Rick,

While you have provided this reader with some good exercises for scapular stabilization I am very disappointed that you have given some simplistic direction and not provided discussion with exercises specific to the capsular stability and strengthening of the rotator cuff. It is known with recurrent subluxations that the kinematics and firing pattern of the rotator cuff are altered and ALL exercise selections should be directed in a manner that will regain normative patterning first and foremost. If your 3 chosen exercises are provided out of the context of the client regaining these normative joint kinematics, I would have grave concern that their subluxations will be mis-managed. The direct discussion of this matter is beyond the scope of this response, so I would like to direct ALL of your readers to the following article which highlights my point and includes not only a comprehensive overview of the research (and mis-guided information that exists), but also includes the exercises that are most effective in this regard. I continue to take this approach in the Corrective Exercise workshops I teach as well as in my clinical management of shoulder injuries:

From the Journal of Orthopaedic & Sports Physical Therapy
http://www.jospt.org/issues/articleID.2290,type.2/article_detail.asp

I urge all Kinesiologists / Trainers to remain within their scope of practice and urge caution when clinical pathology is present. Gaining a detailed understanding of pathology will allow you to continue your work with your client while they work in conjunction with clinicians trained in regaining joint kinematics, as is, in this case, required to avoid recurrent subluxations and prevent surgery in the future.

[Reply]

@Gordon Banks –

Well said Gordon, and I would like to add that if one checks out the article cited in the original posters rather cantankerous reply, it is listed at a Level 5 of evidence.

FYI, Level 5 evidence is the weakest on the Evidence-Based Medicine (EBM) levels of evidence scale:

Sources:
http://www.cebm.net/index.aspx?o=1025
http://en.wikipedia.org/wiki/Evidence-based_medicine
http://www.eboncall.org/content/levels.html

Level 5 is Quoted as being:

“Expert opinion without explicit critical appraisal, or based on physiology, bench research or “first principles”

Level 5 carries a grade of recommendation of ‘D’ which equates to:

“Level D: At least fair scientific evidence suggests that the risks of the clinical service outweighs potential benefits. Clinicians should not routinely offer the service to asymptomatic patients.”

That makes the opinion in that article and that which was shared by the original poster, in a most belligerent way I might add, no better than yours as far as objectivity is concerned.

I’m not chiming in to discredit the article itself. It may very well work in many cases, but the point here is that someone is stomping on you acting as a major authority and belittling your opinion while sharing one that has no more validity scientifically than yours.

The reasoning behind the exercises cited in the article might very well be correct, but I offer up my opinion in agreement with Gordon in that if someone feels the need to belittle your opinion and supplement it with theirs, they should at least have the courtesy of using an article with Level 1 or 2 evidence to back them up. The best thing to do is not be rude or insolant in the first place.

Ben

[Reply]