“Prehab” Exercises for the Shoulder

Musculoskeletal injuries are commonplace in the fire industry; it’s rare to find a seasoned firefighter without some sort of nagging pain. And although fitness awareness and fitness levels have increased among firefighters in recent years, injuries continue to take firefighters “out of service,” especially when surgery, recovery and post-op therapy are prescribed.

The common adage “expect the unexpected” is a bit of an oxymoron, but in our profession, it couldn’t be truer. While fire, rescue and even “man down” emergencies are routine in volume, each incidence has its own set of circumstances and can therefore present diverse challenges. But, as mentioned in previous articles, we don’t know when we’ll be called upon to mitigate an emergency. This means that it’s almost impossible to be ready for the unexpected, and warm up our bodies for the physical challenge of an emergency call. And as we all know, a proper warm-up is essential for athletes if they want to minimize the potential for injury.

All of this may make it sound as if there’s no way for us to keep from injuring ourselves, but in fact, the opposite is true. The key: Stay fit and flexible, and implement some “prehab” exercises into your exercise routine.

What Is It & Where Do We Need It?
The term “prehab” simply means performing some focused exercises with the intent of preventing future injuries to the area that’s being focused on. Often, the exercises used in therapy to rehab an injury are the same ones used as prehab exercises, which makes sense because the intention is to isolate the specific, injured area in order to strengthen it. But you don’t want to wait for an injury to occur to start figuring out how to correct it or help it heal. So you must implement prehab exercises before the injury occurs in order to increase your strength, flexibility and injury resilience.

Shoulders, lower backs and knees are the leading areas of injuries in our department. On a single incident, one firefighter can turn hydrants, extend hose, force entry, pull ceiling and ventilate a roof. These are demanding tasks and very taxing on the shoulder. Increasing the strength and flexibility of the shoulder is therefore essential to injury prevention.

Strengthening the Rotator Cuff
The main joint of the shoulder, the glenohumeral joint, or the rotator cuff, is a ball-and-socket joint made up of four small muscles: the Supraspinatus, Infraspinatus, Teres Minor and the Subscapularis. Together, these muscles are responsible for shoulder stability and integrity; they also help enable the arm to rotate in a circular fashion or to hinge outward and upward, away from the body. While this range of motion makes the shoulder highly adaptable and usable, it also makes it prone to instability and injury.

Three prehab exercises that specifically target the rotator cuff are the external rotation, internal rotation and the “Halo.” The first two exercises are intended to target the small muscles and will require the use of an exercise band of medium resistance. (Note: An exercise band is a rubber tube or band about 3 feet in length.) The latter exercise is extremely beneficial for increasing the shoulder’s range of motion.  

External Rotation
Stand with the upper arm secured to the torso and the elbow bent at 90 degrees. Tie the exercise band to something secure like a doorknob or post, so that it’s level with the hand you’ll be using for the exercise. Start with the hand positioned next to the stomach and rotate the hand outward as far as is comfortable (you probably won’t go far beyond 180 degrees from the starting position). The amount of resistance is determined by how far away you are from the point where you’ve secured the exercise band. Return back to the starting position and repeat 20 times. Keep a smooth and slow tempo. The muscles you’re working are small, stabilizing muscles, and these exercises are intended to isolate them. Poor form or too much resistance can be counterproductive and can actually cause injury.

Internal Rotation
Begin with the exercise band, upper arm and elbow in the same position as the external rotation. Then rotate your body so that your hand and the band tension are away from your body. Next, pull inward so that your hand ends up touching your stomach. Remember to keep the upper arm and elbow stationary so that the only thing moving is the lower arm, which should be moving toward your body and back to the starting position.

The Halo
The Halo is an exercise that can be performed with a kettle bell or exercise plate. The key to this exercise is the range of motion you can accomplish, not the amount of weight you can support. To begin, grasp a kettle bell or weight and raise it overhead. With the elbows bent, move the weight in a circular motion around your head, mimicking a halo. Try to make as big a circle as possible. Do 20 reps and switch direction. You can also do one repetition in one direction, and then do the next repetition in the opposite direction.

There are different variations of the Halo, but the goal of this exercise is to mobilize the shoulder while the arm is in an overhead position. Start with minimal weight and work within your own range of motion. Frequent application of the Halo will increase your shoulder range of motion and may even eliminate some prior shoulder impingement and pain.

Commit to Prehab
Although there are numerous other prehab exercises for the shoulder, these three are basic ones that can be performed in a minimal amount of time. The key is to have a routine that’s easy to perform, doesn’t take a lot of time, and that you’ll be willing to do frequently. It doesn’t do a bit of good if you have scores of exercises in mind, but can’t find the time to do them.

These three basic shoulder exercises can also be performed multiple times a week without the concern of overtraining. They can be done prior to every upper-body workout as a warm-up, or done by themselves as a prehab workout. The bottom line: Commitment to prehab, whether it’s your shoulders, back or knees, will pay dividends by minimizing your potential for injuries and prolonging your overall health and wellness.