So in part one we talked about the theory underpinning eccentric muscle contractions and how you might use this in a patient population. In this seciton we present some exercise modalities that you can use in a clinical setting to improve eccentric force production (Strength).
There are several training / rehabs modalities available to improve eccentric strength but I tend to favour a few for the shoulder becuase they require minimal equipment and are easy for patients to remember.
1. Accentuated eccentric muscle loading (see video below)
This training modality uses a heavy band to overload the posterior rotator cuff eccentrically. The load should at least exceed the muscles maximal concentric strength capabilities. So, from a practical stand point if the muscle is fatiguing at a concentric repetition load of 12 repetitions with a purple Thera band, then a supra maximal load may require a black band or a purple and black band combined.
This type of heavy eccentric training modality can be used effectivelly in your recrational overhead sports player that has a problem with deceleration of the arm during the follow through phase of the serve, pitch or throw. The benefit of an accenuated eccentic programme is two fold.
Firstly, it ticks the specificity box in regard to the muscle action. As you can see in the video below the cricket player has difficulty controlling the eccentric phase of the throw and subsequently complains of symtoms at the end of that action.
Secondly, this type of modality because of the higher tension produced, mechanistically is a strong driver for hyperthophy, maximal force expression (strength) and power ( rate of force development). Therefore it can be very helpful for driving both structural adapatations in tendon and muscle and neuromuscular adaptations (strength and explosiveness).
But, remember it can be used in a non sporting population to drive the basic structural changes in muscle and tendon tissue, and the obvious adapations in stength and explosiveness that all patients require for normal function!
2. Time under tension
Time under tension uses a eccentric load in a time efficient manner. In essence, it is easy to implement for the therapist and easy to understand for the patient. All that is required is the eccentric portion of the exercise is lengthened with a load heavy enough to challenge the muscle. So, for example the eccentric phase is slowly released for 6 seconds while the concentric phase is released over 2 second providing a 3-1 ratio.
3. Upper body ballistic exercise (with a catch) See video below
This type of exercise is incorrectly called a plyometric exercise which I won’t go into here! However, using medicine balls or other weighted objects the aim is to catch and decelerate a falling object to a slow controlled finish. The load with these exercises is often dependent upon technique and the pre-tension of the rest of the kinetic chain. So, these exercises become excellent for improving the patient’s intermuscular coordination between various body segments and regions of the body.
So, I hope this has provided you with some ideas and a basic rational for how you can incorporate eccentric exercise into your shoulder rehabilitation.
Further reading
Cools, A. M., Borms, D., Castelein, B., Vanderstukken, F., & Johansson, F. R. (2016). Evidence-based rehabilitation of athletes with glenohumeral instability. Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA, 24(2), 382–389. https://doi.org/10.1007/s00167-015-3940-x
Douglas, J., Pearson, S., Ross, A., & McGuigan, M. (2017). Chronic Adaptations to Eccentric Training: A Systematic Review. Sports Medicine (Auckland, N.Z.), 47(5), 917–941. https://doi.org/10.1007/s40279-016-0628-4
Kibler, W. B., Wilkes, T., & Sciascia, A. (2013). Mechanics and pathomechanics in the overhead athlete. Clinics in Sports Medicine, 32(4), 637–651. https://doi.org/10.1016/j.csm.2013.07.003
Kovacs, M., Roetert, E. P., & Ellenbecker, T. (2008). Efficient Deceleration: The Forgotten Factor in Tennis-Specific Training. Strength & Conditioning Journal, 30, 58–69. https://doi.org/10.1519/SSC.0b013e31818e5fbc
Michener, L. A., Abrams, J. S., Bliven, K. C. H., Falsone, S., Laudner, K. G., McFarland, E. G., Tibone, J. E., Thigpen, C. A., & Uhl, T. L. (2018). National Athletic Trainers’ Association Position Statement: Evaluation, Management, and Outcomes of and Return-to- Play Criteria for Overhead Athletes With Superior Labral Anterior-Posterior Injuries. Journal of Athletic Training, 53(3), 209–229. https://doi.org/10.4085/1062-6050-59-16
Richardson, E., Lewis, J. S., Gibson, J., Morgan, C., Halaki, M., Ginn, K., & Yeowell, G. (2020). Role of the kinetic chain in shoulder rehabilitation: Does incorporating the trunk and lower limb into shoulder exercise regimes influence shoulder muscle recruitment patterns? Systematic review of electromyography studies. BMJ Open Sport & Exercise Medicine, 6(1), e000683. https://doi.org/10.1136/bmjsem-2019-000683
Suchmel, T. J., Wagle, J. P., Douglas, J., Taber, C. B., Harden, M., Haff, G. G., & Stone, M. H. (2019a). Implementing Eccentric Resistance Training-Part 1: A Brief Review of Existing Methods. Journal of Functional Morphology and Kinesiology, 4(2), E38. https://doi.org/10.3390/jfmk4020038
Suchomel, T. J., Wagle, J. P., Douglas, J., Taber, C. B., Harden, M., Haff, G. G., & Stone, M. H. (2019b). Implementing Eccentric Resistance Training—Part 2: Practical Recommendations. Journal of Functional Morphology and Kinesiology, 4(3), 55. https://doi.org/10.3390/jfmk4030055
Vogt, M., & Hoppeler, H. H. (2014). Eccentric exercise: Mechanisms and effects when used as training regime or training adjunct. Journal of Applied Physiology (Bethesda, Md.: 1985), 116(11), 1446–1454. https://doi.org/10.1152/japplphysiol.00146.2013
Wagle, J. P., Taber, C. B., Cunanan, A. J., Bingham, G. E., Carroll, K. M., DeWeese, B. H., Sato, K., & Stone, M. H. (2017). Accentuated Eccentric Loading for Training and Performance: A Review. Sports Medicine (Auckland, N.Z.), 47(12), 2473–2495. https://doi.org/10.1007/s40279-017-0755-6
Watson, S., Allen, B., & Grant, J. A. (2016). A Clinical Review of Return-to-Play Considerations After Anterior Shoulder Dislocation. Sports Health, 8(4), 336–341. https://doi.org/10.1177/1941738116651956
Wilk, K. E., Arrigo, C. A., Hooks, T. R., & Andrews, J. R. (2016). Rehabilitation of the Overhead Throwing Athlete: There Is More to It Than Just External Rotation/Internal Rotation Strengthening. PM & R: The Journal of Injury, Function, and Rehabilitation, 8(3 Suppl), S78-90. https://doi.org/10.1016/j.pmrj.2015.12.005
Wilk, K. E., Meister, K., & Andrews, J. R. (2002). Current concepts in the rehabilitation of the overhead throwing athlete. The American Journal of Sports Medicine, 30(1), 136–151. https://doi.org/10.1177/03635465020300011201
Wong, E. K. L., & Ng, G. Y. F. (2009). Strength Profiles of Shoulder Rotators in Healthy Sport Climbers and Nonclimbers. Journal of Athletic Training, 44(5), 527–530. https://doi.org/10.4085/1062-6050-44.5.527
Comments