5 EXERCISES TO HELP WITH SHOULDER MOBILITY

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5 EXERCISES TO HELP WITH SHOULDER MOBILITY

Are you suffering from Shoulder pain? Have you had a prior shoulder injury or rotator cuff injury? Have you recently recovered from a frozen shoulder but can’t achieve the last few degrees of range? OR are you just looking at improving your shoulder movements and range?
If so, then read on for some exercises to assist with increasing your shoulder mobility.

The shoulder joint also known as the glenohumeral joint is a ball and socket joint.  This complex joint is one of the most mobile joints in the body. The movements that occur in this joint are:

  1. Flexion – Arm moving forwards and up towards the head
  2. Extension – Arm moving straight backwards, away from the body
  3. Adduction – Arm moving towards the midline/ across the body
  4. Internal Rotation – Rotating the shoulder inwards so that the thumb is pointing towards the midline
  5. External Rotation – Rotating the shoulder outwards so that the thumb is pointing away from the midline.

Mobility V/S Flexibility?

Mobility refers to the ability of a joint to move actively through a range of motion.
Mobility requires both flexibility and strength. Whilst people mistakenly use these terms interchangeably and flexibility is a component of mobility, they are in fact not the same thing.

Flexibility refers to the ability of a muscle to temporarily lengthen. Flexibility is passive.

Why is it important to work on shoulder mobility?

Mobility is important to maintain joint health. Our ability to move without pain or restrictions means we can easily perform our daily activities and strength train. If you have limited mobility, it may lead to compensatory patterns which further predisposes your body to injuries.  As most movements of the upper limb involve the shoulder joint, it is important to ensure shoulder mobility is not compromised.

What influences shoulder mobility?

  • Scapula movements
  • Glenohumeral joint movement (Shoulder joint movement)
  • Thoracic spine (mid-back) mobility

A compromise of either of these along with their surrounding musculature will have an impact on the mobility of the shoulder joint.  Here are some exercises you can try to work on the mobility of your shoulder joint:

Please note, all exercises should be pain free. If you are suffering from pain with movements or are unsure about the exercises, please consult your Physiotherapist before attempting them. Please perform all movements SLOWLY. Sudden entry/ exit of certain positions can result in muscle spasms. Suggestions by our Physiotherapist in Singapore centre:

1) Thoracic Rotations against the wall

1. Start in a half kneeling position next to a wall, with your left hip and knee bent at 90 degrees, out in front of you.
2. Place a block or cushion between your left knee and the wall
3. Have your Left arm extended out resting on the wall at 90 degrees
4. Have your Right hand touch your left palm
5. Ensuring the hips stay pointing forward, rotate through the midback to bring your right arm across, aiming for the wall behind you
6. Return back slowly to have your palms touching again

7. Repeat x10 on each side
* Ensure your back IS NOT arching
* Ensure the movement comes from the mid-back, NOT the lower back or hips
* Ensure you ARE NOT leaning back
* Move into and out of each rotation SLOWLY. Sudden movements can result in muscle spasms.
* Move across as far towards wall as your mid-back will allow you – DO NOT push into pain.

2) Wall slides

1. Place your forearms and hands along a wall so that your elbows are bent and your arms point towards the ceiling.
2. Push your elbows into the wall to pull your shoulder blades away from each other as you slide your hands up the wall.
3. Feel an effort in the Serratus Anterior muscle – along the sides of your ribcage.
4. Return to the original position
5. Repeat x10.

6. Do make this more challenging, you can loop a resistance band around your forearm and follow the steps above.

* Ensure back stays flat and neutral throughout the exercise – Do NOT arch the back
* Ensure forearms stay parallel throughout. AVOID flaring out the elbows as you move up
* Ensure shoulders are relaxed. DO NOT shrug the shoulders to lift the elbows.

3) Sleeper stretch – For the back of the shoulder joint

1. Start by lying on your side with the left arm on the bottom.
2. Your bottom arm should be bent at the shoulder, elbow and forearm at 90 degrees – pointing up to the ceiling
3. Use your top arm to gently draw your left forearm towards the bed for an inward stretch.
4. Hold for 15 seconds, repeat on opposite side
*Ensure there is no pinching pain with this
* DO NOT push into discomfort or pain.

4) Shoulder rotation stretch

1. Start by standing straight with a band or belt in your arms at approximately shoulder’s width apart (or slightly wider)
2. Keeping the back flat, bring the band overhead, as far back as your shoulder allows
3. Hold this position for 5 seconds
4. Return band SLOWLY back to the front
5. Repeat x10

* DO NOT bend your elbows
* DO NOT shrug your shoulders
* DO NOT arch your back when elevating yours arms

5 ) Shoulder joint mobility (CARs)

1. Standing up tall, with the back flat raise your left arm up keeping the elbow straight
2. SLOWLY ROTATE the arm moving up towards the ceiling and then backwards into extension.
3. Try to keep the arm pressed as close to the head as possible
4. Finish by bending the elbow and resting the back of your hand on your back.
5. Repeat x 10 on each side.
6. The GOAL is to move the shoulder through its maximum range of movement.

* DO NOT arch the back
* KEEP elbow straight when moving the arm overhead and into extension
* DO NOT push into a painful range.

Simple Home Exercises to Help with your FROZEN SHOULDER!

Frozen shoulder is a condition that leads to stiffness of the shoulder joint, therefore causing restriction in movement. Simple activities such as reaching overheadsideward, and behind the back can become very difficult and painful.

Although the cause of FS is still unknown, some risk factors identified were diabetes, stroke, sedentary lifestyle, thyroid disease, and a previous history of shoulder injury.

Studies also found that frozen shoulder is two to four times more common in women between 40-60 years of age and with the nondominant shoulder being more affected.

Frozen shoulder, if not secondary to any shoulder injury or preexisting condition such as diabetes, is primarily a diagnosis of exclusion, based on thorough history taking, physical examination and appropriate imaging.Common clinical findings include: stiff and painful shoulder for at least 4 weeks, severe shoulder pain affecting work and daily activities, pain at night, and restriction of both active and passive shoulder motions. 

Although frozen shoulder can be painful, it is important to move the affected shoulder in all directions to maintain and increase available range. Stretching and mobilization exercises should also be done daily to prevent progressive stiffening of the shoulder joint.

Physical therapy has been shown to be beneficial in conservative management of frozen shoulder. Typical program will include mobilization, stretching, and strengthening exercises. Home exercises and self-management techniques are also vital parts of a comprehensive physical therapy program to promote patient independence.

Before initiating any exercise, the affected shoulder should be warmed up first either by taking a warm shower or placing a hot compress on the affected area for 10-15 minutes. Pain can be present when performing exercise but as long as the pain is tolerable it is safe to continue.

1. Pendulum stretch/Codman`s exercise

Goal: Stretch the shoulder joint

Procedure:

a.) Stand and lean slightly over a table using the good arm as a support and letting the affected arm to hang down

b.) Swing the arm in small circles in clockwise, and then counterclockwise directions for 10 revolutions each

c.) Do this once daily and as symptoms improve, progress to bigger swing diameter

d.). If comfortable and pain-free, you can hold a light weight (3-5 lbs) on the affected arm to gently increase the stretch on shoulder.

2. Self-mobilization Technique

Goal: Mobilize the shoulder

Procedure:

 a.) Lie on your stomach, propped up on both elbows

 b.) Shift your body weight downward between the fixed arms

 c.) Return to previous position, and repeat

 d.) Do this or 10-20 times at least twice daily

3. Finger ladder

Procedure:

a.) Face the wall at least three-quarters away with your hand at the level o your waist

b.) With your elbow slightly bent, slowly walk your fingers up the wall, until you`ve raised your arm as high as you can

  • Then, slowly lower your arm back to waist level (with the help of your good arm for more assistance)
  • Do this 10-20 times DAILY!

4. Cross-body stretch

Goal: Stretch the back of your shoulder

Procedure:

a.) In sitting or standing position, use good arm to lift the affected arm at the elbow

b.) Bring the affected arm up and across your body, gently stretching the back of the affected shoulder

c.) Hold the stretch or 10-15 seconds and repeat three times

d.) Do this twice DAILY!

Goal: Increase shoulder flexion

5. Towel stretch

Procedure:

a.) Hold a towel behind your back

b.) Good arm holds the one end above, while the affected arm holds the other end below

  • Using your good arm, then slowly pull the affected arm upward to stretch it
  • Hold the position for 10-15 seconds and repeat three times; do this twice daily

Goal: Increase shoulder inward rotation

If you are suffering from frozen shoulder you can consult one of our Singapore Physiotherapist or Manila Physiotherapist.

Call us for an appointment or send your queries to: info@physioasia.com

REFERENCES:

Cifu, D. X. (2016). Braddom’s Physical Medicine and Rehabilitation (5th ed.) (D. L. Kaelin, K. J. Kawalske, H. L. Lew, M. A. Miller, K. T. Ragnarsson, & G. M. Worsowicz, Eds.). Philadelphia, PA: Elsevier

Donatelli, R. (2012). Physical Therapy of the Shoulder (5th ed.). St. Louis, MO: Elsevier/Churchill Livingstone.

Dutton, M. (2012). Dutton’s Orthopaedic Examination, Evaluation, and Intervention (3rd ed.). New York: McGraw-Hill Medical.

Ferri, F. F. (2017). Ferris Clinical Advisor 2017: 5 Books in 1. Philadelphia, PA: Elsevier, Inc

Kisner, C., & Colby, L. A. (2012). Therapeutic Exercise: Foundations and Techniques (6th ed.). Philadelphia, PA: FA Davis Company

Micheo, W. (2011). Musculoskeletal, Sports, and Occupational medicine. New York: Demos Medical.

Rockwood, C. A. (2017). Rockwood and Matsen’s the Shoulder (5th ed.). Philadelphia, PA: Elsevier.

Sueki, D., & Brechter, J. (2010). Orthopedic Rehabilitation Clinical Advisor (1st ed.). Maryland Heights, MO: Mosby Elsevier.

Wyss, J., & Patel, A. (2013). Therapeutic Programs for Musculoskeletal Disorders (1st ed.). New York: Demos Medical Publishing

Different types of knee pain and what they tell you!

Knee pain can be caused by a variety of conditions depending on what structures are affected. Bonesmuscles, nerves, meniscusand ligaments make up the knee and when any of these structures are injured, it can lead to knee pain. Based on studies, pain in front of the knee is the most common (20-40%) presenting symptom in sports physiotherapy.

Location of pain gives your physiotherapist a general idea on what structures are possibly injured. Other factors to consider include: type of pain (cramping, aching, sharp, tingling), aggravating activities and whether symptom is constant or intermittent.

Common causes of knee pain are :

1.) Patellar Tendinopathy/Jumper`s knee

Clinical Presentation:

            → Pain and swelling just below the knee cap (patella)

            → Tenderness on inferior pole of patella, patellar tendon or on tibial tuberosity

            →  Pain occurs at the start of activity which settles after warm-up and returns after activity

            → Generalized weakness of quadriceps muscle

Aggravating activities:

            → Jumping (volleyball, high jumps, long jumps or triple jumps)

            → Sudden change of direction when running

            → Deceleration

  • Quadriceps Tendinopathy

Clinical Presentation:

            → Pain and swelling just above the knee cap (patella)

            → Tenderness on quadriceps tendon and superior pole of patella

            →  Pain occurs at the start of activity which settles after warm-up and returns after activity

            → Generalized weakness of quadriceps muscle

Aggravating activities:

            → Jumping (volleyball, high jumps, long jumps or triple jumps)

            → Sudden change of direction when running

            → Deceleration

3.) Osgood-Schlatter Lesion

Clinical Presentation:

            → Pain on tibial tuberosity (bony part little below the knee cap)

Aggravating activities:

            → High levels of activity such as running, jumping during a period of rapid growth (adolescents)

4.)Patellofemoral pain syndrome or Pain in front of the knee

Clinical Presentation:

            → Onset of pain is insidious but may occur secondary to an acute traumatic knee injury

            (e.g. falling on the knee, meniscal tear) or following a knee surgery (e.g. ACL reconstruction)

            → Pain located on either front/inner side of the knee, or behind the patella

            → Weakness of Vastus Medialis Obliquus muscle

            → Crepitus (clicking sounds) under patella when bending the knee

Aggravating activities:

            → Ascending/descending stairs

            → Running especially downhill

5.)  Pes anserine Tendinopathy/Bursitis

Symptoms:

            →  Localized tenderness and swelling close to the medial joint line

            → Pain when knee is bent against resistance

Aggravating activities:

            → Swimming (breast strokers)

            → Cycling

            → Running

6.) ITB/Iliotibial Band Friction Syndrome

Clinical Presentation:

            → Ache over the outer portion of the knee

            → Tenderness and swelling over the lateral femoral condyle

            → Crepitus (clicking sounds) when bending and extending the knee

Aggravating activities:

            →  Running

            → Cycling

            → Downhill running

Our Singapore physiotherapists and Manila Physiotherapists can help you to manage knee pain and assist you with exercises to take care of your knee pain. Call us for an appointment or send your queries to: info@physioasia.com