Therapeutic Exercises Shoulder Part 2


With acute frozen shoulder, again, the goal is to maintain the range of motion, slowly increase your range of motion. With that one of the exercises that we can do in addition to the wall crawl and the pendulum that we’ve already done is the passive range of motion, but by doing it yourself. So with that passive range of motion the direction that we’re going to look at focusing on is the flexion of the shoulder. So what you can do is, you have your affected arm, for me it’s going to be the right arm. The unaffected arm is going to come underneath. And what it’s going to do is you’re just going to bring that up slowly, up to as far as we can go, looking at 90 degrees and then slowly bringing it back down. The idea is to make sure that the affected arm stays loose and not engaging the muscles and that the unaffected arm is taking all the weight of that arm as it brings it up, it brings it up to 90 degrees and then slowly brings it back down. This is something that can be repeated. You can do a set of five, you can take a thirty second break and then do another set of five, just looking to maintain. And this is something that you can do once or twice a day and you can do this every day. So when instructing your client to do the passive range of motion, doing it themselves, you’re going to get them seated on a chair. You want them sitting comfortably. The affected arm, which is going to be the
right arm, is going to be just maintaining a loose, not engaging the muscles. You’re going to take the unaffected hand and you’re going to bring it underneath the wrist. And all you want to do is you want to slowly raise
it up to that 90 degrees. Again looking at getting that range of motion all the way through. And then you slowly bring it back down. So the idea of this is you want to maintain the range of motion, try to increase that range of motion while we’re in that acute phase. Yep, keep going. While we’re in that acute phase of the frozen shoulder, want to prevent it from becoming frozen and maintaining that range of motion as we go through. So again, keeping the affected arm loose. The affected arm is bearing no weight. The unaffected arm is doing all the work, trying to increase that range of motion of the shoulder. As we’re in sub-acute frozen shoulder one of the exercises we’re looking at doing is self-mobilization. So basically joint mobs for the shoulder, but you’re doing them yourself. The way you’re going to do that is you want to position yourself at a table or a counter as you’re sitting in a chair, one that’s at a good height, so that as you’re resting your arm on the table the shoulder is resting comfortably, it is not being hiked up too much or it’s not too low that you can’t get at it. So the idea is you want to be sitting parallel to the table with the arm rested. Elbow flexed to 90 degrees with the shoulder being relaxed on the table. You’re going to take your other hand and it’s going to come on top of the shoulder. So you just want to be on the outside part of the shoulder as you do this. And then you want to be able to press the shoulder so that you’re pushing the shoulder down and you’re going to hold that for a count of five to seven seconds and then you’re going to relax. You’re going to come down for a count of five to seven seconds and then you’re going to relax. And you’re going to do this eight times. You’re going to do it once a day and you’re going to do this every other day. And what this is trying to maintain that range of motion, increase the range of motion of the shoulder by passively doing a joint mob yourself, which is going to work to maintain and increase that range of motion. So as you’re instructing your client to go through the self-mobilizations for the sub-acute frozen shoulder, you’re going to get them sitting at a table, good height, or a counter which is a good height so that they can relax their shoulder resting onto it. And then it’s not going to be hiked up or too low. Elbow’s going to be bent. It’s going to be resting comfortably on the table. You’re going to take the unaffected arm, which is going to reach across, it’s going to come to the outside part of the shoulder and it’s going to depress the shoulder downwards. You’re going to hold that for five to seven seconds and then release for two seconds and you’re going to do that again, five to seven seconds and then release. And you want to do that eight times. What that is going to do is looking at increasing that range of motion in that shoulder, prevent it from locking up, maintaining the mobility that’s already there and looking to build on that. Like I said this is an exercise that can be done once a day, every other day. How does that feel?
>>Good.>>And again, it’s a self-mobilization, which is easy because you can do it yourself. You’ve just got to put yourself in the right position in order to complete it. One more. Very good. The next exercise we’re looking at is the pendulum. So, again, we’re still in the acute phase, so we’re not using any weights with this exercise. We’re just going to use gravity in order to maintain the mobility with the pendulum exercise. So you’re going to have a chair. You’re just going to put one knee on the chair and holding the back of the chair. And you want to bend at the waist so that the affected arm is hanging down, just as gravity, hanging there. And now what you want to do is just the pendulum, you just want to start a slow swing of the arm back and forth. So you can go front-back. You can do side-side. And you can do little circles forwards and backwards. So the idea of this exercise is, again, to maintain range of motion through all the ranges of the shoulder by doing a front-back, side-side and the circles frontwards and backwards, trying to maintain that range of motion all the way through during the acute stage. So this is an exercise you can look at doing once or twice a day. And it’s something you can do every day of the week. So you have your client with her knee on the chair. They’re supporting themselves. They’re bending over at the waist. And the affected arm is hanging down. So that you do the pendulum exercise. So what they do to start is just going to be slow back and forth, just to increase that range of motion. And do that for a ten-count. And then once you do that for a ten-count you’re going to do a second ten-count going back and forth, side to side. And after you do a ten-count side to side then you’re going to do circles forward and backward for a ten-count, each of those. So just a little bit slower, a little bit smaller, there we go. That’s better. And then backwards. Good. So again, through the acute phase you just want to maintain that mobility so that we’re not getting into a frozen state, which would affect them more so, so we just want to increase that and then we go back to the front-back swing. And you want to do that rotation two or three times. Front-back, side-side, circles, ten-count for each of them. And it’s something you can do every day. So as we advance to the sub-acute stage of the frozen shoulder we can look at doing the pendulum exercise again, but now we’re going to add a weight,a hand weight. So this could be whatever hand weight you have available that you’re comfortable with. It could even be a can of soup if need be. But something that’s going to add some weight to the resistance to the exercise. So now same positioning, knee’s on the chair. They’re supporting themselves. They’re bending at the waist. Affected hand is down holding the weight. So now what we’re going to do, just changing it up in terms of the exercise that we’re doing, now we’re going to start with doing the alphabet in small letters. So you run through the entire alphabet making small letters. Once you go through a to z then what you’re going to do is you take a little bit of a break for thirty seconds. And then you’re going to come back again and now you’re going to do capital letters. So now what capital letters are going to do is going to increase that movement, so now you’re making bigger movements as you go through the alphabet. You have to know your alphabet, which helps. And you’re going to run through the whole alphabet again. So you’re going to start with the small letters, take a break for thirty seconds and then do the capital letters. So we’ve got a client in position for the subacute frozen shoulder, the weighted pendulum exercise. Again, knee’s on the chair. Hand is on top of the chair supporting themselves. They’re bent over at the waist. Hand that’s affected is hanging down holding the weight. So we start with them just doing the smaller movements which is the small letters of the alphabet. They work their way all the way through, going from a to z. Once they’ve done that they’re going to take a thirty second break. And after that thirty second break, now they’re going to do the capital letters, so the bigger movements, all the way through the alphabet again. So it’s a good way to do it where it maintains your mobility. It moves the shoulder in multiple directions. It allows for that range of motion to be maintained and also increased by doing it. And as you progress you can make even bigger letters as you do the capital letters. You can get even more range or motion through it. And again this is something you can do every day throughout the week. Looking at increasing and maintaining that range of motion that you have. We’re looking at acute frozen shoulder. And the exercise that we’re going to look at first for the acute frozen shoulder is the wall crawl. What this is, it helps with self-mobilization to try to get that range of motion maintained and also trying to increase. So, for this you need a wall. Ad what you’re going to do is, you have your client facing the wall. And they’re going to start with their hand in a comfortable position, which is going to be low if it’s acute and all they’re going to do is they’re going to crawl their fingers up to a point where they can’t go any further. Once they get to that point they can just slowly bring it back down. And the idea is that they can challenge themselves by knowing how far up the wall they’ve gotten and looking at getting as far as they can, trying to get to 90 degrees and maybe even above 90 degrees. So with that acute frozen shoulder the range of motion is maintained and they can slowly bring it back down, so they minimize any pain or effects that are going on. And this is something that they can do on a daily basis, every day. Just looking to keep that mobilization in the shoulder by crawling up the wall with their fingers, trying to maintain that mobility in their shoulder. You get your client for this exercise to face the wall. And then they start with their affected arm in a comfortable position with their fingertips on the wall. Now generally it’s going to be, hand’s going to be in neutral, neutral position. So from here you just get them to slowly walk their fingers up the wall until they reach a point where it’s either too painful or they can’t go any further. And once they get to that point, let’s just say it’s there, they want to note how high on the wall they’ve gotten, how high their shoulder has lifted up. And then they can slowly bring that back down. So as they progress over time they want to look at can I go up further than what I did, increasing that range of motion. So the next time they do it they know how far they’ve gotten. So we’re going to do it again. So now they’re looking at, they know how far they got up the wall the first time, how far the shoulder was up, so now we’re looking at can we get further up the wall? Get that shoulder up to 90, maybe a little bit higher than 90 to maintain that range of motion and the mobility in the shoulder in the acute stage.