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DPT 616 : MSK > Shoulder Exercises and Stretches > Flashcards

Shoulder Exercises and Stretches Flashcards

1
Q

why is PROM important?

A

for pts that are guarding, have AMBRI, or adhesive capsulitis

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2
Q

when are pendulums a good exercise?

A

day 1 in the clinic for distraction, pain relief, and gaining ROM

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3
Q

when would we want to avoid pendulums early on? why?

A

in pts that had a SLAP repair bc of the tension it may put on the biceps tendon

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4
Q

how are shoulder pendulums performed?

A

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

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5
Q

if pendulums are too painful with trunk flexion, what can be adjusted?

A

stand more upright/vary trunk flexion

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6
Q

why may a weighted cuff be a good addition to pendulums?

A

it can add a cue for the pt

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7
Q

why is a weighted cuff better than a dumbbell for added weight to pendulums?

A

bc the dumbbell may cause co-contraction of the muscles

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8
Q

what is the order of directions pulleys should be done in?

A

scaption–>flexion–>abduction

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9
Q

when should table slides be done?

A

week 1

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10
Q

how are table slides performed?

A

in sitting near a table, lean onto the table and slide the arm along the table without active muscle use

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11
Q

what motions can we do with table slides?

A

flexion, abduction, and ER

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12
Q

how can we make sure table slides are being done passively?

A

palpate the delts to make sure they aren’t contracting

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13
Q

what is an alternative to table slides?

A

walk backs in the parallel bars

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14
Q

how are walk back in the parallel bars performed?

A

hold onto the parallel bars and slowly walk yourself back to get a stretch in the shoulder

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15
Q

how can we stretch the UT?

A

bring the arm over head and bring one ear to the same sided shoulder

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16
Q

how can we stretch the MT?

A

with pillow hugs

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17
Q

how can we stretch the LS?

A

bring the ear to the same sided shoulder and bring the head forward a bit more than the UT stretch

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18
Q

how can we stretch the scalenes?

A

stabilize the first rib by pushing down on the shoulder and stretch the head to the other ear

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19
Q

when do we do trap stretches?

A

when there is neck pain and trigger points

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20
Q

what does cervical SB stretch?

A

UT and LS depending on the head position

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21
Q

how can we stretch the pecs?

A

doorway/corner stretch

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22
Q

a doorway stretch with the elbows at ____ degrees is a more direct stretch of the pecs

A

90

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23
Q

a doorway stretch with the elbows further down stretches what portion of the pecs?

A

the clavicular pecs

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24
Q

how can we stretch the rhomboids?

A

doorknob hanging

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25
Q

how can we adjust doorknob hands to stretch the lats and inferior capsule?

A

bring the arms overhead

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26
Q

how can we stretch the supraspinatus?

A

pull the arm behind the head into functional IR

can pull the arm down further with a dowel

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27
Q

how can we stretch the lats and teres minor?

A

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

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28
Q

how can we stretch the subscap?

A

table slides

hold relax ER stretch in supine

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29
Q

how can we stretch the posterior capsule of the shoulder/cuff?

A

bring the arm across the body

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30
Q

how can we stretch the inferior capsule?

A

OH stretching

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31
Q

how can we stretch IR (medial rotation)?

A

sleeper stretch

towel/strap stretch into functional IR

hands behind on table/squat stretch (like a tricep dip)

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32
Q

how do we perform the sleeper stretch?

A

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

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33
Q

if the pt is really tight, what adjustment can we make to the sleeper stretch?

A

have the pt closer to being on their back then move towards true SL

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34
Q

when are wand exercises appropriate?

A

at 4-6 weeks

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35
Q

when are pulleys appropriate?

A

maybe not until 4 weeks

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36
Q

t/f: wand exercises are not usually very effective in IR

A

true

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37
Q

what are wand exercises?

A

using the dowel to do AAROM

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38
Q

when a pt has a shoulder replacement, what motion are we not going to push? why?

A

we don’t want to push ER bc the IRs are detached

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39
Q

in what direction do we start AROM?

A

scaption

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40
Q

when can pts usually do AROM?

A

6-8 weeks

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41
Q

when can pts usually progress to resistive exercises?

A

10 weeks

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42
Q

what is the position for gravity minimized scaption?

A

SL

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43
Q

what is the position for scaption against gravity?

A

prone

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44
Q

what are some AROM shoulder exercises?

A

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)

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45
Q

if the pt can’t do flexion in upright, but supine is too easy for AROM flexion, what can we do?

A

put them in semifowlers by raising the HOB and measuring the level of inclination for your documentation with a goni

46
Q

what are isometric 6 ways?

A

push against wall or PT into IR/ER, add/abd, flex/ext

47
Q

when we are aiming for submax/subpain, the pts pain level should be no more than …

A

1/10

48
Q

when is isometrics a good exercise in the healing timeline?

A

8 weeks

49
Q

how can we progress alternating isometrics?

A

resist at the wrist to increase the lever arm

add perturbations

50
Q

how do we perform the “ball on the wall” exercise for isometrics?

A

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)

51
Q

how can we progress ball on the wall?

A

add cuff weight to the wrist or use a weighted ball

52
Q

how long should pts do the ball on the wall exercise?

A

until they can’t anymore

53
Q

how do we perform wall angels?

A

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

54
Q

what motions are we working on with wall angels?

A

retraction

horizontal abduction

flexion

55
Q

pts have to have good ___ flexibility to do wall angels

A

pec

56
Q

t/f: if pts have increased kyphosis, wall angels may be a difficult exercise

A

true

57
Q

how do we perform boehler exercises?

A

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

58
Q

what are boehler exercises good for?

A

pts with weak end range isometric holds

59
Q

PREs should start in ____ move to ____ and then to____

A

scaption, flexion, abduction

60
Q

what motion strengthens the anterior delt?

A

flexion

61
Q

what motion strengthens the middle delt?

A

abduction

62
Q

what motion strengthens the posterior delt?

A

retraction

63
Q

what is a key thing to be aware of with RC repairs?

A

PAIN

64
Q

what is RC phase 1?

A

shoulder RETRACTION/EXT, IR/ER in neutral

unilateral row/paddle with towel under the axilla

65
Q

what are the steps of progression in RC phase 1 exercises?

A

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

66
Q

what is RC phase 2?

A

RC shoulder ABDUCTION up to 90 around 70 deg (standing) and forward FLEXION to about 110-120 deg (ant delt and scap muscles)

67
Q

what are the steps of progression in RC phase 2?

A

same as phase 1

68
Q

how do we perform abduction in RC phase 2?

A

almost like a chest fly but more upright

69
Q

how do we perform flexion in RC phase 2?

A

pushing forward with a resistance band behind

70
Q

when should a pt get to RC phase 2?

A

by two weeks

71
Q

should a lighter or stronger band be used with ER compared to IR? why?

A

lighter band for ER bc IR is stronger

72
Q

what is RC phase 3?

A

IR/ER out of neutral (more in abduction)

73
Q

if a pt has difficulty at the end range of a motion overhead, what can we do?

A

COIs and dynamic reversals at end range D2 flexion

74
Q

what is centration?

A

the RC ability to keep the humeral head in the glenoid

75
Q

with centration, what are we trying to avoid?

A

superior migration of the humeral head

76
Q

when a pt has issues with centration, what will we often see?

A

compensation with the UT and lifting up the entire shoulder with OH motions

77
Q

what condition can cause issues with centration?

A

adhesive capsulitis

78
Q

what can we do for centration issues?

A

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

79
Q

why is it better to use Tb than free weights for contraction exercises in supine?

A

bc at end range the fre weight will assist the motion instead of resisting it, while the TB will add resistance throughout the range

80
Q

t/f: doing centration exercises in SL will allow gravity to help with centration

A

true

81
Q

what motion do we not do in SL bc it would require the pt lying on their affected shoulder?

A

IR

82
Q

how do we do humeral head depression exercises?

A

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

83
Q

how do we perform no monies?

A

pull a TB out with supinated hands and elbows at the side

84
Q

how do we perform robberies?

A

bring the arms up and out with TB

85
Q

how do we perform pivot prones?

A

typically in prone, bring the elbows to the sides pinkies back and pull the elbows up and back (retraction and depression)

86
Q

how often should the pivot prone exercise be done?

A

5x/day

87
Q

how can we strengthen the lats/teres major?

A

cable columns for lat pull downs and eccentric control back up

seated push ups

88
Q

how do we perform seated push ups?

A

in sitting, push your butt off the table by pushing your hands into the table or lift yourself up

89
Q

what are wall climbs with band at wrists good for?

A

scap muscles

90
Q

what are the Blackburn exercises?

A

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

91
Q

how do we perform Blackburn exercises in prone h abd in neutral?

A

thumbs forward and elbows straight in prone

92
Q

how do we perform Blackburn exercises in prone h abd in ER?

A

in prone with thumbs up

93
Q

how do we perform Blackburn exercises in prone h scaption in neutral?

A

in prone, palms down, straight elbows

94
Q

how do we perform Blackburn exercises in prone h scaption in ER?

A

in prone with thumbs up

95
Q

how do we perform Blackburn exercises in prone h ER (hitchhikers)?

A

in prone with elbows bent going into ER like calling a car as a hitchhiker

96
Q

how do we perform Blackburn exercises in prone extension?

A

like doing “Is”

97
Q

what are some scap exercises for the rhomboids and traps?

A

wall clock

rows

downward rows

lawn mower pulls

OH press

98
Q

how do we perform rows for the scap?

A

at 90 deg abd with elbows flexed, bring the elbows back at about shoulder height pinching scaps together

99
Q

how do we perform downward rows for the scap?

A

same as regular rows, but keep the elbows straight and bring the arms into extension from overhead

100
Q

how do we perform lawn mower pulls for the scap?

A

stand on the TB and pull back on it like pulling on a lawn mower

101
Q

what are some SA exercises?

A

ceiling punch plus

SA wall slides

quadruped SA push ups

SA wall pushups

102
Q

how do we perform ceiling punch plus for SA strengthening?

A

in supine, hold a weighted ball overhead (often heavier at 5-7 lbs) and reach up to the ceiling with added protraction

103
Q

how do we perform SA wall slides?

A

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)

104
Q

t/f: you can do Blackburns in quadruped for added challenge

A

true

105
Q

what PNF positions work the pecs?

A

D1 flexion, D2 extension

106
Q

why should we consider the hip flexors when working on the shoulder?

A

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

107
Q

t/f: thoracic mobility can be an important factor in shoulder issues

A

true

108
Q

what other muscles can influence the shoulder?

A

biceps, pecs, core, deep cervical flexors

109
Q

what are some pec exercises?

A

PNF in D1 flexion, D2 extension

dips

bench presses

110
Q

why is quardruped a good position for shoulder exercises?

A

it causes axial loading and co-contraction at the GH jt

DPT 616 : MSK (23 decks)

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