Perhaps he doesn't think you can stick to the rehab protocol at your age... I could understand that, it is a bit long because you have to give the cartilage time to knit itself back together. If you do something stupid, even something as simple as play-fighting, before the rehab is over then you could undo the surgery. They will give you really specific guidelines for what to do and what not to do, and what the timelines are, and you should stick to them.

You really do need a PT to teach you the exercises correctly, and to help you select the correct exercises for YOU. This is why I have not recommended anything specific to you... IF you do end up going the non-surgical route it is 100% required for you to go to a PT. Saying "strengthen your shoulder on your own" is unacceptable, and you should ask for a referral to a PT clinic that works with athletes as a large part of their patients.

Even if they tell you that you can stop doing rehab at some point, smile and continue doing the rehab work forever. I mean forever, even if you decide to stop working out in the future. I do it too, it's not a big deal. It is simply the only way to stay pain-free.

So are you suggesting that i go to a pt even though my shoulder is ok for over 2 months and i can workout normally without pain?I think the rehab phase is over now i need to just keep working on it to keep it healthy and yes the doctor told me not to have a surgery and strenghen it on my own.He also said that i hadnt tore anything and that my shoulder was just loose.(and btw i only had subluxations never a full dislocations.)

Correct me if i am wrong and thanks to everyone for your help:)

I'm not positive what the literature is on indications for surgery... which is why I think you should ask your doc/surgeon why he recommended nonsurgical treatment.  Things that happen once tend to happen again, and things that happen again are even more likely to keep happening, especially when you're young in this case.  If your dislocation/subluxation (they are on a spectrum... though I don't know if you can get a Hill Sachs with simply a subluxed shoulder) occurred without a traumatic event there are other causes to suspect.  

Do you need to see a PT?  Well you could take the same argument... you've been subluxation/pain free for 2 months, isn't it likely to continue?  Maybe... that's your call.  Maybe you've stopped training MMA and it's not the shoulder work you're doing but just the fact that you're not doing MMA anymore.  Does an Americana freak you out even without much pressure?  Pretty good sign things aren't perfect.  The good news is your arm's not going to like... fall off.

I'm just saying I would want an evidenced based explanation for why no surgery [Dr.: "well, I think your problem was XX and with that type of injury there's XX% chance in 1yr you'll be performing at your peak without increased risk of more injury] with a proper eval by a PT that knows what they're doing and can tell you what's safe and not safe.  Then go from there.

What happened?

How/why did it happen?

Is it going to happen again/how long until it's better?

What can I do to help?

What can you do to help?

Am I really going to mess it up if I do XX?

Those are questions to figure out when you see a doc.

Well you have some very good points:P.Ι have to admit it seemed strange that the doc told no to surgery  and yes he was an orthopedic surgeon.Before my last subluxation i didnt perform any kind of strenghening that's why i suspect that my shoulder is way better now.I think i will buy F1 and rings and start working along with ido portal's shoulder and scapula routines and see how it goes for the next couple of months.But i can also visit the doc and ask some questions as well.

Either way thank you very much i am really grateful for your help:)

 

Visited the doc he told me to have an MRI and the a MRI showed hill sachs lesion and maybe a bankart lesion.

 

mike100 said:

So are you suggesting that i go to a pt even though my shoulder is ok for over 2 months and i can workout normally without pain?I think the rehab phase is over now i need to just keep working on it to keep it healthy and yes the doctor told me not to have a surgery and strenghen it on my own.He also said that i hadnt tore anything and that my shoulder was just loose.(and btw i only had subluxations never a full dislocations.)

 

Correct me if i am wrong and thanks to everyone for your help:)

First, read Nail's post. Second, make sure your parents read Nail's post.

Aside from that, I do think it is worth going to a physical therapist so that you can be taught the correct way to rehab, and continue to rehab, your shoulder.

Just because it doesn't dislocate for 10 months doesn't mean you have healed, or that it won't happen again! I don't quite know the right way to say this, so please forgive me if this comes across the wrong way. You have only been alive for 14 years, and you haven't seen enough time pass, with enough people, to be able to have a really clear perspective on how shoulder subluxes and dislocations tend to be a recurring issue. 

The common theme is that people stop doing their rehab, which is why I am repeating my recommendation that, even if you follow Nail's advice and it turns out that you don't need surgery, you should go see a PT. It might only be for a single session, and that's totally cool. The point isn't to get you going to PT 3x per week! The point is for you to learn, from an experienced professional, the right way to keep your shoulders from dislocating or subluxing in the future.

The reason I have put things this way is that I had this "problem" when I was younger... I just hadn't seen enough to know what the realities of injury and health are. A year seemed like a long time back then. Now... it doesn't. Even now, I am not capable of truly having the same perspective as Coach Sommer, because I don't have 40 years of gymnastic experience. When he says something regarding gymnastic training, whether it is strength or skill or recovery, I listen, because even though I may not have the perspective that he has, I trust the results he has gotten over the course of his life. He has proved that what he says makes sense. I am just hoping to convince you, in the same way, to make a small training investment every day of your life for your shoulder health. I have seen this for a long, long time now, and I know for sure that what I am suggesting to you will be a good idea.

It's ok if this doesn't make sense to you, but I hope I can convince you to, at the very least, find a sports PT who successfully treats a lot of baseball players, volleyball players, or MMA/BJJ fighters. In other words, someone who is used to fixing problem shoulders and getting people back to a high level of performance. Find them, and learn all the exercises that they think you need to keep your shoulder healthy in the future. Tell them that you want to do everything you can to keep your shoulder from subluxing in the future, so you want to learn the right way to do the exercises that will keep your shoulder as stable as possible. Once you learn, make this a part of your life and you will probably be ok.

By the way, you really write well, and present yourself politely. Just period, but especially for a 14 year old!

It is a pleasure to have you here!

I see what you mean.You are right, no doubt about that.I will follow your recommandation and try to have an appointment with a physical therapist as soon as possible.In the meantime i will buy f1 and keep doing shoulder strenghening exercises.

Thank you for your kind words, I am happy to be here.