SLAP Tear Rehab & Exercises (Stretching | Strengthening | Education)

Understanding SLAP Tears and Their Management

Overview of SLAP Tears

• The video introduces the topic of SLAP tears, discussing the necessity of surgery and presenting a comprehensive rehabilitation program.

• A brief review of shoulder anatomy is provided, highlighting the glenohumeral joint's structure and mobility due to its ball-and-socket design.

• The term "SLAP" stands for Superior Labrum Anterior and Posterior, with four types classified by Snyder et al. in 1990.

Types of SLAP Tears

• Type 1: Fraying or degeneration of the superior labrum; labrum remains attached with an intact biceps tendon.

• Type 2: Detachment of the superior labrum along with the biceps tendon.

• Type 3: Bucket handle tear of the superior labrum while keeping the biceps tendon intact.

• Type 4: Bucket handle tear extending into the biceps tendon; original classifications remain widely recognized despite additional subtypes.

Causes and Prevalence

• Acute trauma can lead to compression or traction type injuries, often from falls or heavy lifting.

• Chronic injuries are common in athletes involved in repetitive overhead activities; asymptomatic individuals may also show abnormalities on imaging studies.

• Research indicates that SLAP tears become more prevalent with age, particularly among athletes like rock climbers.

Surgical Necessity Debate

• Not all SLAP tears require surgical intervention; many individuals experience favorable outcomes without surgery.

• A study comparing real surgery to sham surgery for Type 2 SLAP tears found no significant clinical benefit from surgical repair over placebo treatments.

Patient Education and Nonoperative Management

• Dr. Kristen Matthew emphasizes that MRI findings can cause unnecessary anxiety leading to harmful interventions; educating patients about asymptomatic lesions is crucial before diagnosis.

• Patients should understand that labral issues are just one aspect of shoulder problems, advocating for nonoperative protocols as a first-line treatment option.

Rehabilitation Program Insights

• A systematic review suggests successful non-operative treatment for athletes who adhere to rehabilitation programs prior to returning to play.

• The video will present a comprehensive rehab program focusing on shoulder strength, range of motion, and power across various difficulty levels tailored to individual needs.

Shoulder Rehabilitation Exercises

Introduction to Shoulder Rehabilitation

• Following shoulder surgery, patients will experience immobilization and restrictions in range of motion. Clearance from a medical doctor and physical therapist is essential before starting new exercises.

External Rotation Strengthening

• Option 1: Sideline External Rotation - Lie on your side with the top arm at your side, elbow bent at 90°. Hold a weight and rotate the arm outward, then return to the starting position.

• Option 2: Standing External Rotation - Use a cable or band while keeping the elbow bent at 90° against your side. Rotate the arm outward slowly and control back to start.

• Option 3: Elbow on Knee - Sit with your elbow supported on your knee holding a weight. Rotate inward as far as possible without rolling the shoulder forward, then return.

• Progression can be done in a "9090 position" (shoulder and elbow both bent at 90°). Perform for two to three sets of 10 to 15 repetitions, two to three times per week.

Isometric Variations

• An easier option involves static holds either sideline or standing with resistance bands. This can be performed safely against a wall or door frame for two to three sets of 30 to 45 seconds.

Internal Rotation Strengthening

• The primary exercise is standing internal rotation using cables or bands. Keep the elbow bent at 90° against your side while rotating inward slowly.

• For an easier isometric variation, press into a wall or door frame; perform for two to three sets of 30 to 45 seconds.

Shoulder Elevation Exercises

• The main exercise is lateral raises using weights or bands, raising arms up to shoulder height either directly outwards or in the scapular plane (30°–45° angle).

• Thumbs can face up towards the ceiling for added challenge; consider butterfly lateral raises where arms go overhead.

Strengthening Back Shoulders & Upper Back

• Start with A's, T's, and Y's exercises lying face down on an incline bench. Progress from A's (arms down), T's (shoulder height), to Y's (overhead).

• Resistance can be added through cuff weights or dumbbells when ready; alternatively use cables/bands while standing.

Plank Variations for Weightbearing Strengthening

• Standard plank positions focus on glute engagement and maintaining flat low back posture. Adjust difficulty by performing planks on knees or elevating hands.

• Examples include long lever planks and dolphin pose variations that engage shoulder protraction effectively.

Shoulder and Bicep Strengthening Exercises

Shoulder Taps

• Begin in a tall plank position, spreading your feet for stability. Alternate tapping opposite shoulders while minimizing trunk movement.

• Focus on pushing the floor away with the hand that remains on the ground.

• Recommended to perform 2-3 sets lasting 30-60 seconds, two to three times per week.

Bicep Strengthening

• The last exercise category focuses on bicep strengthening, particularly through seated or standing dumbbell curls.

• To increase demand on the biceps tendon, extend your shoulder during curls.

• Isometric exercises can be performed using bands or dumbbells against an immovable object; aim for 2-3 sets of 10-15 repetitions or 30-45 second holds.

Shoulder Flexion Range of Motion

• Start with supine shoulder flexion using a dowel; lie back with knees bent and move arms overhead as comfortable.

• Use assistance from the uninvolved side if needed; palms should face down initially but can switch to facing up for increased intensity.

Advanced Shoulder Flexion Techniques

• Incorporate pullover variations with dumbbells for thoracic extension; adjust repetitions based on speed and comfort level.

• For post-operative patients, aim for 2–3 sets one to three times daily; otherwise, two to three times weekly is sufficient.

External and Internal Rotation Exercises

External Rotation Range of Motion

• Begin seated or supine with a dowel; support the involved shoulder at your side and use the unaffected side to assist in rotation.

• As tolerance improves, actively rotate outward without assistance. Holding light weights can increase intensity.

Internal Rotation Techniques

• Lie back and rotate your hand toward your stomach while keeping your elbow bent at 90°; work towards shoulder height gradually.

• The sleeper stretch involves lying on your side and gently pushing down with your top hand to improve internal rotation range.

Advanced Compound Pulling Exercises

Horizontal vs. Vertical Pulling Movements

• Horizontal pulling movements (like rows) are less demanding than vertical ones (like pull-ups), especially those requiring hanging positions.

Exercise Variations

• Options include single-arm seated rows, cable rows, banded rows, inverted rows, and TRX rows. Adjust body position for difficulty levels.

Progressing Towards Pull-Ups

• Ensure strength building through various pull-down variations before attempting pull-ups. Assisted versions may help beginners ease into this challenging exercise.

Exercise Strategies for Shoulder Rehabilitation

Isometric Holds and Eccentrics

• Focus on isometric holds or eccentric exercises, emphasizing the lowering phase of movements. Starting with a neutral grip is recommended as it places less demand on the biceps compared to supinated or pronated grips.

Rep Schemes and Frequency

• Suggested rep schemes include 2-3 sets of 5-20 repetitions, performed 2-3 times per week. Early rehab phases typically utilize higher rep ranges, while later phases may shift to lower reps based on evolving goals and symptoms.

Horizontal vs Vertical Movements

• Horizontal movements are generally less demanding than vertical ones, with exceptions like dips. Push-ups are highlighted as an effective exercise that can be modified in difficulty by adjusting hand or foot elevation.

Advanced Pressing Exercises

• Dips are categorized as advanced horizontal pressing exercises requiring significant strength development over time. Incline dumbbell presses and landmine presses serve as alternatives for progressing towards vertical pressing exercises. Overhead presses allow for weight adjustments based on comfort levels.

Power Coordination and Reactivity

• The final category focuses on enhancing shoulder power, coordination, and reactivity through various exercises aimed at force absorption and generation over extended periods. Options include medicine ball throws (e.g., chest passes) and dribbling variations with a bouncy ball to improve dynamic capabilities. Aim for 2-3 sets of 4-8 repetitions focusing on speed rather than endurance in this context.

Individualizing Your Rehabilitation Program

Key Considerations for Personalization

1. Flexibility in Protocol: Adherence to suggested sets, reps, and frequency should be adjusted based on individual circumstances; not every exercise will suit everyone’s needs.

2. Relevance of Exercises: Only perform exercises relevant to your specific rehabilitation goals; unnecessary categories can be omitted if they do not address current issues.

3. Variety in Exercise Selection: A comprehensive list of potential exercises was not provided; however, including diverse movements can enhance mobility without needing exhaustive categories.

4. Rehabilitation Stage Influence: The current stage of rehabilitation significantly impacts which aspects (strengthening vs range of motion) should take precedence in training focus.

5. Sample Program Structure: An example program includes varied exercises across two days targeting different muscle groups while considering individual capacity and recovery needs—emphasizing the importance of customizing workouts according to personal progressions and challenges faced during rehab sessions.

Sample Weekly Program Overview

Monday:

• Dumbbell pullover (3x8) super set with Dolphin pose (3x8)

• Medicine ball throws (3x5)

• Neutral grip Pull-Ups (3x6) super set with deficit push-ups (3x12)

Thursday:

• Dumbbell pullover (3x8) super set with prone angels (3x5)

• Medicine ball slams (3x6)

This structure emphasizes starting with dynamic warm-ups followed by power movements before transitioning into compound strength exercises, concluding with accessory work while maintaining appropriate rest intervals between sets ranging from 1 to 3 minutes for optimal recovery during sessions.

Rehabilitation Strategies for Overhead Athletes

Importance of Technique and Realistic Expectations

• Emphasizes the significance of good technique in range of motion and strengthening exercises, advocating for a slow and controlled tempo to ensure tolerability.

• Highlights the necessity of setting realistic expectations, noting that nonoperative management may require 3 to 6 months of dedicated effort with potential ups and downs.

Comprehensive Approach to Rehabilitation

• Stresses that rehabilitation extends beyond gym workouts; athletes must integrate specific throwing programs, gradually increasing exposure to throwing, catching, and hitting.

• Mentions the need for lower body exercises, cardiorespiratory fitness, and other training aspects tailored to different sports (e.g., baseball players vs. Olympic weightlifters).

Surgical Considerations

• Discusses when surgery is indicated: if nonoperative management fails, surgical intervention should be carefully considered with an understanding that prior performance levels may not be regained.

• Notes that surgery does not guarantee long-term success and carries inherent risks; thus, conservative management is preferred initially.

Rehabilitation Program Structure

• Points out that some athletes may fail one rehabilitation attempt but succeed on a second try, underscoring the importance of a well-structured rehab program.

• Indicates that surgical options vary based on factors like age, symptoms, function goals, imaging findings; decisions should involve collaboration among medical professionals.

Long-Term Recovery Post-Surgery

• Underlines the critical role of a comprehensive rehab program post-surgery for long-term success; full recovery can take 9 to 12 months.

• Defines labrum anatomy and its role in shoulder stability; explains SLAP tears as injuries affecting the top part of the labrum which can occur both traumatically or gradually over time.