Shoulder Exercises and Stretches Flashcards
why is PROM important?
for pts that are guarding, have AMBRI, or adhesive capsulitis
when are pendulums a good exercise?
day 1 in the clinic for distraction, pain relief, and gaining ROM
when would we want to avoid pendulums early on? why?
in pts that had a SLAP repair bc of the tension it may put on the biceps tendon
how are shoulder pendulums performed?
lean on the table and rock your body back and forth to passively get the arm swinging
perform for about 30 seconds at a time
if pendulums are too painful with trunk flexion, what can be adjusted?
stand more upright/vary trunk flexion
why may a weighted cuff be a good addition to pendulums?
it can add a cue for the pt
why is a weighted cuff better than a dumbbell for added weight to pendulums?
bc the dumbbell may cause co-contraction of the muscles
what is the order of directions pulleys should be done in?
scaption–>flexion–>abduction
when should table slides be done?
week 1
how are table slides performed?
in sitting near a table, lean onto the table and slide the arm along the table without active muscle use
what motions can we do with table slides?
flexion, abduction, and ER
how can we make sure table slides are being done passively?
palpate the delts to make sure they aren’t contracting
what is an alternative to table slides?
walk backs in the parallel bars
how are walk back in the parallel bars performed?
hold onto the parallel bars and slowly walk yourself back to get a stretch in the shoulder
how can we stretch the UT?
bring the arm over head and bring one ear to the same sided shoulder
how can we stretch the MT?
with pillow hugs
how can we stretch the LS?
bring the ear to the same sided shoulder and bring the head forward a bit more than the UT stretch
how can we stretch the scalenes?
stabilize the first rib by pushing down on the shoulder and stretch the head to the other ear
when do we do trap stretches?
when there is neck pain and trigger points
what does cervical SB stretch?
UT and LS depending on the head position
how can we stretch the pecs?
doorway/corner stretch
a doorway stretch with the elbows at ____ degrees is a more direct stretch of the pecs
90
a doorway stretch with the elbows further down stretches what portion of the pecs?
the clavicular pecs
how can we stretch the rhomboids?
doorknob hanging
how can we adjust doorknob hands to stretch the lats and inferior capsule?
bring the arms overhead
how can we stretch the supraspinatus?
pull the arm behind the head into functional IR
can pull the arm down further with a dowel
how can we stretch the lats and teres minor?
OH stretch against a wall while turning towards the arm
OR
lie in supine and bring the arms over head with posterior pelvic tilt to prevent lumbar compensation
how can we stretch the subscap?
table slides
hold relax ER stretch in supine
how can we stretch the posterior capsule of the shoulder/cuff?
bring the arm across the body
how can we stretch the inferior capsule?
OH stretching
how can we stretch IR (medial rotation)?
sleeper stretch
towel/strap stretch into functional IR
hands behind on table/squat stretch (like a tricep dip)
how do we perform the sleeper stretch?
have pt in SL and have them push their arm into IR down into the table by pushing at their wrist with their upper arm
if the pt is really tight, what adjustment can we make to the sleeper stretch?
have the pt closer to being on their back then move towards true SL
when are wand exercises appropriate?
at 4-6 weeks
when are pulleys appropriate?
maybe not until 4 weeks
t/f: wand exercises are not usually very effective in IR
true
what are wand exercises?
using the dowel to do AAROM
when a pt has a shoulder replacement, what motion are we not going to push? why?
we don’t want to push ER bc the IRs are detached
in what direction do we start AROM?
scaption
when can pts usually do AROM?
6-8 weeks
when can pts usually progress to resistive exercises?
10 weeks
what is the position for gravity minimized scaption?
SL
what is the position for scaption against gravity?
prone
what are some AROM shoulder exercises?
wall slides
finger ladders
UE ranger (like a dowel with a handcuff on it and can put it on the floor or wall to move the arm around)
if the pt can’t do flexion in upright, but supine is too easy for AROM flexion, what can we do?
put them in semifowlers by raising the HOB and measuring the level of inclination for your documentation with a goni
what are isometric 6 ways?
push against wall or PT into IR/ER, add/abd, flex/ext
when we are aiming for submax/subpain, the pts pain level should be no more than …
1/10
when is isometrics a good exercise in the healing timeline?
8 weeks
how can we progress alternating isometrics?
resist at the wrist to increase the lever arm
add perturbations
how do we perform the “ball on the wall” exercise for isometrics?
with the arm at 90 deg shoulder flexion, move a ball against the wall in varying patterns (up/down, side to side, spelling, drawing, etc)
how can we progress ball on the wall?
add cuff weight to the wrist or use a weighted ball
how long should pts do the ball on the wall exercise?
until they can’t anymore
how do we perform wall angels?
with your back against a wall, bring your arms up over your head trying to touch your hands together while keeping your arms in contact with the arm behind you
what motions are we working on with wall angels?
retraction
horizontal abduction
flexion
pts have to have good ___ flexibility to do wall angels
pec
t/f: if pts have increased kyphosis, wall angels may be a difficult exercise
true
how do we perform boehler exercises?
facing your back to a wall wall put your arms against the wall overhead and then take a step forward and hold your arms there
what are boehler exercises good for?
pts with weak end range isometric holds
PREs should start in ____ move to ____ and then to____
scaption, flexion, abduction
what motion strengthens the anterior delt?
flexion
what motion strengthens the middle delt?
abduction
what motion strengthens the posterior delt?
retraction
what is a key thing to be aware of with RC repairs?
PAIN
what is RC phase 1?
shoulder RETRACTION/EXT, IR/ER in neutral
unilateral row/paddle with towel under the axilla
what are the steps of progression in RC phase 1 exercises?
1 set of a color for 15 reps for 2-3 days
then progress to 2 sets
then progress to the next color for 1 set of 15 reps
then progress to 2 sets
so on with all colors
what is RC phase 2?
RC shoulder ABDUCTION up to 90 around 70 deg (standing) and forward FLEXION to about 110-120 deg (ant delt and scap muscles)
what are the steps of progression in RC phase 2?
same as phase 1
how do we perform abduction in RC phase 2?
almost like a chest fly but more upright
how do we perform flexion in RC phase 2?
pushing forward with a resistance band behind
when should a pt get to RC phase 2?
by two weeks
should a lighter or stronger band be used with ER compared to IR? why?
lighter band for ER bc IR is stronger
what is RC phase 3?
IR/ER out of neutral (more in abduction)
if a pt has difficulty at the end range of a motion overhead, what can we do?
COIs and dynamic reversals at end range D2 flexion
what is centration?
the RC ability to keep the humeral head in the glenoid
with centration, what are we trying to avoid?
superior migration of the humeral head
when a pt has issues with centration, what will we often see?
compensation with the UT and lifting up the entire shoulder with OH motions
what condition can cause issues with centration?
adhesive capsulitis
what can we do for centration issues?
TB in supine in D2 UE pattern (gravity helps with centration)
In SL gravity stabilizes humeral head in the glenoid
humeral head depression exercise
pt with hands on back of a chair and then walk backwards with hands staying on the chair and as they push down they get scap and humeral depression and stepping back adds dynamic work
why is it better to use Tb than free weights for contraction exercises in supine?
bc at end range the fre weight will assist the motion instead of resisting it, while the TB will add resistance throughout the range
t/f: doing centration exercises in SL will allow gravity to help with centration
true
what motion do we not do in SL bc it would require the pt lying on their affected shoulder?
IR
how do we do humeral head depression exercises?
sit next to table with arm on the table, try to get pt to push their humeral head down into the glenoid without lifting the arm by putting your hand on their acromion one finger on acromion and other on humeral head and tell pt to try and move their arm away from the one on the humeral head
how do we perform no monies?
pull a TB out with supinated hands and elbows at the side
how do we perform robberies?
bring the arms up and out with TB
how do we perform pivot prones?
typically in prone, bring the elbows to the sides pinkies back and pull the elbows up and back (retraction and depression)
how often should the pivot prone exercise be done?
5x/day
how can we strengthen the lats/teres major?
cable columns for lat pull downs and eccentric control back up
seated push ups
how do we perform seated push ups?
in sitting, push your butt off the table by pushing your hands into the table or lift yourself up
what are wall climbs with band at wrists good for?
scap muscles
what are the Blackburn exercises?
Prone H. Abd in Neutral
Prone H. Abd in ER (thumb up)
Prone H. Scaption in Neutral
Prone H. Scaption in ER
Prone H. ER (Hitchhikers)
Prone Extension
how do we perform Blackburn exercises in prone h abd in neutral?
thumbs forward and elbows straight in prone
how do we perform Blackburn exercises in prone h abd in ER?
in prone with thumbs up
how do we perform Blackburn exercises in prone h scaption in neutral?
in prone, palms down, straight elbows
how do we perform Blackburn exercises in prone h scaption in ER?
in prone with thumbs up
how do we perform Blackburn exercises in prone h ER (hitchhikers)?
in prone with elbows bent going into ER like calling a car as a hitchhiker
how do we perform Blackburn exercises in prone extension?
like doing “Is”
what are some scap exercises for the rhomboids and traps?
wall clock
rows
downward rows
lawn mower pulls
OH press
how do we perform rows for the scap?
at 90 deg abd with elbows flexed, bring the elbows back at about shoulder height pinching scaps together
how do we perform downward rows for the scap?
same as regular rows, but keep the elbows straight and bring the arms into extension from overhead
how do we perform lawn mower pulls for the scap?
stand on the TB and pull back on it like pulling on a lawn mower
what are some SA exercises?
ceiling punch plus
SA wall slides
quadruped SA push ups
SA wall pushups
how do we perform ceiling punch plus for SA strengthening?
in supine, hold a weighted ball overhead (often heavier at 5-7 lbs) and reach up to the ceiling with added protraction
how do we perform SA wall slides?
put a band around the wrists and pull apart against them and pushing arms into the wall sliding forearms up and down the wall OR can have them walk their arms up and down the wall (monster walk with the hands)
t/f: you can do Blackburns in quadruped for added challenge
true
what PNF positions work the pecs?
D1 flexion, D2 extension
why should we consider the hip flexors when working on the shoulder?
the hip flexors may be tight with reaching and therefore lack hip extension to reach which can lead to compensation to get the arm further up causing the shoulder issue
t/f: thoracic mobility can be an important factor in shoulder issues
true
what other muscles can influence the shoulder?
biceps, pecs, core, deep cervical flexors
what are some pec exercises?
PNF in D1 flexion, D2 extension
dips
bench presses
why is quardruped a good position for shoulder exercises?
it causes axial loading and co-contraction at the GH jt
