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My Top 5 LEAST Favorite Rehabilitation Exercises

Posted Dec 23 2008 9:43pm 1 Comment

I’ve been thinking about some posts like this for a while now, I don’t want to be too controversial but I wanted to talk about some common exercises that I never perform with my patients.  So, to begin, I want to clarify:

  • This purely just my opinion
  • I may be wrong
  • You may get great results with these exercises
  • Or you may get great results despite these exercises!

The Empty Can Exercise

I have been trying real hard the last several years to provide enough evidence that we shouldn’t be using the empty can exercise.  Still, it comes up and I suspect is still a fairly common exercise.   The legendary Dr. Frank Jobe was the first to recommend this exercise for the supraspinatus.  Since then it was widely popular as an exercise to isolate the supraspinatus.  To clarify, it is a good exercise for the supraspinatus, but not the best.  Jobe did discuss the empty can exercise in his classic 1983 article on shoulder exercises but he never mentioned that it “isolated” the supraspinatus.  As we all know, we can’t isolate the supraspinatus like this. 

empty-can

So why do I dislike this exercise?   Have you tried it?  It hurts.  Why does it hurt?  It is simple actually.  My EMG paper a few years ago discussed that EMG of the supraspinatus was the same between the empty can and full can exercise, but that the middle deltoid was significantly more active during the empty can.  This articles is free to read from the Journal of Athletic Training.

Simply said, if the deltoid overpowers the supraspinatus, the rotator cuff can not keep the humeral head centered within the glenoid fossa and superior migration occurs.  Superior humeral head migration = impingement.  Not good, and that is why it hurts.  There are numerous other anatomical and biomechanical reasons to not use the empty can exercise, but if the full can has the same EMG activity I don’t see the controversy.

Prone Hangs for Knee Extension

What do you do when your patient has some tightness and can’t achieve full knee extension?  That is a common dilemma as a knee flexion contracture is not good for our patients.  One option is prone hangs over the edge of the table.

prone-hang

Why do I dislike this exercise?   When someone can’t achieve full knee extension, there knee typically hurts and is uncomfortable stretching, especially when performing a low-load, long-duration stretch for 10+ minutes.  It is difficult for the patient to relax, avoid compensation, and sit still in this position.  What happens is the patient ends up rotating and flexing his hip to decrease knee extension, and thus minimize any potential benefit from the stretch.  Interestingly, I couldn’t even find a picture of this without a clinician in the photo holding their hip down, which isn’t very realistic for a stretch.

Working Through a Shoulder Shrug

Many times after shoulder surgery, we want to try to work on both passive and active range of motion.  When a patient is either tight (usually tight inferior capsule) or does not have adequate rotator cuff function (see empty can description above), a shrug may occur.  This can occur during many active and active-assisted ROM exercises such as rope and pulley, L-bar exercises, or simply just during arm elevation.

shrug

Why do I dislike this exercise?   It comes down to what is actually happening with the shrug.  If the inferior capsule is tight or the cuff can’t center the humeral head, again, superior humeral head migration occurs.  And what does that cause?  That’s right, impingement.   Over the years I have seen patients try to work through a shrug by working through the exercise or even by watching themselves in a mirror.  Unfortunately, this isn’t a neuromuscular pattern that needs to be relearned.  You need to solve the cause of the shrug first and foremost.

Stool Scooting for Hamstrings

Many patients need to work on hamstring strength.  One rehab exercise I see is stool scooting, where the patient sits and digs their heels into the ground, scooting around your clinic. 

stool

Why do I dislike this exercise?  This one isn’t too low down the list for me, I don’t think it is that bad.  But, I really don’t think it is good either.  You really are not getting a lot of hamstring strengthening, you are basically just work on endurance.  But, I tend to not use this because it really irritates patients.  I have seen hamstring tendonitis, pes irritation, and other annoyances that could be avoided.  Sorry, I don’t use this exercise so I didn’t even have a picture of it, nice stool, though!

Behind the Back Internal Rotation Stretching

The winner of my least favorite rehabilitation exercise is hand down the behind the back stretch for shoulder internal rotation.  This is performed by the patient actively, with the assist of a towel, or even manually by a clinician.

ir-behind-back

Why is this my least favorite common rehabilitation exercise?   It places the rotator cuff at an extremely disadvantageous position, placing considerable torque on the rotator cuff insertion.  This can lead to even more irritation or worse for the cuff.  This really isn’t a pure IR stretch, either, it is a combined motion of shoulder extension, adduction, and IR.  My thought is that if the patient is limited in that motion, there must be a reason.  Rather than just jam my hand behind my back and try to push harder or use a towel to torque even more, I would rather try to address cause, not the effect.

Sorry for the controversy!  I want to hear your thoughts, do you agree or disagree?  What else would you add to this list?  I’ll work on a follow-up to this post on my recommendations on how to achieve the same results without having to perform any of the above exercises.

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Comments (1)
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I know this post is old, but if you still keep an eye on it, I'd love to know what you suggest to replace the behind the back stretch....I am having a lot of difficulty with this and the shrugging as mentioned above. I just had surgery for bone spur removal and tightening of the capsule (labrum pleat) for a loose shoulder. I am 3.5 months out and seem to be having some issues with being so tight.
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