Physical Therapy Corner: Shoulder Range of Motion Exercises The shoulder is the most flexible joint in the human

body. The anatomical structure of this joint enables it to have an incredible amount of freedom or range of motion. The ability to move the shoulder joint in a wide variety of directions is vital for complete functionality in sporting activities. Increased mobility of the shoulder joint comes at the potential expense of joint stability. Therefore anyone can experience shoulder problems. Active young people, especially children and athletes often develop shoulder injuries. After the age of 25, many individuals develop shoulder pain from the wear and tear of routine activities. Individuals who reach middle age, and use their shoulders frequently in their specific occupation are particularly susceptible to problems. Other groups especially prone to shoulder problems are weekend athletes and do it yourself painters. Early treatment is imperative for a good prognosis. So, if you have shoulder pain, see your doctor without any hesitation. It is natural to react to shoulder pain by not moving your shoulder, which can lead to complete loss of shoulder mobility. Your doctor may refer you to a physical therapist. After evaluation, an exercise program will be designed to keep your shoulder in motion. One good exercise which can improve motion and decrease shoulder pain is Codmans Exercise or Pendulum Exercise. This exercise may be performed in a prone (face-down) lying position or standing while leaning on a chair with the opposite arm.

PURPOSE: To relax the muscles in your shoulder. To relieve pain and increase motion. POSITION: Lie on your stomach close to the edge of the bed. Let your weak arm hang over the edge of the bed. Relax your shoulder, arm and hand. Let your shoulder blade relax and drop down. ACTION: Slowly and gently swing your arm forward and back. Do not use your neck muscles. Relax them. It might be easier to have someone else gently start swinging your arm. As pain decreases, increase your swing. Initially arm swing should begin at 15 degree angles and eventually progress to 30-45 degree angles as pain subsides within time. The duration of the swing should initially be 15 seconds and eventually progress to 3-5 minutes.

PURPOSE: To relax the muscles in your shoulder, in order to relieve pain and to increase motion. POSITION: Stand and hold onto a sturdy chair with your good arm. Bend forward at the waist and bend your knees to help protect your back. Relax your weak arm, let it hang limp. Relax your shoulder blade and let it drop. ACTION: Keep your shoulder relaxed and use body motion to swing your arm in small circles. Stand tall and relaxed. Repeat motion and change direction of circles. The duration of the circles should initially be 30 seconds and eventually progress to 3-5 minutes. To get a rough idea of the type of motion involved, the image to the side is an animation; if it is not moving, try reloading this page.

Shoulder Exercise Program

Please consult with your physician before beginning any exercise program using Press-Grip products. This program is a general guide as your physician will help you determine the proper number of repetitions, sets and the proper weights for your program. This program is designed to improve flexibility and strength in the small muscles of the shoulder. The following eight exercises should be performed with 12-15 repetitions per set, three sets per workout for each arm and shoulder: Shoulder Flexion Rotator Cuff Elevation Shoulder Abduction Horizontal Abduction Shoulder Extension Horizontal Adduction External Rotation Internal Rotation The overall program should normally be completed three times per week. The following weight measurements are available: .5 Pounds = .5 Pound Weight 1.0 Pounds = 1.0 Pound Weight 1.5 Pounds = Bar 2.0 Pounds = 2.0 Pound Weight 2.5 Pounds = Bar + 1.0 Pound Weight 3.0 Pounds = 3.0 Pound Weight 3.5 Pounds = Bar + 2.0 Pound Weight 4.5 Pounds = Bar + 3.0 Pound Weight Always place weight at Level 1, which is as close to the grip as possible. Hold bar in center with the weight in your hand. NEVER USE MORE THAN ONE WEIGHT ON BAR AT A TIME!! shoulder.htm - topshoulder.htm - topUp to Top of Page

Shoulder Flexion

Stand or sit with your arm at your side. Hold the Press-Grip in the center, with your palm pointing towards your thigh. Keeping your elbow straight, raise your arm, leading with the thumb as shown in the above illustration. Continue slowly until your arm is fully extended over your head.

Return SLOWLY to the starting position. Repeat until the exercise set is completed.

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Rotator Cuff Elevation

(Supraspinatus)

Stand with your arm at your side, holding the Press-Grip in the center. Keeping your elbow straight, rotate your arm so that your thumb is pointing downward as shown in the illustration above. Bring your arm forward so that it is slightly in front of your body. Raise your arm slowly to 80 degrees, keeping your elbow extended and thumb pointing toward the floor. Return SLOWLY to the starting position. Repeat until the exercise set is completed.

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Shoulder Abduction

Stand with your arm at your side. Hold the Press-Grip in the center, with your palm pointing towards your thigh as shown in the above illustration. Lift your arm to shoulder height, keeping your elbow straight. Return SLOWLY to the starting position. Repeat until the exercise set is completed.

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Horizontal Abduction
Stand next to a table or bench, leaning forward from the hips, with your arm perpendicular to the

floor as shown in the above illustration. Hold the Press-Grip in the center, using your other arm for balance on the bench or table. Keeping your elbow straight, lift your arm up and to the side until your arm is parallel to the floor. (DO NOT LIFT YOUR HAND HIGHER THAN YOUR SHOULDER.) Return SLOWLY to the starting position. Begin the next repetition right away to avoid unnecessary traction on your shoulder. Repeat until the exercise set is completed.

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Shoulder Extension

Stand next to a table or bench, leaning forward from the hips, with your arm perpendicular to the floor as shown in the above illustration. Hold the Press-Grip in the center, using the other arm for balance on the bench or table. Keeping your elbow straight, lift your arm backwards until it is parallel to the floor. (KEEP YOUR ARM CLOSE TO YOUR UPPER BODY.) Return SLOWLY to the starting position. Begin the next repetition right away to avoid unnecessary traction on your shoulder. Repeat until the exercise set is completed.

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Horizontal Adduction

Lie on your back on the floor or on a bench, holding the Press-Grip in the center. Hold your arm out to the side, with the elbow straight and the palm facing the ceiling as shown in the illustration above. Raise your arm slowly until the hand is pointed at the ceiling. Return SLOWLY to the starting position. Repeat until the exercise set is completed.

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External Rotation
(Infraspinatus and teres minor)

Lie on your side opposite of the shoulder you are exercising, holding the Press-Grip in the center. With your arm at your side, bend your elbow at 90 degrees as shown in the above illustration. Lift your hand toward the ceiling. (KEEP YOUR ARM AND ELBOW CLOSE TO YOUR UPPER BODY.) Return SLOWLY to the starting position. Repeat until the exercise set is completed.

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Internal Rotation
(Subscapularis)

Lie on your side of the shoulder you are exercising, holding the Press-Grip in the center. Pull your elbow from underneath your side, slightly in front of your trunk. Place a pillow under your chest, bring your arm slightly forward and bend your elbow 90 degrees. Keeping your elbow bent at 90 degrees lift your arm toward your chest. (DO NOT MOVE YOUR UPPER BODY; THE MOVEMENT SHOULD BE CONFINED TO YOUR SHOULDER.) Return SLOWLY to the starting position. Repeat until the exercise set is completed.

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shoulder biomechanics
SHOULDER KINEMATICS SCAPULO-HUMERAL RHYTHM The scapula must upwardly rotate to allow overhead activity. Scapulo-humeral rhythm= The first 45 degrees of humeral abduction is accompanied by movement of the scapula. For every 15 degrees of abduction that occurs there is 10 degrees at the gleno-humeral joint and 5 degrees at the scapulo-thoracic joint. The range of glenohumeral to scapulothoracic motion is 2:1 Loss of this smooth motion (normal scapulo-humeral rhythm) can result from alterations in the normal postural relationships of the humerus and scapula. HUMERO-THORACIC RHYTHM Represented by the Global Diagram Images2/shouldmech1.jpg The global diagram is an effective method for displaying humerothoracic positions because it allows presentation of both the planes of elevation ("longitudes") and the angles of elevation ("latitudes"). The details of humeral motions can be indicated on a global diagram as a series of points or arrows.

Codman's Paradox: Codman proposed that the completely elevated humerus could be shown to be in either extreme external rotation or in extreme internal rotation by lowering it either in the coronal or sagittal plane, respectively, without allowing rotation about the humeral shaft axis. Using the global diagram to examine Codman's paradox: Images2/shouldmech2.jpg Images2/shouldmech2.jpg Carry out the movement sequence described below without allowing rotation about the humeral shaft axis: (1) Place the arm at the side with the forearm internally rotated across the stomach. (2) Elevate the arm 180 degrees in the plus 90 degree thoracic (sagittal) plane. (3) Lower the arm 180 degrees to the side in the 0 degree (coronal) plane. Note that the forearm now points 180 degrees from its original position.

Kinematic Descriptors Shoulder motion can be described / modeled using 3 possible systems: 1. Euler/Cardan angles - describes the pathway of motion in 3 planes 2. Joint Co-ordinate System - segment position is in relation to the joint itself, rather than the coronal or sagittal planes.

3. Helical Screw Axis - most accurate - during an arc of movement the position & orientation of the axis will change & the path followed by the axis defines the arc of movement. INDIVIDUAL JOINT MOTION Glenohumeral jointImages2/shouldmech3.jpg

Images2/shouldmech3.jpg = minimally constrained ball-and-socket joint Motion= 1. Rotation 2. Translation (gliding) 3. Rolling (combination of rotation & translation) Stabilisers: Static: 1. Humeral version - neck-shaft angle 135deg., Head retroverted 20deg. 2. Glenoid version - 7deg. retroversion, 5deg. superior tilt 3. Articular Conformity 4. Glenoid Labrum - deepens socket by 5-9mm, resticts translation, attachment for glenohumeral ligaments. 5. Intra-Articular Pressure - may have a role in centering the humeral head, particularly in the neutral or early ranges of motion. 6. Glenohumeral Ligaments and CapsuleImages2/shouldmech4.jpg Images2/shouldmech4.jpg 7. Coracohumeral Ligament - primary restraint to inferior translation of the adducted arm and to external rotation.

Dynamic: 1. Joint Compression - from contraction of the rotator cuff muscles 2. Rotator Cuff 3. Proprioception 4. Biceps Tendon - When the arm is internally rotated, tension on the biceps reduces anterior humeral head translation. When the arm is externally rotated, the biceps limits posterior translation. 5. Scapular Rotators - altered scapulothoracic motion may be related to glenohumeral instability Acromioclavicular joint = plane, synovial joint with meniscus Motion: 1. Forward rotation of the clavicle relative to the scapula - constrained by the conoid ligament 2. Backward rotation - constrained by the trapezoid lig. 3. Axial rotation - constrained by both ligaments.

Sternoclavicular joint = synovial joint, meniscus Stabilisers: 1. costoclavicular ligaments 2. sternoclavicular ligament 3. subclavius muscle (from costochondral jx of 1st rib to subclavian groove undersurface of clavicle) Motion: 1. protraction/retraction 2. elevation/depression 3. rotation Total motion = 40deg. during arm elevation Motion is reciprocal with ACJ motion Scapulothoracic articulation Motion: 1. protraction/retraction 2. elevation/depression 3. rotation The lack of true joint allows for the wide range of shoulder motion The range of glenohumeral to scapulothoracic motion is 2:1 scapula twists at maximal arm elevation (coracoid moves up)