Closed Kinetic Chain Shoulder Rehabilitation Exercises

In order for the arm and shoulder to optimally function, muscles of the entire body must contribute.   During most dynamic activities in everyday life and sport, the lower body creates most of the needed energy.  Energy is transferred from the lower half of the body up through the trunk and finally to the arm.  The important links in this sequence are the core and shoulder blade muscles.  Shoulder strengthening exercises which focus on the rotator cuff are usually only partially effective for patients with shoulder pain.  Muscles do not function in isolation.  The brain programs movement as patterns, not individual muscles.  Therefore, shoulder rehabilitation programs should include exercises which integrate the entire kinetic chain including the core and shoulder blade.

These same rehabilitation exercises can also be utilized as part of a dynamic warm-up for athletes.  Ideally, muscles throughout the body are involved in the pre-game warm-up for baseball and other overhead sports such as tennis and swimming.   These exercises have the potential to improve strength, performance and reduce the risk of injury.  The 5 closed kinetic chain exercises included in this article activate the core muscles along with the trapezius and serratus anterior.   Closed kinetic chain exercises involve bearing weight through the arms and hands.

Quadruped Band Series

Begin in the quadruped position with the hands positioned under the shoulders and knees under the hips.  Maintain a neutral spine and pelvis.  Loop a resistance band around the wrists.  Next, reach 6-8 inches to the side with one arm.  The hand is placed down on the floor for 2 seconds before returning to the start position.   Typically, 8 repetitions are performed on one side then repeated on the opposite side.  This exercise activates the serratus anterior muscle.   To keep these muscles highly activated, push the upper back up toward the ceiling throughout the exercise.

High Plank on Balance Board

This exercise is performed in a push-up position with the hands on a balance board or BOSU.  The hands are positioned below the shoulders with the pelvis in a neutral position.  From this position, move the board in a circular fashion by touching the edges of the board to the floor.   Perform 30 seconds in one direction.  After a brief rest period, repeat the same sequence moving the board in the opposite direction.   This exercise activates the serratus anterior muscle.

Shoulder Taps

Begin in a push-up position with the hands under the shoulders.  Maintain a neutral spine and pelvis.  Perform the exercise by alternately touching the opposite shoulder with the opposing hands while maintaining a pelvic neutral plank position.   Perform 8 to 10 slow touches to each shoulder.  This exercise highly activates the serratus anterior muscle and to a lesser degree the lower trapezius.  To keep the serratus anterior highly activated, push the upper back up toward the ceiling throughout the exercise.

Ball Walkouts

Begin by lying over an exercise ball with both hands on the floor.  Walk your hands and body out from the ball.  Maintain a neutral spine and pelvis as you walk out from the ball.  Pause and hold the end position for 10 seconds.  Then walk back to the starting position.  Perform 8 repetitions is a slow and controlled fashion.

Bear Crawls

Assume an all-4’s position with the hands shoulder-width apart and the knees under the hips.  Elevate the knees from the floor so you are stabilized by 4 points of contact.  Begin by pushing the back up towards the sky to protract the scapula and activate the serratus anterior.  Crawl forward starting with your right hand and your left foot following with the left hand and the right foot.  After each step, pause briefly to exhale. Take four steps or more depending on space, then turn around and bear crawl back.  To increase the challenge, crawl in both a forward and backward direction.

Final Thoughts

The 5 exercises shown in this article integrate the lower body, core, and upper body.  More specifically, these exercises challenge the rotator cuff and scapular muscles while simultaneously activating the core.  This is similar to how we function in sport and everyday life.   Closed-chain exercises are excellent for improving the coordination between muscles and adjacent body regions.  Integrate these exercises into a warm-up or as part of a stand-alone exercise program.  If you have questions, contact your physical therapist for help.