A different form of shoulder strength

Building Shoulder Strength in End Ranges: How Physical Therapy Can Prevent Injury

Many shoulder injuries that bring athletes to physical therapy are the result of overuse or instability when the shoulder reaches its end range of motion. Whether you’re lifting weights, throwing a ball, or performing overhead movements, your shoulder is vulnerable when pushed to its limits.

It’s common to assume that the solution to these issues lies in increasing flexibility through stretching and mobility drills. While flexibility is important, it’s only part of the equation. The real issue often lies in a lack of strength and stability when the shoulder is in these extreme positions.

Why Strength at End Range Matters

When the shoulder reaches its end range of motion—whether during an overhead press, a throw, or any extreme movement—your muscles can’t generate the same amount of force as they can when the shoulder is in a more neutral position. This weakness leaves the shoulder joint less stable and more prone to injury.

Without the ability to control the joint at these extreme ranges, you’re at an increased risk of instability-related injuries such as shoulder dislocations or subluxations. Over time, these challenges can lead to wear and tear on the shoulder joint, causing issues like rotator cuff tears, labral injuries, or impingement syndromes.

However, there’s good news! By incorporating targeted physical therapy exercises, you can train your shoulder to be strong even in these vulnerable positions. Strengthening the muscles that support the shoulder at end range can significantly reduce your risk of injury and improve your overall performance in sports and daily activities.

Strengthening the Shoulder in End Ranges with Physical Therapy

At its core, physical therapy is about improving movement quality and building strength where it’s needed most. For athletes and active individuals, this often means focusing on increasing shoulder stability in the ranges of motion where injuries are most likely to occur.

Here’s where physical therapy really shines—helping you develop strength at the edges of your mobility. Instead of simply increasing flexibility, we work to build strength and control in these end ranges. This approach not only enhances performance but also prevents injuries by ensuring that your muscles can stabilize the shoulder joint in even the most extreme positions.

PAILs and RAILs in Shoulder Rehab

One of the best ways to strengthen the shoulder at end range is through Progressive Angular Isometric Loading (PAILs) and Regressive Angular Isometric Loading (RAILs) exercises. These exercises involve applying tension to the muscles in both their stretched and shortened positions, helping to increase both flexibility and strength in end ranges.

For example, Shoulder Flexion PAILs with a Lift Off Challenge and Shoulder External Rotation PAILs with a Lift Off Challenge are highly effective exercises for targeting the muscles that stabilize the shoulder when it’s in its most extended and rotated positions. These exercises focus on developing strength while the joint is near its limit of movement, allowing for greater control and reducing the likelihood of injury.

I recently demonstrated these drills to a group of CrossFit athletes, who need exceptional shoulder strength and stability to lift heavy weights overhead and perform complex movements. However, you don’t need to be a CrossFit athlete to benefit from these exercises. Whether you’re involved in overhead sports like swimming, tennis, or volleyball, or simply want to improve your shoulder health, these exercises are fantastic for anyone looking to build strength and prevent injuries.

Exercises to Try:

1. Shoulder Flexion PAILs with a Lift Off Challenge

2. Shoulder External Rotation PAILs with a Lift Off Challenge

Why Physical Therapy is Key for Shoulder Health

Incorporating these types of exercises into your routine can dramatically improve your shoulder strength and stability, particularly in those vulnerable end ranges of motion. Working with a physical therapist ensures that you’re doing the exercises correctly and progressively, so you can safely build strength without putting your joint at risk.

A physical therapist will assess your specific needs, tailoring exercises to your unique shoulder mechanics and helping you regain control over your movements. With proper guidance, you can significantly reduce your risk of injury and improve your overall performance in your sport or daily life.

Ready to Strengthen Your Shoulders and Prevent Injury?

If you’re experiencing shoulder pain or instability, or if you want to improve your strength in end ranges of motion, physical therapy can help. Contact us today to learn how a tailored treatment plan can get your shoulders strong, stable, and ready for anything life or sport throws your way!

I felt stuck

Times have certainly changed, haven’t they? Just look at all that hair! And it seems like they couldn’t do much about the sun glare on picture day either…

“I really need to stretch more. Should I try Yoga?”

“Everyone’s talking about how Pilates strengthens your core. Maybe I should take a class?”

“I know strength training is crucial, but where do I even begin?”

If you’ve ever had thoughts like these when thinking about exercise, you’re not alone.

The world of health, fitness, sports physical therapy, and injury rehabilitation can feel massive and even a bit daunting. I remember a time when I was unsure about how to approach my own fitness journey.

After wrapping up my college football career, I no longer had coaches designing my training plans. No more structured practices, conditioning workouts, weightlifting sessions, or recovery routines that typically involved stretching, foam rolling, yoga, and light cardio.

With no clear direction, I stuck with what I knew best: lifting weights, following my old off-season routine, and adding a couple of conditioning sessions each week.

After a few weeks of this, I stopped and asked myself a simple but important question: “Why?”

Why was I training this way? What were my goals now? And what were the most effective ways to achieve them? After reflecting and writing down my thoughts, I realized that my training program no longer aligned with my new goals.

My football days were behind me, and it was time to focus on staying healthy long-term.

At the same time, I still enjoyed strength training and the feeling of being strong. Plus, I was working toward becoming a Certified Strength and Conditioning Specialist (CSCS), so I needed to practice what I preached (this was all before I entered sports physical therapy school).

I ultimately designed a new strength training program that focused on increasing strength and muscle mass while also enhancing my mobility. The goal was to feel strong and stay healthy.

This approach worked because I took a moment to slow down and ask myself a few basic questions.

When was the last time you did that? Ask yourself these questions:

– What are the outcomes I want from my training? Do I want to be stronger? Have less discomfort? Improve my mobility? Be honest with yourself.
– What are the best methods to achieve these outcomes?
– If I don’t know the answer to the above, who can help guide me?

As question three suggests, you don’t need to figure it all out on your own. There are experts available who can help you reach your goals, but only you can determine what those goals are.

Once you have that clarity, our team of sports physical therapists in Bethesda and McLean is here to help. Along with being Doctors of Physical Therapy, our Performance Physical Therapists are also Certified Strength and Conditioning Specialists. We specialize in helping injured athletes recover and get back to doing what they love.

How to “Fix” Rounded Shoulders

As physical therapists, we often answer questions pertaining to “poor posture.” One of the most common reports from our patients in Bethesda and Chevy Chase is having “forward shoulders.”

The solution to this, which is often taught by other physical therapists, is to stretch the muscles in the front of the shoulders. The most common of these muscle groups is the pecs.

The logic goes something like this. “Your pecs are tight and pulling your shoulders forward. If you stretch them, your shoulders can move back and correct your posture.”

While this reasoning isn’t necessarily wrong, it is shortsighted. It fails to question why muscles like the pecs became tight in the first place. Simply stretching these muscles won’t correct the root cause of the issue.

The shoulder complex rests on top of the rib cage and the pecs attach to the sternum (ribs 1-7 attach to the sternum) as well as the ribs on the front of the rib cage.

As we breath in the rib cage should expand in 360 degrees and as we breath out it should do the opposite.

People with forward shoulders and stiff pecs often have difficulty expanding the front part of their rib cage during a relaxed breath in. This prevents the pecs from lengthening fully and often causes them to remain stiff, pulling the shoulders forward.

If you are looking to improve your posture and “pull your shoulders back”, the solution must include breathing exercises that emphasis relaxation and expansion of the chest/front part of the rib cage.

Here is an example from our YouTube page that illustrates this concept.

If you are looking to improve your posture or shoulder function, contact us now!

Photo Credit

“Orlando’s Poor Posture” by hewy is licensed under CC BY-NC-ND 2.0

Does Your Metabolism Actually Slow As You Age?

As we age it is common to feel that it is increasingly difficult to prevent injury or reach our fitness goals. We have spoken to many people in Bethesda that feel the help of a physical therapist is inevitable. Many challenges that are experienced are often attributed to a slowing metabolism.

However, this may not be the case.

There has been evidence that suggests that our metabolism doesn’t slow much, if at all, during adulthood. However, even if we later discover that some of these findings are misleading, a slowing metabolism is not the only reason that it takes longer to recover from injuries or fail to reach our fitness goals as we age.

Many of the challenges associated with aging stem from lifestyle changes.

In modern times humans have become more sedentary as we age. We no longer participate in organized sports, play outdoor games with our friends, and migrate to sedentary desk jobs for much of the day. This results in a large decrease in our daily energy expenditure and increases our risk of injury. Prolonged sedentary activity causes our body to become de-conditioned and less prepared for the rigors of life. As an example, this is why we suggest partaking in a running analysis prior to training for a race.

Another factor we may not realize is that as we get older, we take on a lot more responsibility.

Think back to your teenage years or time in your 20s. Did you have a lot of worries back then? A career? Family commitments? A mortgage? As these “adult things” add up, so do our commitments, resulting in less free time. Less time for exercise, less time for self-care, and less time for sleep.

Countless studies have shown us that as sleep decreases our health is negatively impacted in several ways, including an increased risk of orthopedic injury.

While it may be easy to see all of this as a negative, the good news is that many of the seemingly negative effects of aging are not as inevitable as we may have thought! Furthermore, feeling better and healthier doesn’t require you to be perfect.

As performance physical therapists, we help our patients identify the smallest possible improvement that will make the largest possible impact to overcome an injury.

Image Information

“Tiantan Park-life: The Elderly Exercising in China’s Parks – Parallel Bars” by _chrisUK is licensed under CC BY-NC-ND 2.0

Why We Need to Stop Comparing Adult Movements to Children’s

It has become common in fields of physical therapy and performance training to compare adult movement to the ways that babies move. You may have spoken to a professional that uses this comparison in their approach.

The logic usually goes something like this…“Humans were born with the ability to squat fully, and our modern lifestyles robbed us of that ability, so we need to regain it.”

Sounds understandable, right?

I thought so too. I even took a couple of continuing education courses based loosely upon this concept. The class instructors showed pictures of babies at various development stages and attempted to teach movements that mimicked these phases. The idea was to help adults gain back some of the movement capabilities that they once had as children and this new freedom of movement would help to alleviate pain and resolve injury.

Adults Are Not Babies

While I think we’d all love to be able to squat to the floor, crawl around all day, and never get tired, the truth is that we are not babies anymore.

Babies have a large amount of joint laxity that allows them to get into a variety of different positions, that we don’t have as adults. Babies also have a very large head in relation to the body, which helps to provide a counterbalance for easy squatting. In fact, according to Healthline, many of a baby’s bones are composed of cartilage, a type of connective tissue that is tough but flexible. This cartilage turns to bone as we grow.

Their bodies are still growing and changing. They fall often and make mistakes (essential for learning), which flexibility and mobility help with. Because of this, the ability to squat to the floor is normal for a baby. The same cannot always be said for adults.

Adults are not babies, and we cannot use a baby’s movement as a model for how an adult should move. Not only do babies have much different bone and structural compositions, but all adults have different movement capabilities due to variations in torso lengths and body proportions (among other reasons). Using singular movement standards would overlook this critical aspect.

It is nice to think that we could be able to squat to the floor like we once did when we were a toddler. However, adults are not babies, and our bodies are not the same as they once were.

Because of this, we do not expect our physical therapy patients to squat to the floor. It is essential for all of us to set realistic movement standards that will help to live pain-free and healthy lives. For help in the arena, talk to our experienced physical therapy team in Bethesda!

A Window to Cardiovascular Health

“Casual Runner” by Chris Hunkeler is licensed under CC BY-SA 2.0

Resting heart rate paints a vivid picture of cardiovascular health and impacts the body’s response to sports physical therapy interventions. RHR, or resting heart rate, is the number of times the heart beats per minute when the body is not physically active — such as when sitting.

According to the Mayo Clinic, the “normal” range for a resting heart rate is between 60 and 100 beats per minute (BPM), though resting heart rates vary from person to person based on various circumstances. For example, resting heart rate is significantly influenced by mood, environment, cardiovascular fitness, and stress.

As a rule of thumb — as cardiovascular health increases, resting heart rate tends to decrease. Therefore, athletes often have lower resting heart rates than those that do not regularly exercise. That said, resting heart rate is an important measure for anyone looking to improve their overall health.

What Your Resting Heart Rate Says About Your Cardiovascular Health

The heart is responsible for pumping blood and oxygen throughout the body. An elevated resting heart rate causes increased strain on the heart, often linked to high blood pressure, high cholesterol, and a higher risk of heart disease.

A resting heart rate of more than 100 BPM is called tachycardia, whereas an RHR below 60 beats per minute is called bradycardia.

Other than a few exceptions (for example, medications that lower the heart rate), a lower resting heart rate is an indication that the heart is more efficiently pumping blood, requiring fewer beats per minute to distribute blood throughout the body. Because each beat is more powerful, the heart is much stronger than one with a high resting heart rate.

Fortunately, there are many ways to improve resting heart rate, thus improving overall cardiovascular health.

How To Improve Your Resting Heart Rate

This is where cardiovascular exercise comes in handy. A recent study conducted at the University of Lousiville concluded that regular exercise effectively lowers resting heart rate, which reduces the risk of cardiovascular disease.

We think of cardiovascular exercise as strength training for the heart. Aerobic workouts, like walking, jogging, or swimming, train your body to use oxygen more efficiently, which gradually reduces your resting heart rate and breathing rate — both of which are important factors of cardiovascular health.

A more efficient heart can even help athletes recover quicker between grueling workouts. Plus, it allows many of our physical therapy patients in Chevy Chase and Bethesda to better adapt to the physical demands of their lives.

Final Thoughts

Resting heart rate is an important measure of cardiovascular health. A significantly high resting heart rate often correlates with many health problems such as cardiovascular disease, high blood pressure, and high cholesterol. Conversely, a low resting heart rate indicates a strong, healthy cardiovascular system.

If you’re struggling to improve your resting heart rate, try adding in regular cardiovascular exercise to gradually improve cardiovascular efficiency. Resting heart rate will improve as a byproduct.

If you’d like to work directly with a physical therapist in Chevy Chase or Bethesda to help you with this, please contact us today to schedule a free consultation!