Basic REMEX, H/C and Active Rehab Shoulder

Question 1

Key elements about a basic REMEX, homecare and active rehabilitation program:

Answer 1

 Any program must be gradual as to avoid re-injury
 Any program must not increase inflammation
 A program must start as soon as the inflammation has been stabilized- this is to help:
a.) Prevent the articular cartilage of a joint from breaking down from
inactivity (usually starts with 48 hours of inactivity)
b.) Prevent adhesions and promote functional scar formation
 Every activity or exercise should be performed pain-free. If pain is generated,
the activity or exercise should be modified

Question 2

How do you know when it’s too much?

Answer 2

 Discomfort post exercise lasting more than 2 hours in acute/subacute stage
 Discomfort post exercise lasting more than 4 hours in the chronic stage
 Need pain medication to control discomfort after activity or exercise
 Pain @ rest
 Extreme fatigue
 Rebound muscle spasm
 Increased weakness
Should any of the following take place, the therapist &/or guest should appropriately
modify the program.

Question 3

A natural and gradual progression in any program may include:

Answer 3

PROM AAROM AROM muscle settingIsometricsIsotonics

Propioceptive exercisesAdvanced exercises for power, balance and stability

Question 4

REMEX of the Shoulder Complex
Although most of the exercises for the shoulder involve external rotation and abduction (most often the restricted movements), a program should be changed toward

Answer 4

the guest’s presenting symptoms. In the later stages or with recurring conditions, a program should address posture and work on changing noxious influences.

Question 5

Exercises for the early stages of healing (Ch. 2, Ch.9 p.363 - THEX)

Answer 5

1. Grade 1-2 self distraction (ADHESIVE CAP, AC SEP, IMPING) – sitting with the backrest of a chair in the axilla (padded). Let arm drop and provide slight distraction (use a weight if needed)
2. Manual PROM/AAROM techniques (ADH CAP, AC SEP)
3. Pendulum (AdH Cap, AC SEP) – use a weight in the later stages to increase joint traction
4. Multiple-angle muscle setting (DISLOC, AC SEP)
5. Stabilization exercises - closed chain or protected weight bearing (DISLOC, AC SEP) – leaning into hands or elbows gently moving from side to side – seats humeral head in glenoid fossa and stimulates muscle action

Question 6

Exercises for Later stages of healing

Answer 6

1. Isometric strengthening (DISLOC, AC SEP) – against a wall (p.373 –THEX)
2. Eccentric strengthening, submaximal (IMPING, DISLOC) – using theraband
3. Continued Stabilization exercises adding different dimensions of movement and with more weight (DISLOC, AC SEP)
4. Exercises to increase flexibility and ROM (ADH CAP, IMPING) – sitting next to table (p.365-367 – THEX)

Question 7

Exercises for Chronic or advanced stages

Answer 7

1. Strengthening in combined motions – Isotonic, maximal exercises, using weights or theraband, plyoball, doing opposite movements of throwing for example (all conditions)
2. Proprioception (DISLOC, AC SEP) – like stabilization exercises but with a body ball
3. Self-capsular stretches (ADH CAP) – prolonged sustained stretches with weight if possible – AB and ER especially
4. Scapula muscle strengthening – push-ups with end protraction, “flying”, retraction exercises (p.376 and 377- THEX)
5. Exercises that help muscle force coupling (p.381 – THEX) – scapular push-ups (scapular depression and humeral adduction) and “super man” (lower trapezius and serratus anterior) prone or sitting

Question 8

Various strengthening and stretching during a massage session:

Answer 8

1. Stretch the Pec Mjr/ Mnr muscles (p.368 & 369), latissimus dorsi (p.367 – THEX), levator scap. (p.370 –THEX)
2. Isometric strengthening to the scapula (p.371 and 372 - THEX) – SL and seated
3. Isometric strengthening to GH muscles (p.372 –THEX)
   * ** Note: use breath to help with stretches. Use isometric contractions as active inhibition