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Supraspinatus strengthening
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Supraspinatus strengthening - November 16, 2005 8:27:00 AM
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PJM
Posts: 25
Joined: October 25, 2005
From: Australia
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Probably a no brainer of a topic to post but I was wondering on the different approaches used by clinicians for strengthening this muscle.
Following a partial tear I tend to use isometric shoudler external rotation and then progress to dynamic external rotation using resistance tubing. Then I progress from easy resistance tubing to hard.
Sometimes I would use a weight in sidelying for resistance of external rotation. As a higher level progression I would use the elastic tubing at 90 degrees abduction and ask the patient to perform external rotation(for all these exercises I would normally have the patient in elbow flexion 90 degrees).
Do other people use the empty can position of shoulder internal rotation and arm elevation with the elbow straight to strengthen this area?
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Re: Supraspinatus strengthening - November 16, 2005 10:59:00 AM
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VagusX
Posts: 220
Joined: March 26, 2003
From: Savannah, GA, USA
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Take a look at this http://www.aptei.com/articles/index.jsp on some new paradigms on supraspinatus strengthening. I have just started to try some of these techniques so I don't how well they work. I have had some success with empty can strengthening, but I'd say that 75% of my patient's think that it is an uncomfortable exercise so I have them stop. The open can position is more comfortable and seams to work just as well. Take care
-Daniel
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Re: Supraspinatus strengthening - November 16, 2005 11:00:00 AM
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bburas
Posts: 54
Joined: April 22, 2001
From: colorado springs, co, usa
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PJ,
if i'm not mistaken, one of the best ways to strengthen the supraspinatus is prone scaption. i tend to avoid the empty can position because it is irritating to a lot of patients. and i'm not sure it's any better than the "full can" position. although a chiro friend of mine likes the empty can because he feels it stretches the suprispinatus therefore allowing work through a greater range. i don't put a great deal of stock in that.
brett
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Re: Supraspinatus strengthening - November 16, 2005 1:19:00 PM
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certMDT
Posts: 155
Joined: April 5, 2004
From: Durham, NC
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I stopped doing the empty can as an exercise a long time ago. Just too much potential to impinge the tendons, which is often exactly what we are trying to avoid. There was a study about 4-5 years ago showing just about equal supraspinatus activation with "full can" vs. "empty can" position, but a much higher level of comfort in full can. Unfortunately I can't find the reference at the moment.
Here is another reference:
Am J Sports Med. 2005 Nov 10;
Scapular Kinematics During Supraspinatus Rehabilitation Exercise: A Comparison of Full-Can Versus Empty-Can Techniques.
Thigpen CA, Padua DA, Morgan N, Kreps C, Karas SG.
Interdisciplinary Program in Human Movement Science, Sports Medicine Research Lab and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
BACKGROUND: Supraspinatus strengthening is an important component of shoulder rehabilitation. Previous work has determined that the full-can and empty-can exercises elicit the greatest amount of supraspinatus activity. However, scapular kinematics has not been considered when prescribing supraspinatus exercises. HYPOTHESIS: Scapular downward rotation, internal rotation, and anterior tipping during the empty-can exercise are increased when compared with the full-can exercise. STUDY DESIGN: Descriptive laboratory study. METHODS: Twenty participants performed full-can and empty-can exercises while an electromagnetic tracking system was used to collect three-dimensional scapular kinematic data. Scapular angles at 30 degrees , 60 degrees , and 90 degrees of the ascending and descending phases of humeral elevation were compared using 2-way repeated measures analysis of variance. RESULTS: There was more scapular anterior tipping and internal rotation during the empty-can exercise at all sampled humeral elevation angles except at 30 degrees of the descending phase for anterior/posterior tipping (P < .05). CONCLUSION: Scapular anterior tipping and internal rotation are increased during the empty-can exercise, whereas scapular upward rotation was not different between exercises. CLINICAL RELEVANCE: Increased scapular internal rotation and anterior tipping decrease the volume of the supraspinatus outlet during the empty-can exercise. When maintenance of the subacromial space is important, use of the full-can exercise seems most appropriate for selective strengthening of the supraspinatus muscle.
_____________________________
Charles Sheets PT OCS Dip MDT
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Re: Supraspinatus strengthening - November 16, 2005 2:25:00 PM
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MPTSTUDENT
Posts: 88
Joined: April 29, 2004
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I believe prone scaption has been shown to have very high supraspinatus activity on emg
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Re: Supraspinatus strengthening - November 16, 2005 2:40:00 PM
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drbuddy
Posts: 429
Joined: July 30, 2005
From: Pennsylvania
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FWIW, we were taught to avoid the empty can position when strengthening.
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Re: Supraspinatus strengthening - November 16, 2005 2:59:00 PM
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jma
Posts: 2432
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From: NY
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scaption is good but I wouldn't go further into abduction/flexion past 90 degrees with the shoulder internally rotated.
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Re: Supraspinatus strengthening - November 29, 2005 4:46:00 AM
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spfister
Posts: 23
Joined: September 7, 2003
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The supraspinatus is an abductor and stabilizer. External Rotation exercise won't do a lot for it. The prone exercise has been shown to be a good way to fire the supraspinatus. That said, I am not sure why the fascination with the supraspinatus. I understand that it is the most often injured, but the infraspinatus and teres minor have a greater role in the inferior glide needed for normal elevation and as much for stability (Payne et al AmJSM Dec 1997). This I believe is confirmed by the fact that an isolated supraspinatus tear will result in very minor functional deficits, wheras involvement of the infraspinatus leads to a significant loss in shoulder elevation. (Thompson et al AmJSM June 1996)
_____________________________
Steve
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Re: Supraspinatus strengthening - November 29, 2005 8:03:00 AM
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marptatc
Posts: 47
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From: NC
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I ditto the response by spfister. Why the emphasis on strengthening the supraspinatus when humeral head elevation is one of the issues that we try to correct with many shoulder dysfunctions? If you want to keep a rotator cuff repair in the clinic longer, possible with a re-rupture and further surgery, continue with the empty can exercises. Avoid this and see what results you might obtain.
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Re: Supraspinatus strengthening - December 21, 2005 5:13:00 PM
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Gameth
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Joined: May 23, 2005
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Ditto number two, external rotation is working the infraspinatus and teres minor.
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Re: Supraspinatus strengthening - December 22, 2005 12:00:00 AM
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connie.pt
Posts: 76
Joined: March 28, 2005
From: Michigan
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"Following a partial tear I tend to use isometric shoudler external rotation and then progress to dynamic external rotation using resistance tubing. Then I progress from easy resistance tubing to hard."
This sounds like the progression is too aggressive to me. Instead of jumping to resistance training, try AAROM, followed by AROM then resistance. If someone has a partial tear, or if I suspect they have a partial tear I always make it very clear to the patient that they should have absolutely no soreness during or after exercise. If they have soreness, there is a probability that the exercise is causing more damage than healing.
I also avoid the empty can and work on the infra & t. minor. ER with a towel roll under the elbow will reciprically inhibit the supraspinatus, making this a safe exercise if only the supra is torn.
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Re: Supraspinatus strengthening - December 22, 2005 2:27:00 AM
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FLAOrthoPT
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Joined: May 8, 2004
From: West Palm Beach
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that spfister guy is smart
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