2004 Thera-Band Most Creative Use Contest Honorable Mention

Exercise Name: Tigger Bounces and PNF Stretching for Adhesive Capsulitis Submitted by: Marsha Rutland, PT, MEd, OCS, CSCS Assistant Professor, Department of Physical Therapy Hardin-Simmons University Abilene, TX Summary: Two great ideas to use Thera-Band resistive bands to increase range of motion in shoulder patients with adhesive capsulitis, which allow patients to work on their range at home or in the clinic. Exercise #1: Tigger Bounces Small oscillations of bouncing in painfree range to assist shoulder pain patients with pain control mechanisms. Bouncing can be done in straight planes of flexion, abduction, or in the scaption plane. As pain decreases, and motion increases, the motion is taken to a higher range and tigger bounces are tried in the new range of motion. I usually do this for at least 5 minutes prior to stretching, mobilization, or the hold-relax exercise. I am unaware of this exercise being used for adhesive capsulitis patients, but have found great results with my patients over the last 10 years. This exercise is unique, in that it replicates some of the mobilization techniques used by therapists in the clinic. It can then be carried to a home program. This is a great way to initiate pain reduction techniques into a home program for patients. We suggest use of ice following exercise to decrease the pain. Also, pendulum (Codmans exercise) is another exercise to assist with pain control and motion. The patient can be sent home with a Thera-Band resistive band to use over a closed door. (A Thera-Band Door Anchor can be used to attach the band over the door.) This principle is based upon mobilization techniques of grade I-II, in which small motion in the pain free range facilitates pain reduction. This exercise is found useful in my patients for pain reduction before stretching, or as a warm up of shoulder girdle prior to stretching. I also have them follow stretching with this to again help facilitate pain reduction. Tigger Bounces are an appropriate principle, for patients with pain, such as those with adhesive capsulitis. Many of the patients find themselves moving their arm back and forth in a small pain free range automatically in an effort to reduce pain. If they can incorporate this into their daily living, they can continue with less pain while performing functional activities.

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FIGURE 1: Tigger Bouncing in the standing position bouncing in the flexion-abduction plane. Exercise #2: PNF Hold-Relax Stretching for shoulder patients with limited ROM or those with Adhesive Capsulitis Used with patients with Adhesive Capsulitis or limited shoulder range of motion (ROM), this exercise uses neurophysiological principles to increase range without pain. The patient contracts against the Thera-Band resistive band for 5-10 seconds, then relaxes as the band pulls upward into the limited range. The process is repeated as the patient tolerates, following PNF principles. It is an easy way to gain ROM at home, without the therapist. Based upon proprioceptive neuromuscular facilitation (PNF) techniques, the PNF Contract Relax stretch follows principles outlined in Kisner and Colbys book, Therapeutic Exercise, Foundations and Techniques, 4th Edition, pg, 195-196 and Essentials of Strength Training and Conditioning by Baechle and Earle, 2nd edition, 2000, pg.322-328. 1. Have patient sitting with Thera-Band resistive band overhead and secured with a TheraBand Door Anchor at the top of a closed door. The band should have a loop so the patient can rest wrist/hand in loop. For gaining motion, a loose relaxed hand helps to decrease firing of muscles that tighten shoulder muscles. No gripping of the band is suggested. 2. Start with the range-limiting muscle in a lengthened pain free range. 3. Have the patient to isometrically contract against the band for 5-10 seconds until the muscle fatigues.(in the example of internal rotation restrictions, the patient pushes into elbow extension and shoulder ext for 5 seconds, then relaxes for 5-10 seconds, as the band takes them into the new range. 4. Patient then relaxes. 5. The band lengthens the muscle by moving the shoulder through the new range. Hold for 10-seconds. 6. Repeat procedure 3-5 x. On last stretch, maintain stretch for up to 10 seconds. 7. As new motion is gained, a patient may need to move the chair farther away from the wall. (due to the principle of plasticity) 8. Can be used with the motions of flexion, abduction, external rotation, and internal rotation. I am again unaware of this exercise being used, with the exception of students, therapists, and patients I have taught over the last 10 years. It has been a great home exercise to help carry over activities done in the clinic. This exercise incorporates PNF principles that therapists learn in school into a home program with Thera-Band resistive bands. This exercise allows patients with limited ROM such as those with adhesive capsulitis to apply
2004 The Hygenic Corporation. All Rights Reserved. Unauthorized use is strictly prohibited. THERA-BAND and Associated Colors are registered trademarks of The Hygenic Corporation.

principles of stretching by using the Thera-Band resistive bands to gain ROM with the least amount of pain. The patient can be issued a band and attach over a closed door. They will only need a chair to sit in. This procedure is based upon PNF principles of agonist contraction to achieve reciprocal and autogenic inhibition. The Golgi Tendon Organs (GTOs) are mechanoreceptors located near musculotendinous junction and are sensitive to increased muscle tension. Relaxation occurs in the same muscle experiencing increased tension. This tension stimulates the GTO and causes a reflexive relaxation of the muscle during the following stretch. It produces gained motion with the least amount of pain. Tendons, ligaments, joint capsules, fascial sheaths, and skin may limit motion. One of the effects of stretching is to gain new motion through the principle of plasticity. Plasticity is the tendency to assume a new and greater length after a passive stretch of connective tissue. Biomechanically, it can assist with ROM of the shoulder complex. This is a great way to gain functional ROM such as reaching up to a shelf, reaching out to close a door, or reaching to comb ones hair.

FIGURE 2: Example of Contract Relax stretching during the relaxation phase after patient has pushed into elbow and shoulder extension

2004 The Hygenic Corporation. All Rights Reserved. Unauthorized use is strictly prohibited. THERA-BAND and Associated Colors are registered trademarks of The Hygenic Corporation.