Rotator Cuff, Part 5 – Pilates Equipment Helps Retrain Shoulder Movement with Rotator Cuff Pathology
In Rotator Cuff Part 1, we discussed that the ball of the shoulder joint sits in a rather shallow socket so arm motions require very coordinated control of several muscles around the shoulder blade and shoulder joint. While it is important to address the specific tightness with stretches or specific weakness with strength exercises as discussed in Rotator Cuff Part 4, a very important part of the physical rehabilitation is gaining back the coordinated control and timing of these muscles. This is called neuromuscular control. Pilates is an exercise method that helps the neuromuscular control of motion.
The frame of the Pilates reformer carriage gives the patient feedback. As an example, in this exercise, the patient is lying on their back performing this exercise with the hands in the straps. Shoulder motions are performed in pain free range of motion. Lying on the back gives the patient support. As well, if the patient tries to use their trunk to assist with the motion, the patient will feel their body move away from the mat. If the patient fails to stabilize the shoulder blade, the shoulders will butt up against the shoulder blocks, giving the patient feedback. The resistance is provided by springs. The movement is meant to be smooth, flowing and precise such that the muscles around the shoulder fully control the movement. If the patient fails to control the movement or the timing (uses momentum), the patient will feel the jerky motion of the carriage or the ropes will buckle, again giving the patient feedback. Generally, patients with rotator cuff pathology can initially only control the movement in a small range of motion with light resistance. As the patient progresses, the movement is progressed through larger ranges of motion and higher resistance. Shoulder exercises are also progressed to other exercises in upright positions.