Shoulder rehab case study

[george_97]

Hello Mr. Rippetoe,

I'm a 27-year-old lad from Sweden. I've watched your video on YouTube titled "Shoulder Case Study" several times, and I'm trying to understand why you include lat pulldowns as an exercise to rehab a shoulder injury. What I did understand from your anatomy lesson is that the top of the military press is in agreement with the rotator cuff's natural biomechanical role, which is compressing the top of the humerus against the glenoid and acting as a dynamic stabilizer. Another dynamic stabilizer for the shoulder joint is the long head of the biceps brachii. Is that the reason you include the lat pulldown? Because the biceps is a dynamic stabilizer for the shoulder? Or because it's rotating the scapula in the opposite direction?

Best regards,
George

[Mark Rippetoe]

What is the latissimus dorsi action on the shoulder?

[george_97]

The lattisimus dorsi attaches anteriorally on the humerus and is active in the extension of the humerus. It also adducts and rotates the humerus ? I know if the lats become tight they internally rotate the shoulder. Im trying to think why you asked me that question sir but my intuition is not kicking in. I don't understand. I don't understand the intuitive interplay between shoulder rehab and the function of the lats .. Help me understand sir

[george_97]

Alright i think i get it now we need to strengthen the shoulder in its respective directions i.e. Flexion,extension,abduction,adduction + the collective function of the rotator cuff. In a military press we get the rotator cuff function + abduction, flexion. Left is adduction and extension, which you include in a lat pulldown and later chins + we get the biceps involved aswell which is also a dynamic stabilizer for the shoulder. Am i overcomplicating things or on the right track Sir?

[Mark Rippetoe]

You've got it. The shoulder is arguably the most geometrically and anatomically complex articulation in the body, and all its functions must be employed in the rehab.

[george_97]

Thank you so much for the help, sir. It's an honor that you answered and helped me. I will never forget this for the rest of my life.

May I take this opportunity to ask a follow-up question? Can I include some form of rowing variation as part of the rehab? Right now, I'm doing rack pull deadlifts, presses, and lat pulldowns. I feel that "rowing" are tough on my shoulder at the moment, but is there any rowing variation that could benefit my shoulder, or should I wait until I have better control over my shoulder joint?

Br
George

[Mark Rippetoe]

Barbell rows should be okay. Try them.

[george_97]

Hello again, Sir! I hope you don't mind helping me with some more questions =D

How many sets and reps should I include each week for the eccentric military press and the lat pulldown? And how should I approach increasing the weights? Tomorrow, I plan to increase the weight from 15 to 20 kg and start doing eccentric military presses, with the bar placed high, aiming for 3-5 sets of 8-12 reps, and I'll do the same sets/reps for the lat pulldown. For the rack pulls, I'm doing 5x5. I perform these three exercises on the same day, twice a week.

I'm feeling a bit lost regarding the sets and reps for the eccentric press and lat pulldowns. For the press, I feel like I should maybe include more sets per week. I thought I should ask you before I do something that could reinjure myself and lose all my progress!

a) How many sets and reps should I aim for?
b) How much weight should I increase weekly, at most, if it feels good in the shoulder, considering I've maintained the same weight for at least two sessions? I take precautions when increasing the weight, and I try to monitor any shoulder discomfort during the training session and the day after. If it feels good for two sessions with the same weight, I increase the next week. Is this a good indicator?
c) When should I start thinking about limiting the repetitions from tens to fewer repetitions?

Br
George