Strength and conditioning specialists working with an individual with labral pathology need to be aware of positions and lifts that stress the superior labrum and proximal biceps tendon. Avoidance of the high-five position will reduce stress on the anterior GH joint and decrease the amount of peel-back stress in end-range ER. Additionally, caution is warranted in any exercise that places increased stress on the proximal biceps tendon because of anterior migration of the humeral head. Common exercises that may cause irritation of the biceps tendon or the superior labrum are dips, incline bench press, and military press. Focus of strengthening should be on rotator cuff strength and closed kinetic chain stabilization, as previously mentioned, and scapular strength, stability, and rhythm.
1. Abrams G and Safran M. Diagnosis and management of superior labrum
anterior posterior lesions in overhead athletes. Br J Sports Med
44: 311-318, 2010.
2. American College of Sports Medicine. Position stand on the recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness in healthy adults. Med Sci Sports Exerc
22: 265-274, 1990.
3. American Physical Therapy Association. Guide to Physical Therapist Practice (2nd ed). Phys Ther
81: 9-744, 2001.
4. Andrews J, Carson W, and McLeod W. Glenoid labrum
tears related to the long head of the biceps. Am J Sports Med
13: 337-341, 1985.
5. Baechle T, Earle R, and Wathen D. Resistance training. In: Essentials of Strength Training and Conditioning
(3rd ed). Baechle T and Earle R, eds. Champaign, IL: Human Kinetics, 2008. pp. 381-412.
6. Bak K, Cameron EA, and Henderson IJ. Rupture of the pectoralis major: A meta-analysis of 112 cases. Knee Surg Sports Traumatol Arthrosc
8: 113-119, 2000.
7. Baltaci G. Subacromial impingement syndrome in athletes: Prevention and exercise programs. Acta Orthop Traumatol Turc
37: 128-138, 2003.
8. Bell J. Arthroscopic management of multidirectional instability. Orthop Clin North Am
41: 357-365, 2010.
9. Bitter N, Clisby E, Jones M, Magarey M, Jaberzadeh S, and Sandow M. Relative contributions of infraspinatus and deltoid during external rotation in healthy shoulders. J Shoulder Elbow Surg
16: 563-568, 2007.
10. Boettcher C, Ginn K, and Cathers I. Which is the optimal exercise to strengthen the supraspinatus? Med Sci Sports Exerc
41: 1979-1983, 2009.
11. Bottoni C, Wilckens J, DeBerardino T, D'Alleyrand J, Rooney R, Harpstrite J, and Arciero R. A prospective, randomized evaluation of arthroscopic stabilization versus nonoperative treatment in patients with acute, traumatic, first-time shoulder dislocations. Am J Sports Med
30: 576-580, 2002.
12. Brislin K, Field L, and Savoie F. Complications after arthroscopic rotator cuff
23: 124-128, 2007.
13. Brockmeier S, Voos J, Williams R, Altchek D, Cordasco F, and Allen A. Outcomes after arthroscopic repair of type-II SLAP lesions. J Bone Joint Surg Am
91: 1595-1603, 2009.
14. Burkhart S and Morgan C. The peel-back mechanism: Its role in producing and extending posterior type II SLAP lesions and its effect on SLAP repair rehabilitation
14: 37-40, 1998.
15. Burkhart S, Morgan C, and Kibler W. The disabled throwing shoulder: spectrum of pathology Part I: pathoanatomy and biomechanics. Arthroscopy
19: 404-420, 2003.
16. Cahill BR. Osteolysis of the distal part of the clavicle in male athletes. J Bone Joint Surg Am
64: 1053-1058, 1982.
17. Callanan M, Tzannes A, Hayes K, Paxinos A, Walton J, and Murrell GA. Shoulder instability
. Diagnosis and management. Aust Fam Physician
30: 655-661, 2001.
18. Caprise P and Sekiya J. Open and arthroscopic treatment of multidirectional instability of the shoulder. Arthroscopy
22: 1126-1131, 2006.
19. Carreira D, Mazzocca A, Oryhon J, Brown F, Hayden J, and Romeo A. A prospective outcome evaluation of arthroscopic Bankart repairs: Minimum 2-year follow-up. Am J Sports Med
34: 771-777, 2006.
20. Cho N and Rhee Y. The factors affecting the clinical outcome and integrity of arthroscopically repaired rotator cuff
tears of the shoulder. Clin Orthop Surg
1: 96-104, 2009.
21. Cohen B, Romeo A, and Bach B. Shoulder injuries. In: Clinical Orthopaedic Rehabilitation
(2nd ed). Brotzman SB and Wilk KE, eds. Philadelphia, PA: Mosby, 2003. pp. 125-250.
22. Cools A, Declercq G, Cambier D, Mahieu N, and Witvrouw E. Trapezius activity and intramuscular balance during isokinetic exercise in overhead athletes with impingement symptoms. Scand J Med Sci Sports
17: 25-33, 2007.
23. Costouros J, Porramatikul M, Lie D, and Warner J. Reversal of suprascapular neuropathy following arthroscopic repair of massive supraspinatus and infraspinatus rotator cuff
23: 1152-1161, 2007.
24. Durall C, Giangarra C, and Humphrey C. Anterior capsulolabral reconstruction. In: Postsurgical Rehabilitation Guidelines for the Orthopedic Clinician
. Cioppa-Mosca J, Cahill J, Cavanaugh J, Corradi-Scalise D, Rudnick H, and Wolf A, eds. St Louis, MO: Mosby, 2006. pp. 526-534.
25. Dutton M. The shoulder complex. In: Orthopaedic Examination, Evaluation, and Intervention
(2nd ed). Dutton M, ed. New York, NY: McGraw Hill, 2008. pp. 516-519.
26. Ellenbecker T, Bailie D, and Kibler W. Rehabilitation
after mini-open and arthroscopic repair of the rotator cuff
. In: Postsurgical Orthopedic Sports Rehabilitation: Knee & Shoulder
. Manske R, ed. St Louis, MO: Mosby, 2006. pp. 671-677.
27. Ellenbecker T and Cools A. Rehabilitation
of shoulder impingement syndrome and rotator cuff
injuries: An evidence-based review. Br J Sports Med
44: 319-327, 2010.
28. Ellenbecker T and Mattaliino A. Glenohumeral joint range of motion and rotator cuff
strength following arthroscopic anterior stabilization with thermal capsulorraphy. J Orthop Sports Phys Ther
29: 160-167, 1999.
29. Ellenbecker T, Roetert E, Bailie D, Davies G, and Brown S. Glenohumeral joint total rotation range of motion in elite tennis players and baseball pitchers. Med Sci Sports Exerc
34: 2052-2056, 2002.
30. Erol O, Ozcakar L, and Celiker R. Shoulder rotator strength in patients with stage I-II subacromial impingement: Relationship to pain, disability, and quality of life. J Shoulder Elbow Surg
17: 893-897, 2008.
31. Escamilla R, Yamashiro K, Paulos L, and Andrews J. Shoulder muscle activity and function in common shoulder rehabilitation
. Sports Med
39: 663-685, 2009.
32. Feigenbaum MS and Pollock ML. Prescription of resistance training for health and disease. Med Sci Sports Exerc
31: 38-45, 1999.
33. Galatz L, Ball C, Teefey S, Middleton W, and Yamaguchi K. The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff
tears. J Bone Joint Surg Am
86: 219-224, 2004.
34. Garth WP, Allman FL, and Armstrong WS. Occult anterior subluxations of the shoulder in noncontact sports. Am J Sports Med
15: 579-585, 1987.
35. Ghilarducci M and Maxey L. Rotator cuff
repair and rehabilitation
. In: Rehabilitation for the Postsurgical Orthopedic Patient
(2nd ed). Maxey L and Magnusson J, eds. St Louis, MO: Mosby, 2007. pp. 70-84.
36. Goertzen M, Schoppe K, Lange G, and Schulitz KP. Injuries and damage caused by excess stress in bodybuilding and power lifting. Sportverletz Sportschaden
3: 32-36, 1989.
37. Graichen H, Hinterwimmer S, von Eisenhart-Rothe R, Vogl T, Englmeier K, and Eckstein F. Effect of abducting and adducting muscle activity on glenohumeral translation, scapular kinematics and subacromial space width in vivo. J Biomech
38: 755-760, 2005.
38. Gross ML, Brenner SL, Esformes I, and Sonzogni JJ. Anterior shoulder instability
in weight lifters. Am J Sports Med
21: 599-603, 1993.
39. Halder A, Zhao K, Odriscoll S, Morrey B, and An K. Dynamic contributions to superior shoulder stability. J Orthop Res
19: 206-212, 2001.
40. Haupt H. Upper extremity injuries associated with strength training. Clin Sports Med
20: 481-490, 2001.
41. Jaggi A and Lambert S. Rehabilitation
for shoulder instability
. Br J Sports Med
44: 333-340, 2010.
42. Jennings J, Davies G, Tanner S, and Fowler B. Examination, surgical procedures, and rehabilitation
procedures for superior labral anterior and posterior (SLAP) injuries. In: Postsurgical Orthopedic Sports Rehabilitation: Knee & Shoulder
. Manske RC, ed. St Louis, MO: Mosby, 2006. pp. 613-625.
43. Jobe F, Giangarra C, Kvitne R, and Glousman R. Anterior capsulolabral reconstruction of the shoulder in athletes in overhand sports. Am J Sports Med
19: 428-434, 1991.
44. Jobe F, Kvitne R, and Giangarra C. Shoulder pain in the overhand or throwing athlete. The relationship of anterior instability and rotator cuff
impingement. Orthop Rev
18: 963-975, 1989.
45. Jobe F, Schwab D, and Brewster C. Anterior capsular reconstruction. In: Rehabilitation for the Postsurgical Orthopedic Patient
(2nd ed). Maxey L and Magnusson J, eds. St Louis, MO: Mosby, 2007. pp. 50-56.
46. Jost B, Pfirrmann C, Gerber C, and Switzerland Z. Clinical outcome after structural failure of rotator cuff
repairs. J Bone Joint Surg Am
82: 304-314, 2000.
47. Keener J, Wei A, Kim H, Paxton E, Teefey S, Galatz L, and Yamaguchi K. Revision arthroscopic rotator cuff
repair: Repair integrity and clinical outcome. J Bone Joint Surg Am
92: 590-598, 2010.
48. Kendall F, McCreary E, Provance P, Rodgers M, and Romani W. Upper extremity and shoulder girdle. In: Muscles: Testing and Function With Pain and Posture
. Baltimore, MD: Lippincott Williams & Wilkins, 2005. pp. 328-329.
49. Kerr Z, Collins C, and Comstock R. Epidemiology of weight-training-related injuries presenting to United States emergency departments, 1990 to 2007. Am J Sports Med
38: 765-771, 2010.
50. Kibler W, McMullen J, and Uhl T. Shoulder rehabilitation
strategies, guidelines, and practice. Orthop Clin North Am
32: 527-528, 2001.
51. Kibler W and Sciascia A. Current concepts: Scapular dyskinesis. Br J Sports Med
44: 300-305, 2010.
52. Kibler W, Sciascia A, and Dome D. Evaluation of apparent and absolute supraspinatus strength in patients with shoulder injury using the scapular retraction test. Am J Sports Med
34: 1643-1647, 2006.
53. Kibler W, Sciascia A, Uhl T, Tambay N, and Cunningham T. Electromyographic analysis of specific exercises for scapular control in early phases of shoulder rehabilitation
. Am J Sports Med
36: 1789-1798, 2008.
54. Kim S, Ha K, Kim S, and Choi H. Results of arthroscopic treatment of superior labral lesions. J Bone Joint Surg Am
84: 981-985, 2002.
55. Kolber MJ, Beekhuizen K, Cheng M, and Hellman M. Shoulder joint and muscle characteristics in the recreational weight training population. J Strength Cond Res
23: 148-157, 2009.
56. Kolber MJ, Beekhuizen K, Cheng M, and Hellman M. Shoulder injuries attributed to resistance training: A brief review. J Strength Cond Res
24: 1696-1704, 2010.
57. Kolber MJ, Corrao M, and Hanney W. The relationship between exercise selection and reported shoulder pain during weight-training. Poster presented at: National Strength and Conditioning Association, National Conference; July 2010; Orlando, FL.
58. Kolber MJ, Beekhuizen K, Cheng MS, and Hellman M. The effect of a 4-week educational intervention on shoulder joint and muscle characteristics in recreational weight-training participants: A pilot study [abstract]. J Orthop Sports Phys Ther
39: OPO2213, 2009.
59. Kolber MJ. Shoulder Joint and Muscle Characteristics in the Recreational Weight Training Population
[dissertation]. Ft. Lauderdale, FL: Department of Physical Therapy, Nova Southeastern University; 2007.
60. Konig M and Biener K. [Sport-specific injuries in weight lifting]. Schweiz Z Sportmed
38: 25-30, 1990.
61. Koo S and Burkhart S. Rehabilitation
following arthroscopic rotator cuff
surgery. Clin Sports Med
29: 203-211, 2010.
62. Krupp R, Kevern M, Gaines M, Kotara S, and Singleton S. Long head of the biceps tendon pain: Differential diagnosis and treatment. J Orthop Sports Phys Ther
39: 55-70, 2009.
63. Lestos A, Sagantos D, Michalis M, Baschalis P, and Baltopoulos P. Occult shoulder instability
in weight lifters. In: The 14th International Jerusalem Symposium on Sports Medicine: Program and Book of Abstracts
. Jerusalem: The Israel Society of Sports Medicine, 1997.
64. Levinson M. Superior labrum
anterior to posterior (SLAP) repair. In: Postsurgical Rehabilitation Guidelines for the Orthopedic Clinician
. Cioppa-Mosca J, Cahill J, Cavanaugh J, Corradi-Scalise D, Rudnick H, and Wolf A, eds. St Louis, MO: Mosby, 2006. pp. 546-554.
65. Levinson M and Altchek D. Capsular shift procedures: Neer and multidirectional instabilities. In: Postsurgical Rehabilitation Guidelines for the Orthopedic Clinician
. Cioppa-Mosca J, Cahill J, Cavanaugh J, Corradi-Scalise D, Rudnick H, and Wolf A, eds. St Louis, MO: Mosby, 2006. pp. 551-560.
66. Lewis A, Kitamura T, and Bayley J. Mini symposium: Shoulder instability
(ii). The classification of shoulder instability
: New light through old windows! Curr Orthop
18: 97-108, 2004.
67. Lippitt S and Matsen F. Mechanisms of glenohumeral joint stability. Clin Orthop Relat Res
291: 20-28, 1993.
68. Lovering R and Russ D. Fiber type composition of cadaveric human rotator cuff
muscles. J Orthop Sports Phys Ther
38: 674-680, 2008.
69. Ludewig P and Borstead J. The shoulder complex. In: Joint Structure and Function: A Comprehensive Analysis
. Levangie P and Norkin C, eds. Philadelphia, PA: FA Davis Company, 2005. p. 257.
70. Oatis CA. Mechanics and Pathomechanics of Muscle Activity at the Shoulder Complex. In: Kinesiology: The Mechanics and Pathomechanics of Human Movement
(2nd ed). Oatic, CA ed. Baltimore, MD: Lippincott Williams & Wilkins, 2009. p. 172.
71. Malanga G, Jenp Y, Growney E, and An K. EMG analysis of shoulder positioning in testing and strengthening the supraspinatus. Med Sci Sports Exerc
28: 661-664, 1996.
72. Maschi R and Fives G. Rotator cuff
repair: Arthroscopic and open. In: Postsurgical Rehabilitation Guidelines for the Orthopedic Clinician
. Cioppa-Mosca J, Cahill J, Cavanaugh J, Corradi-Scalise D, Rudnick H, and Wolf A, eds. St Louis, MO: Mosby, 2006. pp. 499-509.
73. Meister K and Andrews J. Classification and treatment of rotator cuff
injuries in the overhead athlete. J Orthop Sports Phys Ther
18: 413-420, 1993.
74. Meller R, Krettek C, Gosling T, Wahling K, Jagodzinski M, and Zeichen J. Recurrent shoulder instability
among athletes: Changes in quality of life, sports activity, and muscle function following open repair. Knee Surg Sports Traumatol Arthrosc
15: 295-304, 2007.
75. Mohtadi NGH. Advances in the understanding of anterior instability of the shoulder. Clin Sports Med
10: 863-870, 1991.
76. Moraes G, Faria C, and Teixeira-Salmela L. Scapular muscle recruitment patterns and isokinetic strength ratios of the shoulder rotator muscles in individuals with and without impingement syndrome. J Shoulder Elbow Surg
17: 48S-53S, 2008.
77. Muraki T, Yamamoto N, Zhao K, Sperling J, Steinmann S, Cofield R, and An K. Effect of posteroinferior capsule tightness on contact pressure and area beneath the coracoacromial arch during pitching motion. Am J Sports Med
38: 600-607, 2010.
78. Namdari S and Green A. Range of motion limitation after rotator cuff
repair. J Shoulder Elbow Surg
19: 290-296, 2010.
80. National Strength and Conditioning Association: Strength & conditioning professional standards and guidelines. Strength Cond J
31(5): 14-38, 2009.
81. Neer C. Impingement lesions. Clin Orthop Relat Res
173: 70-77, 1983.
82. Nho S, Shindle M, Sherman S, Freedman K, Lyman S, and MacGillivray J. Systematic review of arthroscopic rotator cuff
repair and mini-open rotator cuff
repair. J Bone Joint Surg Am
89: 127-136, 2007.
83. Noffal G. Isokinetic eccentric-to-concentric strength ratios of the shoulder rotator muscles in throwers and nonthrowers. Am J Sports Med
31: 537-541, 2003.
84. Ogston J and Ludewig P. Differences in 3-dimensional shoulder kinematics between persons with multidirectional instability and asymptomatic controls. Am J Sports Med
35: 1361-1370, 2007.
85. Rathburn J and MacNab I. The microvascular pattern of the rotator cuff
. J Bone Joint Surg Am
86. Reinold M, Wilk K, Macrina L, Dugas J, and Andrews J. Rehabilitation
after thermal-assisted capsular shrinkage of the glenohumeral joint. In: Postsurgical Rehabilitation Guidelines for the Orthopedic Clinician
. Cioppa-Mosca J, Cahill J, Cavanaugh J, Corradi-Scalise D, Rudnick H, and Wolf A, eds. St Louis, MO: Mosby, 2006. pp. 587-604.
87. Smith J, Dietrich C, Kotajarvi B, and Kaufman K. The effect of scapular protraction on isometric shoulder rotation strength in normal subjects. J Shoulder Elbow Surg
15: 339-343, 2006.
88. Tyler T, Nicholas S, and Seneviratne A. The Bankart lesion. In: Postsurgical Rehabilitation Guidelines for the Orthopedic Clinician
. Cioppa-Mosca J, Cahill J, Cavanaugh J, Corradi-Scalise D, Rudnick H, and Wolf A, eds. St Louis, MO: Mosby, 2006. pp. 569-579.
89. Tyler T and Zeman C. Superior labral anterior posterior repair (SLAP repair). In: Rehabilitation for the Postsurgical Orthopedic Patient
(2nd ed). Maxey L and Magnusson J, eds. St Louis, MO: Mosby, 2007. pp. 97-107.
92. Walch G, Boileau P, Noel E, and Donell S. Impingement of the deep surface of the supraspinatus tendon on the posterosuperior glenoid rim: An arthroscopic study. J Shoulder Elbow Surg
1: 238-245, 1992.
93. Weiser W, Lee T, McMaster W, and McMahon P. Effects of simulated scapular protraction on anterior glenohumeral stability. Am J Sports Med
27: 801-805, 1999.
94. Wilk K, Crockett H, and Andrews J. Rehabilitation
after rotator cuff
surgery. Tech Shoulder Elbow Surg
1: 128-144, 2000.
95. Wilk K, Harrelson G, and Arrigo C. Shoulder rehabilitation
. In: Physical Rehabilitation of the Injured Athlete
(3rd ed). Andrews J, Harrelson G, and Wilk K, eds. Philadelphia, PA: Saunders, 2004. pp. 545-553.
96. Yu J and Habib P. Common injuries related to weightlifting: MR imaging perspective. Semin Musculoskelet Radiol
9: 289-301, 2005.