Does the shoulder have to actively lift itself into abduction? It is difficult to come up with a strategy where the body chooses to move into active abduction.
As a client presents with pain, stiffness or a motor control/strength problem, it is a health care provider’s responsibility to evaluate the condition and determine a treatment plan. Considering how the body uses shoulder abduction in natural motion, the best way to see natural, uninhibited movement patterns is in healthy individuals, which takes us to youth — think ages 5-25.
Picture athletes and consider when would they abduct their shoulder versus when would they find their shoulder in an abducted position. Those are two very different movement strategies.
Patterns and strategies
Another strategy to determine normal movement patterns is to watch humans move under heavy load. If you had to move a car by pushing or pulling it, how would you position your body to complete the task? How about if you had to pull your whole body weight up and over a wall or a boulder? What strategy would you use to lift 200 pounds off the ground or hold 100 pounds over your head? What body positions would you find yourself in?
Think about these patterns and strategies; the body will always try to stack joints and use kinetic linking to its advantage. In other words, you could not do the movements in isolation; you would need to organize your kinetic chain to accomplish this effectively without injuring yourself. This is an innate skill and the preferred motor control pattern of human movement.
Now let us circle back on shoulder abduction. Were you able to come up with a time while playing sports, or a time under extreme loads, that a human would raise their arm out to the side into abduction? It has been difficult to come up with a strategy where the body chooses to move into active abduction. Although, you may have thought of positions where the shoulder is in abduction. Consider throwing a baseball (in the arm cocking phase), doing a side plank, doing a bench press or push-up, swinging a bat/club, or maybe holding something overhead.
At this point, you now have to ask: “How did the person get into these positions?” At no time did they lift their arm into abduction. The shoulder needs to be able to achieve abduction, but it does not have to actively lift itself into abduction. This is a critical concept as we consider how we train our clients to be stronger and more confident in abduction.
Shoulder abduction: mechanics, anatomy and interventions
The mechanics of abduction are some of the most stressful movements on the body. As the humerus moves laterally and approaches 90 degrees of abduction, it begins to impinge upon the acromion. In this 1- to 5-mm. space sit many tissues. The supraspinatus, superior labrum and joint capsule, bicipital tendon and bursa all exist in this tiny space and get impinged upon during abduction at 90 degrees or above. We often refer to this zone as the upper quadrant. To be in this range of motion, you must have perfect flexion, external rotation and abduction. This is all review, and nothing has changed — but we must consider that impingement is less of a diagnosis and more of a symptom. Impingement is the result of another problem, like a torn/weak rotator cuff, swelling from tendinitis/ tendinopathy, or chronic wear/ arthritis/bone spur.
Abduction requires a nearly perfect subacromial space and a solid rotator cuff to hold the humeral head directly in the glenoid socket. Essentially, if you can get the humeral head to stay squarely in the socket and not glide superiorly, abduction is possible. Without this, there is no hope.
In summary to this point, we will not be strengthening the movement of abduction via abducting the arm, but rather through achieving abduction by changing body position. Second, we will strengthen and develop motor control of the rotator cuff to maximize the ability of the humeral head to stay squarely aligned in the socket. These two concepts combined allow for abduction to be an achievable motion.
I have never found a reason to actively abduct the shoulder with any form of resistance, therefore I never prescribe this movement.
Abduction without abduction
Let’s look at options for intervention to improve abduction without actually doing abduction. First step is to establish rotator cuff stability to stabilize the ball in the socket. This can be done with isometric holds in safe positions for up to one-minute holds (prone letters A, T, W, Y). Another option would be a floss band wrapped around the proximal humerus while doing shoulder flexion. Kinesiology tape is also a great option to facilitate rotator cuff activity while doing the prone letters work.
Once we have established cuff stability, we can have more dynamic movement. At my clinic, we use tubing as a way to introduce this motor control. The motions I prefer are flexion, horizontal abduction and adduction, external rotation, and shoulder extension. Typical rep schemes are 2×15.
To continue to develop road tolerance and prepare the body to tolerate stacking or kinetic linking, using an arm bar with a kettlebell is the preferred option. Start supine and work flexion for up to one minute. Once ownership of this position is established, then have the client roll into side-lying, keeping the arm pressed to the sky, and there you are in abduction! This is called a sidling or lateral arm bar — an excellent tool for developing scapular control and rotator cuff endurance.
There are many progressions from here, but our preferred position to master abduction control is a thoracic bridge, or (as I have heard it referred to) flip dog in yoga. This movement truly demands stacking of the shoulder and linking force through the trunk. It demands that force be transferred through the shoulder and trunk, defining kinetic linking. We look to hold this position for 30-60 seconds.
When progressing loaded strength, it is best to prepare the body for load. Exercises to this point can be used to warm up, and vibration or oscillation in short 10-second bursts can prep the tissue. We use a vibration gun or an IASTM tool for rapid oscillations.
Steps further could include upper body strengthening exercises including rowing, lat pull-downs, shoulder presses and bench presses. We could look to develop speed with medial throws and slams.
Avoid abduction, but rather train the body
In conclusion regarding shoulder abduction, it is my recommendation that we avoid training abduction, but rather train the body to achieve abduction and control it very effectively. There is a very specific progression to developing shoulder control and ownership.
Tony Mikla, DPT, MSPT, CSCS, is a sports physical therapist and performance coach. His practice, Kime Performance Institute, is dedicated to the improvement of his clients’ performance in life and on the field. He has worked as a consultant for professional teams in the MLB and NBA, as well as individual athletes including Olympic champions, MMA champions, PGA Tour pros, U.S. military special operators, and athletes from the NBA, MLB, NFL and NHL.