Manual Therapy: Help for Your Shoulder Pain

As many as 1 in 4 Americans experience shoulder pain.  Pain ranges from a mild nuisance to severe disability.  Shoulder pain has many origins.  Rotator cuff disorders are the most common.  Many others suffer from a frozen shoulder, labral tear, or instability.

In addition to the many origins of shoulder pain, there are even more options for treatment.  In some respects, different options are a good thing.  However, many treatment options in physical therapy are a waste of time.  Manual therapy is proven to help people with all types of shoulder problems.

Proven Physical Therapy Treatments for People with Shoulder Pain

A 2020 research review in The Journal of Orthopaedic and Sports Physical Therapy looked at all treatment choices physical therapists use for shoulder pain.  This includes exercise, manual therapy, electrotherapy, ultrasound, laser, and other combined approaches.

Based on this extensive research, exercise clearly has the most powerful influence on shoulder pain.  Lso, manual therapy is strongly recommended.  Manual therapy by itself has only a small influence on shoulder pain.  However, when done together manual therapy enhances the effects of exercise.

Other treatments proven to be no help are electrical stimulation, ultrasound, laser, and shockwave therapy.  Based on this research, individualized exercise combined with manual therapy is the best approach to help your shoulder pain.

3 Different Types of Manual Therapy for Shoulder Pain

Physical therapists use various manual therapy techniques.  This includes joint mobilization, spinal manipulation, soft tissue mobilization, and manual resistance exercise.  Your physical therapist performs an in-depth examination at your first visit. This allows him or her to determine the techniques that are best for you.  Below are a few examples.

Shoulder Joint Mobilization

Joint mobilization stretches the capsule and ligaments surrounding your shoulder.  Your physical therapist tests the mobility of your joints.  Then he or she determines whether or not these structures are contributing to your pain or stiffness.  These techniques are painless.  And they often result in immediate improvements in pain and shoulder mobility.

Spine Manipulation

When you raise your arms overhead, your spine extends and rotates.  When this does not happen, greater stress is placed on the muscles and tendons of your shoulder.  Thoracic spine manipulation involves a quick stretch to your spinal joints. You may or may not experience a “pop”.  In either case, you will feel an immediate improvement in your shoulder pain.

Shoulder Manual Resistance Exercise

Mobilization and manipulation improve mobility.  Immediately after regaining your mobility, it is important to retrain your muscle strength and coordination.  Otherwise, you will quickly lose your new range of motion.  Physical therapists are skilled at using their hands to provide resistance.  In some ways, this is superior to using weights or bands.

Get the Right Manual Therapy for Your Shoulder Pain

Manual therapy accelerates your response to exercise.  You will see greater and quicker improvements when the 2 are combined.  Your physical therapist will determine the best manual therapy techniques for you after your initial examination.

If you are suffering from shoulder pain or stiffness, contact your physical therapist today.  Take the first step and schedule your initial examination.  The physical therapists at BSR have been helping Southern Ocean County move without pain since 2007.  We would like to help you achieve your goals.

5 Exercises for a Better Recovery After Shoulder Surgery

Since the late 1990’s, shoulder surgeries have risen by nearly 10 times.  The most common reason for surgery is shoulder impingement.  Impingement occurs when your rotator cuff, biceps tendon, and/or bursa are pinched or irritated.  Irritation occurs between the bones of your upper arm and shoulder blade.  Subacromial decompression is an arthroscopic surgery that removes or shaves away bone.  This creates more space for the irritated structures in your shoulder.

Shoulder surgery exercises
Pinching of the bursa and rotator cuff with shoulder impingement

Recovery from arthroscopic surgery is a long process.  Soreness lasts anywhere from a few weeks to several months.  During your recovery, it is important that you move and exercise your shoulder.  Inactivity leads to a stiff or frozen shoulder.  Also, the muscles around your shoulder need retraining in order for your arm to function properly.  This article shows you several important exercises to do right after your shoulder surgery.

Physical Therapy Improves Your Recovery After Shoulder Surgery

A 2016 study published in the Physical Therapy Journal, investigated the effectiveness of physical therapy after subacromial decompression surgery.  A total of 126 patients were split up into 2 groups.  One group received post-surgical rehab supervised by a physical therapist 2 times per week for 8 weeks.  The other group received no formal physical therapy after their surgery.

Three months after surgery, the physical therapy group showed greater improvements in pain and function.  These improvements were even more evident in the physical therapy group 1 year after surgery.  Therefore, this study proves the short and long-term benefits of completing physical therapy after your shoulder surgery.

3 Keys to Your Recovery After Shoulder Surgery

Your shoulder will feel sore, stiff, and heavy immediately after your surgery.  This is normal.  However, the right behaviors and actions will speed up your recovery.  Here are 3 things to do during the first 1 to 2 weeks after surgery.

  1. Use Ice. The cold will keep your pain and swelling under control.  About 10 to 20 minutes of ice is all you need each time. For the first week, ice 3 times per day. Don’t overdo it.  Gradually reduce the frequency of icing based on your pain levels.
  2. Gradually Remove Yourself From the Sling. A few days or even a week in the sling is going to be fine. However, you do not want to become dependent on it. As long as your rotator cuff was not repaired, you will want to slowly (not all at once) remove yourself from the sling.  Each day, remove your sling and get comfortable with your arm hanging by your side.  While walking, relax your arm and let it swing naturally.
  3. Gently Start Moving Your Arm. Taking dedicated time each day to exercise your shoulder is important.  Keeping your arm in a sling or anchored across your body will lead to a stiff or frozen shoulder.  You want to avoid this at all costs.  The exercises that follow in this article are a great starting point.  Perform them daily during the first month after surgery.

Shoulder Pulley Exercises

Pulley exercises are great for early rehab because they allow you to get your arm overhead with assistance.  You can order pulleys online or your therapist may provide you with a set.  They easily fit over any door.  Just pull a chair up.

Start with your involved arm resting down towards your lap. Your uninvolved arm starts overhead.  Pull down with your uninvolved arm.  Keep the elbow of your involved arm straight as you move it overhead.  Your good arm does most of the work.  Hold the stretch for 5 to 10 seconds.  Perform 20 to 30 repetitions.  Many people feel better when they do the pulleys several times per day.

Wand-Assisted External Rotation

When your shoulder stiffens after surgery, you will first notice difficulty turning or twisting your arm.  This occurs when you reach behind your head or behind your back.  Therefore, it is important for you to start moving your arm into external rotation early after your surgery.

Begin on your back with a small pillow or towel roll under your upper arm.  Hold a cane, golf club, or similar object with both hands.  Use your other arm to passively rotate your involved arm out to the side.  Maintain the elbow of your involved arm at a 90-degree angle.  Pause and hold the position for 5 to 10 seconds.  Avoid exercising through pain and avoid overstretching the shoulder into excessive external rotation.

Low Row Isometrics

The muscles in the back of your shoulder are very important.  They work together to move and position your shoulder blade so your arm can function properly.  If your shoulder blade muscles are not working in sync, you will put excessive stress on the front of your shoulder.

The low row exercise is a great way to begin retraining your lower and middle trapezius muscles.  Stand with your hand resting on a tabletop, chair, or counter.  Your arm does not move during the exercise.  Keep it relaxed.  Focus your attention on moving your shoulder blade diagonally down and back towards your opposite back pocket.  Hold this contraction for 5 to 10 seconds and do 20 repetitions.

Push-Up Plus

Your serratus anterior is another important muscle that moves and positions your shoulder blade.  This muscle is activated when you raise your arm fully overhead or when doing a punching motion.

Get on your hands and knees with your weight distributed evenly.  Keep your elbows straight.  Gently lift your upper back straight up towards the sky.  Your spine moves away from your shoulder blades.  Hold this contraction for 5 to 10 seconds and do 20 repetitions.

Band Scaption to 60 Degrees

After a few weeks of doing the previous 4 exercises, you will begin some light resistance work.  Raising your arm in the scapular plane against some light resistance activates your rotator cuff.  The scapular plane is a natural position for our arms to function in.  It is not the same for everyone.  It is somewhere in between raising your arms straight out in front and straight out to the side.  Pick an angle that is comfortable for you.  Start, with small arm raises to avoid pain early on.

Stand with a resistance band anchored under your opposite foot.  Hold the other end of the band with a thumb-up grip.  Maintain a straight elbow.  Raise your arm to about chest level and hold 3 to 5 seconds.  Start with 2 or 3 sets of 10 to 12 repetitions.  As you become more comfortable with the exercise, increase the number of reps to 15 or 20.

Get Started Early After Surgery

Shoulder surgery rehab
Manual therapy improves shoulder mobility after surgery

Subacromial decompression surgery is essentially a “clean-up” of your shoulder.  No tendons or ligaments are repaired.  Therefore, you are clear to begin moving your arm right away.  Starting early and remaining consistent are your keys to success.

Working with your physical therapist will get you started off on the right foot.  BSR has been helping people recover from shoulder surgery since 2007.  Give our office a call to schedule an evaluation with your physical therapist.

Foam Roller Exercises for Better Shoulder Mobility

Are you stretching your shoulder but not seeing any real improvement in your range of motion? Many people see little carryover or long-term change by doing stretching exercises alone.  Manual therapy performed by your physical therapist provides an additional benefit to self-stretching exercises.  However, you can’t see your physical therapist forever.  If you want to see greater improvements on your own, add foam roller exercises to your shoulder stretching routine.

The Science of Foam Rolling

The exact way foam rolling works is unclear.  There are 3 primary theories.  First foam rolling is believed to improve local blood flow to muscles. This makes them easier to stretch.  Second, some suggest it improves the mobility of your fascia.  We are not convinced about this one.  Fascia is the thin connective tissue that surrounds and holds your organs, blood vessels, bones, nerves, and muscles in place.  It is questionable whether or not fascia restricts the range of motion. Finally, foam rolling may reduce the sensitivity of your nervous systems allowing tight muscles to relax.  This one makes the most sense to us.

Lat Foam Roller Exercises
Foam rolling your lats improves shoulder mobility.

Even though the reason why foam rolling works is not known, we do know it helps improve range motion.   At least, in the short term, foam rolling improves your range of motion for up to 30 minutes.  The degree of improvement is very variable between people.  Some people will see no improvement.  Others will see a 20% to 25% improvement.

It is best to perform 1–3 sets of rolling for each area before doing your stretching exercises.  Combining foam rolling with stretches produces the best results. Each set lasts 30 to 120 seconds.  We recommend closer to 30 seconds.  While rolling, identify tight or tender areas.  Apply sustained pressure to these areas for 2 to 4 seconds.

5 Foam Roller Exercises for Your Shoulder

Below are 5 foam roller exercises that will improve your shoulder mobility.  You do not have to perform them all.  Identify the 2 or 3 areas that are most limited or tender.  Roll these areas for a few minutes then immediately perform your shoulder stretching exercises.

Foam Rolling Your Upper Back

Tightness in your thoracic spine and rib cage will limit your shoulder mobility.  In order to raise your arm overhead your upper back must be able to extend and rotate.  Foam rolling in this area will solve this problem.

Begin in a lying position over a foam roller.  Place your hands behind your neck supporting, but not pulling on, your neck.  Raise your buttocks off the ground and roll your upper back up and down the foam roller.  Identify a sensitive, stiff, or tender area, and then drop your buttocks down to the floor.  From this position perform small extension movements by lifting your elbows up towards the ceiling.  Be careful not to overextend your lower back.

Foam Rolling Your Lats

Your lat muscles span from your pelvis and low back all the way up to your armpit.  Tightness in your lats will restrict your ability to reach over and behind your head.  This is very common.

To roll your lats, lie on your side with the foam roller positioned in your armpit.  Bend your bottom leg and straighten your top leg.  Your palm is facing up to rotate your upper arm and apply a stretch to your lats.  Engage your abdominals slightly to maintain a posterior tilt of your pelvis.  Slowly roll up and down covering an area of about 6 to 12 inches.  Gentle pressure is all that is needed.  Aggressive pressure or foam rolling will increase tension in your lats.

Foam Rolling Your Thoracolumbar Fascia

Your thoracolumbar fascia is a thick broad band of connective tissue that spans from your pelvis and spine to your upper back.  Your lats and several other major muscles attach to this large structure.  Rolling this area is not the most comfortable.  Start with light pressure for no more than 30-second sets.

Lie on your side with the foam roller positioned just above your hip.  Slightly lean back so the foam roll contacts your backside.  Bend your top and straighten your lower leg.  Engage your abdominals slightly to maintain a posterior tilt.  Slowly roll up and down covering an area of about 6 to 8 inches.   Remember, use light pressure at first.

Foam Rolling Your Triceps

The long head of your triceps muscle crosses your shoulder joint.  Therefore, restrictions in this muscle will limit your ability to reach overhead.  Also, this is a tough muscle to stretch on your own.  Foam rolling will help.

Get in a kneeling position with a bench or table in front of you.  With your palm up, place the foam roller under your upper arm.  Shift your weight back and forth to roll the back of your arm.  Try bending a straightening your elbow to localize the pressure.  Sustain the pressure over any tight or tender areas.  You can even twist your arm to apply pressure more to the inside or outside of your arm.

Foam Roller Exercise for Your Pecs

Your pectoral muscles attach to your ribs, shoulder blade, and upper arm.  Short pec muscles will pull your shoulder forward.  In order for your arms to move overhead, your shoulder blade must tilt back and rotate.  If it can’t you will be limited and place more stress on other structures around your shoulder.

This is more of a stretch than a rolling exercise.  To stretch your pecs, lie on a foam roll longways so it rests between your shoulder blades.  With your elbow bent allow your arms to fall down towards the floor.  Fully exhale and relax in this position for 30 seconds.  Do 3 stretches each day.

See Your Physical Therapist to Learn the Right Foam Roller Exercises for You

Foam rolling does not cause any strength, power, or speed performance deficits. Thus athletes can use a relatively wide selection of repetitions, and durations to improve the extensibility of their muscles and soft tissue without significant reduction in performance.  This makes it a great tool to warm up with.

If you are unsure about foam roller exercises that are right for you, give us a call.  Your physical therapist will help you design the best foam roller exercise and stretching program to help you achieve your goals.

 

Shoulder Dislocation: Who Needs Surgery and How to Get Started with Rehab

About half of people who suffer a shoulder dislocation will have a second dislocation within 2 years. Several types of surgery are proven to reduce future dislocations. But not everyone needs surgery after a shoulder dislocation. Special rehabilitation exercises are proven to improve pain and function after a shoulder dislocation. This article highlights recent research findings that help us identify who would benefit most from surgery.

Who is at Risk for a Second Shoulder Dislocation?

A 2015 study published in the British Journal of Sports Medicine investigated the risk factors that predict recurrent shoulder dislocations.  Specifically researchers looked at adults 1 or more years after a shoulder dislocation.

Three important risk factors for future dislocations were identified.

  1. Men are 3.2 times more likely to dislocate their shoulder a 2nd time
  2. People 40 years and younger are 13.5 times more likely
  3. People with “loose joints” are 2.7 times more likely

So, younger more active males with “loose joints” are most at risk for re-injuring their shoulder.  If this is you, it would be best to visit an orthopedic surgeon.  You are at high risk for re-dislocating your shoulder.  If you are older than 40 and more “stiff-jointed” then stick with rehab for at least 3 to 6 months before considering surgery.

Rehab after Surgery for a Shoulder Dislocation

Immediately after surgery, your shoulder is immobilized in a sling.  The length of time depends on several factors. This includes your age, activity levels, and the type of surgery done.  In general, expect to be in a sling anywhere from 1 to 5 weeks.  Your surgeon and physical therapist will determine when it is best to lose your sling.

In most cases, it is safe and recommended you begin range of motion and strengthening exercises within 1 week from surgery.  However, the specific exercises prescribed depends on the type of surgery done and the extent of your injuries.  The exercises included in this article are examples of what we commonly prescribe.

Controlled Range of Motion Exercises

It is important to protect your repaired ligaments and joint early after surgery.  In most cases, the front part of your shoulder joint is repaired.  It is important to protect the repair for the first 4 to 6 weeks.  However, controlled movement into safe ranges is safe and encouraged immediately after surgery.

This means partial range of motion exercises involving some shoulder rotation and flexion.  Flexion exercises are limited to about 50% of your normal range for the first 2 weeks or so.  Then you are gradually progressed back to full overhead range of motion.  Expect full flexion range of motion by 6 to 8 weeks after surgery.

Your shoulder external rotation range of motion will be progressed more slowly.  This movement directly stresses your repair.  For the first 4 weeks keep your elbow close to your side when externally rotating away from your body. Your therapist will instruct you how far to move during each exercise.  Go easy and don’t expect full external rotation motion until about 8 to 10 weeks after surgery.

Early Strengthening Exercises

During your first week of rehab you will be performing light pain free isometric exercises.  Manual resistance exercises with your therapist is a great option. You will also perform pain free rotator cuff isometrics at home. Within 4 weeks after surgery, you will start light band exercises for your rotator cuff.  Initially, your therapist may restrict your range of motion during these exercises.

Your scapula provides the base for your shoulder and arm to move.  Your base must be stable in order for your shoulder to be stable (and not dislocate).   Scapula muscle retraining exercises begin immediately after surgery.  Early emphasis is placed on strengthening your serratus anterior, middle trapezius, and lower trapezius.

Your rotator cuff muscles function to keep the ball of your shoulder joint in the socket.  You want your rotator cuff to be extra strong to reduce your risk of dislocating your shoulder again.  During the first 3 months of your rehab, we encourage band and light dumbbell exercises.

For the Best Results Start Your Rehab Early

After shoulder stabilization surgery, your risk for another dislocation is significantly less.  Also, greater than 90% of people undergoing surgery are able to return to sports.  However, it is a long road back.  Depending on your sport, it may take 6 to 12 months to return.

Your post-surgery rehab is a key factor in you achieving the best outcome after surgery.  To avoid a stiff shoulder and prolonged weakness, start your rehab early.  The physical therapists at BSR have been rehabbing the people of  Southern Ocean County since 2007.  Call us and schedule your initial visit to get started.

Shoulder Dislocations: 5 of the Best Types of Rehab Exercise

Your shoulder is the most mobile joint in your body.  However, it is also the most often dislocated joint.  Shoulder dislocations are most common in active people under 25 years old.  About 200,000 shoulder dislocations occur in the U.S. each year.  Surgery or non-surgical treatments are available.  5 types of exercises are required for you to recover without surgery.

Multiple structures become injured after a shoulder dislocation.  Your ligaments tear.  Your labrum and rotator cuff are injured.  And some people experience bone bruising or fractures.  Because of the complexity of these injuries, rehab is comprehensive.  Your shoulder will not recover with only passing time.  You need to take rehab seriously.

Shoulder instability
Anterior shoulder dislocation with the ball coming out of the socket.

Shoulder Dislocations: A Proven Exercise Approach

A 2020 study published in The Orthopaedic Journal of Sports Medicine looked at 56 patients after a shoulder dislocation.  Half of these patients performed a generic home exercise program.  These exercises targeted range of motion and strength.  The other half performed specialized exercises supervised by a physical therapist.

After 12 weeks, the group performing the specialized exercises achieved nearly 50% greater improvement in pain and function.  Also, 25% of the patients performing the home exercises eventually required surgery, compared to only 11% in the specialized exercise group.

5 Important Types of Exercise after a Shoulder Dislocation

The rest of this article highlights 5 of the keys to an individually tailored exercise program after a shoulder dislocation.

  1. Controlled Early Range of Motion
  2. Scapula Control Exercises
  3. Dynamic Stabilization Exercises
  4. Rotator Cuff Strengthening Exercises
  5. Proprioceptive Exercises

Controlled Early Range of Motion

After a shoulder dislocation, your damaged shoulder needs time to heal.  This involves a very short period of rest in a sling.  The length depends on many factors like your age and activity levels.  Your doctor will make this determination.

Your physical therapist will individually prescribe the right exercises for you.  Exercises will protect healing tissues so you don’t suffer a second dislocation.  Also, it is important to maintain and slowly restore your mobility so you don’t lose it for good.

Follow your physical therapist’s recommendations closely.  In most cases, gentle range of motion exercises begins within 1 or 2 weeks of your injury.  Supine shoulder flexion and the forward bow are 2 common exercises used early during rehab.

Scapula Control Exercises

Your scapula, or shoulder blade, makes up half of your shoulder joint, along with your upper arm.  Your shoulder blade is the base for your entire arm.  It has many important muscle attachments.  You have to be able to control the position and movement of your shoulder blade.  This enhances stability and reduces your risk for dislocations.  Your first step is to properly activate your middle and lower trapezius muscles.  Practice this every day.

Dynamic Stabilization Exercises

Dynamic stability refers to your muscle’s ability to hold the head of your humerus in the socket.  Passive stability refers to your ligaments and joint capsule.  Muscle and nerve function is dynamic.

Dynamic stability occurs during daily use when your muscles and nervous system respond on time and with sufficient force.  Let’s say you fall on your shoulder.  If your muscles and nerves respond too slow or with not enough force, you will dislocate your shoulder.

Exercises that target coordination and timing retrain dynamic stability.  Early during rehab, your physical therapist will perform exercises using their hands as manual resistance.  This improves your ability to react to external forces.  As you progress in rehab you will utilize various tools to train dynamic stability.  Bodyblade exercises are included in most programs. 

Rotator Cuff Strengthening Exercises

Your rotator cuff functions to hold the head of your humerus bone in the socket of your shoulder blade.  Essentially the 4 muscles of your rotator cuff keep the ball in the socket.  The rotator cuff muscles respond rapidly when your shoulder is challenged.  They must have excellent strength and endurance to do their job properly. If not, you are at risk for another dislocation.

There are many excellent exercises to strengthen your rotator cuff.  Start with side-lying external rotation.  And do these exercises at least 3 days per week.  Perform 3 to 4 sets of 10 to 20 reps with low loads.  Light weights, 2 or 3 pounds, gets the job done at first.

Proprioceptive Exercises

Proprioception refers to an awareness of where your body is in space.  For example, closing your eyes and touching your finger to your nose requires proprioception.  This is able to happen because of small specialized nerve endings in your muscles, tendons, and joints.

After a shoulder dislocation, nerve endings and pathways become disrupted.  Restoring these pathways requires specialized exercise.

Early during rehab, you are prescribed exercises that require you to reposition your shoulder in various positions.  These exercises require ongoing feedback from your therapist.  As you progress in your rehab, you will perform exercises on unstable surfaces like a balance board or BOSU ball.

Get Help From Your Physical Therapist

Rehab after shoulder dislocations require a delicate balance.  On the 1 hand, you have to perform the right exercises correctly without overstressing your healing tissues.  Multiple dislocations are common, especially in younger people.

On the other hand, your shoulder will not get better on its own.  You need to move it to regain your range of motion.  And you need to improve your strength, stability, and proprioception in order to regain function.  This requires the help of your physical therapist.

So don’t delay your rehab.  Call your physical therapist to get started on the road to recovery.  The doctors of physical therapy at BSR have been helping people in Southern Ocean County with painful shoulders since 2007. We are here to help you move without pain.

Massive Rotator Cuff Tears: Proven Exercises to Ease Your Pain

In the United States approximately 17 million people struggle with rotator cuff tears. Often, pain and an inability to raise the arm overhead becomes debilitating.  Both surgery and physical therapy are effective ways to treat small and massive rotator cuff tears.  Many factors, including the size and characteristics of your tear, determine your best course of treatment.

Older tears involving multiple tendons are classified as massive.  Not all massive rotator cuff tears can be repaired with surgery. Sometimes there is not enough healthy tissue left. In these cases, you are told to live with the pain.  However, there is now evidence that certain exercises can help people with massive rotator cuff tears.  This article describes how you can get started feeling better.

Physical Therapy Decreases Pain from Massive Rotator Cuff Tears

Would you prefer to avoid the risks associated with surgery?  Or maybe you are a poor surgical candidate because of other medical conditions?  If so, there is hope for you. Research out of Vanderbilt University has outlined a rehabilitation protocol with overall success rates as high as 96%.

This physical therapy protocol is proven to decrease pain, increase strength, and improve shoulder function.   The protocol includes 12 weeks of physical therapy. The exercises focus on supine lying exercises with a gradual progression to standing upright.  In some cases, shoulder injections and anti-inflammatory medications are part of the treatment program.

Rotator Cuff Basics and Why This Program Works

Your rotator cuff is made of 4 muscles and their corresponding tendons.  Collectively, your rotator cuff keeps the ball of your shoulder joint in the socket.  Without a properly functioning rotator cuff, the ball leaves the socket.  This results in a shoulder shrug or a complete inability to raise your arm.

With a massive tear, your rotator cuff may be nonfunctional.  Attempting to strengthen your rotator cuff may provide only a little help.  Instead, you want to strengthen other muscles that will compensate for your torn rotator cuff.

We see many people with massive rotator cuff tears who can raise their arm overhead without pain.  This is because their deltoid muscle is strong enough to compensate.  The exercises outlined in his program retrain and strengthen your deltoid.  With consistent adherence to the program, expect to see gradual improvements in pain and raising your arm overhead.

Range of Motion Exercises

Your first goal is to improve your passive overhead range of motion without pain. Perform these exercises lying on your back. Start by using a cane or wand for assistance.  Then remove the assistance as you become stronger.  Gradually progress the exercises to an inclined and then upright position.

Perform 3 sets of 10 to 15 repetitions each day.  Don’t worry about holding the stretch.  Instead, perform the exercises in a smooth, slow, and controlled fashion.  If you experience pain during certain points in the range of motion, limit how far you go.

Strengthening Exercises

After you see improvements in your range of motion, incorporate deltoid and teres minor strengthening exercises.  Perform these exercises in sitting or standing.  Perform 3 sets of 15 to 20 repetitions each day.  Some discomfort is ok.  But you don’t want sharp pain when doing these exercises.

Your teres minor is the smallest of your rotator cuff muscles.  It is not involved in most massive rotator cuff tears.  Side-lying external rotation strengthens your teres minor.  Start with the weight of your arm.  After you can perform 3 sets of 15 repetitions incorporate a light 1 pound hand weight.

Final Thoughts on Exercises for Massive Rotator Cuff Tears

Progress will be slow at first.  Expect to see improvements within 3 to 6 months as long as you do the exercises consistently.  Not coincidently, this is about the same time frame it takes most people to recover from rotator cuff repair surgery.

For the best results, perform the exercises at least 5 days per week.  Perfect form is a must!  If you can’t do the exercises properly, you will experience more pain.  Let us know if you need help.  Call our office to schedule an appointment with your physical therapist.  We are here to help you move without pain.

 

Reverse Shoulder Replacement Recovery: Strengthening Exercises

The reverse shoulder replacement has a specific design that takes advantage of your large deltoid muscle.  So even if your rotator cuff is damaged, you can still raise your arm overhead. Strengthening exercises in physical therapy targets your deltoid muscle.  It is also important to strengthen the muscles attaching to your shoulder blade.  This articles shows you 5 of the most common strengthening exercises we prescribe to help with your reverse shoulder replacement recovery.

Shoulder Replacement Recovery: Returning to Sport

Many people pursue shoulder replacement surgery with expectations of returning to their favorite activities or sports.  A 2020 systematic review investigated the rate of return to sport in patients recovering from shoulder replacement surgery.  This paper included 12 different studies looking at patients after shoulder replacement surgery.

Overall, 82% of patients returned to playing their favorite sport.  Swimming showed the highest rate of return (84%), followed by fitness (77%), golf (77%), and tennis (69%).  Strengthening your shoulder is key to returning to these types of activities.

Reverse Shoulder Replacement Recovery: The Basics of Strength Training

For the best reverse shoulder replacement recovery you will need to be diligent with your strengthening exercises.  Light strengthening exercises begin 6 to 8 weeks after your surgery.  Again, the focus is on improving the strength of your deltoid muscle and the muscles that attach to your shoulder blade.

Strengthening exercise are performed once daily 3 to 5 times per week.  Initially, start with 15 repetitions per set.  Also, we recommend 2 to 3 sets of each exercise.  As you progress, increase the resistance as you lower the reps to 10 for each set.

Band Forward Elevation in Supine

Lying on your back to exercise minimizes the effect of gravity.  This makes it ideal to begin exercising with light resistance while protecting your healing shoulder.

To perform this exercise begin on your back. Hold a resistance band in your uninvolved side hand at waist level. Your involved side shoulder starts flexed 90° with your elbow straight holding the band in a thumb-up position. Place minimal tension on the band in this starting position.  Then, actively lift your arm into forward elevation to approximately 160°.  This will lengthen the band.  Pause 2 to 3 seconds at the top.  Finally, lower slowly back to the starting position.  Perform 10 to 15 repetitions for 2 to 3 sets each day.

Press-Up in Standing

Initially, perform this exercise without any weight.  As your strength improves, add 1 to 2 pounds.  Start standing with your hand close to your body and elbow bent.  Perform an overhead pressing movement.  Straighten your elbow as your arm passes overhead.  Hold for 2 to 3 seconds before slowly lowering your arm back down to the starting position.  Perform 2 to 3 sets of 10 to 15 repetitions each day.   It is important to avoid “shrugging” your shoulder or arching your low back.

Prone Row

Begin lying on your stomach holding a dumbbell.  Start with your arm in an extended position.  Perform a row.  Your elbow stays close but not all the way against the side of your body.  Hold the top position for 1-2 seconds before slowly lowering the weight.  It is important to pull your shoulder blade back as you raise your elbow.  Avoid overextending and shrugging your shoulder.  Perform 2 to 3 sets of 10 to 15 repetitions each day.

Prone Horizontal Abduction

Lie face down with your arm over the side of a bed or bench.  With your thumb up and arm straight lift toward the ceiling at a 90-degree angle (the 9:00 and 3:00 positions of a clock). Be careful to avoid shrugging your entire shoulder as you raise your arm.  Instead, think about tilting your shoulder blade backward as you raise your arm.  Pause at the top of the movement before returning to the start position in a controlled manner.  Perform 2 to 3 sets of 10 repetitions each day.

Serratus Wall Slide with Foam Roll

Begin with your forearms resting on a foam roll against a wall. Protract your shoulder blades by pushing your upper back away from the wall.  This activates your serratus anterior muscle.  Next, “roll” your forearms up the wall in a controlled manner.  Make sure you don’t lose the protraction.  Return back to the starting point in a controlled manner.  Perform 2 to 3 sets of 10 repetitions each day.

Final Thoughts on Your Shoulder Replacement Recovery

Performing a gradual and progressive strength training program is important after your reverse shoulder replacement recovery.  Everyone progresses at a different rate.  Your physical therapist will be your guide as you work towards your goals.  Most people return to their favorite sports or activities within 3 to 6 months.  This of course, assumes you have restored 85% to 90% of your shoulder strength.

If you would like help developing the best individually-tailored exercise program give us a call.  The doctors of physical therapy have been helping the people of Southern Ocean County move without pain since 2007.

Reverse Shoulder Replacement and Early Rehabilitation

Reverse shoulder replacement is becoming an increasingly common surgery.  If you are plagued by painful shoulder arthritis along with rotator cuff disease this surgery is an option for you.  Also, some types of arm or shoulder fractures are best treated with a shoulder replacement.   After surgery, your outcome becomes largely dependent on your rehabilitation.  This article focuses on what is most important during the first month of your recovery.

Early Motion is Beneficial after Reverse Shoulder Replacement

There are two possible early complications following reverse shoulder replacement.  First, it is important to protect the shoulder from dislocating during the first month of your recovery.  Your shoulder is most at risk for dislocating when you attempt to reach behind your body.  You should avoid movements that involve reaching behind your back to dress or reaching into the backseat of your car.

Rehabilitation

The second common complication is a stiff shoulder.  Not moving your arm at all will result in shoulder stiffness.  This leads to a poor long-term outcome.  A recent study from the University of California showed excellent results when patients began range of motion exercise 1 week after surgery.  Both early exercisers and those who delayed exercise 6 weeks achieved excellent outcomes with very low complication rates.  This study suggests both immediate and delayed rehabilitation are safe and effective.

Exercises after Reverse Shoulder Replacement

This article describes 5 exercises we prescribe early after shoulder replacement.  We emphasize overhead range of motion.  For the first 6 weeks we refrain from performing exercises that involve reaching behind your back.  Some pain is acceptable during exercise.  However, pain should be minimal and dissipate soon after completing your exercises.  Most surgeons advise using a sling for the first few weeks.  You want to slowly wean yourself from using the sling to minimize your change of developing stiffness.

Table Slides

 Stand holding a towel with your hand resting on a table top or counter.  Relax your shoulder and neck muscles.  Slowly lean forwards and slightly out to the side (a 45 degree angle) while sliding your hand on the table or counter.   When a mild stretch is felt, pause and hold the position for 5 to 10 seconds.  Avoid exercising through pain.

Waiter’s Bow

Begin standing with your hands resting on a table top or counter.  Relax the shoulder and neck muscles.  Slowly step backwards while keeping your hands on the table or counter.   When a mild stretch is felt, pause and hold the position for 5 to 10 seconds.  Perform 10 repetitions.  Avoid holding your breath, bouncing, or exercising through pain.

Washcloth Press Up

Lie on your back with your knees bent.  Hold a small towel with your hands close together.  Your other arm assists lifting your involved arm straight up to the ceiling.  Straighten your elbow fully.  Then pause and hold the position for 5 to 10 seconds.  Avoid exercising through pain.   Progress this exercise by performing it in a slightly reclined position.

Self-Assisted Shoulder Flexion

Begin lying on your back with your hips and knees bent.  With your other hand grasp the wrist of your involved side.  Next, passively lift your involved arm overhead.  Maintain a straight elbow.  Pause and hold the position for 5 to 10 seconds.  As your pain decreases, progress the exercise by increasing the duration of the stretch up to 30 seconds.

Wand-Assisted Shoulder Flexion

Begin on your back holding a cane or wand in each hand.  Space your hands slightly wider than shoulder-width.  The cane or wand is grasped between your thumb and index finger with a thumb-up position.  The thumb-up position will maximize movement at your shoulder joint.  With both elbows straight, lift your arms overhead until a mild to moderate stretch is felt.  Hold this position for 5 to 10 seconds.  Then slowly lower back to the start position.  Perform 10 to 20 repetitions.

Final Thoughts on Rehabilitation after Reverse Shoulder Replacement

We have described 5 safe and effective exercises to begin soon after your reverse shoulder replacement surgery.  Start with the 2 or 3 exercises that are most comfortable for you.  Perform these exercises 2 to 3 times per day.  After a few weeks you want to be performing all 5 exercises several times per day.  After 6 to 8 weeks you will be ready to begin some gentle strengthening exercises.  Next week’s article will go into more detail about this phase of your rehabilitation.  Give us a call if you have questions or would like some help getting started.

Shoulder Stretches: 5 Stretches to Improve Reaching Behind Your Back

If you are dealing with shoulder pain you probably have a few movements that are painful or even impossible.  One of those movements is likely reaching behind your back.  During your typical day you routinely reach behind your back for personal hygiene, retrieving our wallets, putting a belt on, or for females, fastening your bra. People with many different shoulder problems experience a great deal of pain and stiffness when attempting these types of activities.  Thankfully, there are shoulder stretches that can help you.

Oftentimes, reaching behind the back is the last movement to return to normal when dealing with a shoulder problem.  There are exercises you can perform at home to speed up your recovery.  This article highlights 5 shoulder stretches you can perform to improve reaching behind your back.

Breaking Down Behind the Back Movements

Reaching behind your back involves complex movements of your spine, shoulder blade, shoulder joint, and elbow joint.  All of these areas must be mobile in order to fully reach behind your back for functional tasks.  Your thoracic spine has to extend and rotate.  Your shoulder blade needs to tilt backwards.  And, your elbow must bend.  Most importantly, your shoulder must rotate internally.  Shoulder internal rotation stiffness is the most common problem associated with limitations reaching behind your back.  However, stiffness in any of the previously mentioned areas must be addressed in order for you to function without pain.

Proof Shoulder Stretches Work

In order to reach your back pocket or perform personal hygiene your shoulder must internally rotate at least 45 degrees.  People recovering from shoulder surgery or those with a frozen shoulder typically have about 50% or less of this range of motion.  People with rotator cuff tendinitis or impingement usually have about 2/3 of the required range of motion.  A recent study published in the journal Sports Health showed people with shoulder impingement and limited internal rotation range of motion respond very well to home shoulder stretches.  Those that performed shoulder stretches daily saw more than a 50% improvement in their range of motion and pain after 4 weeks.

Pec Minor Shoulder Stretch

Your pectoralis minor muscle attaches onto your ribs and shoulder blade.  Short pec muscles will pull your shoulder forward.  In order for your hand to get behind your back, your shoulder blade must tilt back.  If it can’t you will be limited and place more stress on other structures around your shoulder.  To stretch your pec minor, lie on a foam roll long ways or with a rolled up towel between your shoulder blades.  With your elbow bent allow your arms to fall down towards the floor.  Fully exhale and relax in this position for 30 seconds.  Perform 3 to 5 stretches each day.

Thoracic Reach Backs

Your upper back has to extend and rotate when you reach behind your back.  Many people have stiffness in their upper back.  This places additional stress on your neck and shoulder.  To perform the reach back stretch, begin sitting back on your heels, with one hand behind your head and your other forearm resting on the ground in front of you.  This position minimizes movement in your low back and maximizes movement to your upper back.  From here, rotate your elbow up to the sky while exhaling.  Your other forearm remains in contact with the ground.  Return to the starting position and repeat for 10 to 20 repetitions before switching to the other side.  You can modify or progress this exercise by placing your hand behind your back instead of behind your head.

Cross Body Stretch

This shoulder stretch addresses muscles in the back of your shoulder which are prone to tightness.  This stretch is performed lying on your involved side with your hips and knees bent.  Your involved shoulder and elbow are positioned in 90 degrees of flexion.  Your hand of the uninvolved arm grasps your elbow and gently pulls it across your body.  Once a mild stretch is felt on the outside or back of your shoulder, hold for 30 seconds.  Perform this stretch 2-3 times each session.  Research from several studies suggests this stretch is the most effective for improving shoulder internal rotation range of motion.  We agree.

Sleeper Stretch

The sleeper stretch is also very effective for improving internal rotation range of motion.  For this stretch, assume the same starting position as the cross body stretch.  However, with the sleeper stretch, gently move your wrist and forearm down towards the table.  Once a mild stretch is felt on the outside or back of your shoulder, hold it for approximately 30 seconds.  The stretch is typically performed 2-3 times each session.

Hand Behind the Back Stretch

The final stretch in this series is the most uncomfortable and in many cases, the most effective.  It is important that you perform this stretch gently without significant pain.  Restoring hand behind the back movements takes time.  Consider it a marathon, not a sprint. Don’t try to regain all your mobility back at one time.  Slow and steady is best with this stretch.

Stand holding a towel or stretch-out strap.  Drape the strap over your opposite shoulder and gently pull your hand up your back.  Your body will want to lean forward.  Try to remain standing tall.   Also, avoid holding your breath.  Concentrate on each slow breath.  Hold the stretch at least 10 seconds to start.  Work up to performing each stretch for 30 seconds for 3 to 5 repetitions each day.

Want Help Getting Started Stretching Behind the Back?

These are the 5 shoulder stretches we think are best for improving range of motion reaching behind your back.  Most people can perform the first 3 shoulder stretches without considerable pain or difficulty.  The sleeper stretch and stretch behind the back will likely cause some pain.  Start easy, be consistent each day and go slow.  If you need more help give us a call.  We are here for you.  Many people do better when they perform their home shoulder stretches supplemented with manual therapy performed by your physical therapist.

Shoulder Labrum Tears: 5 Exercises Before Jumping into Surgery

Pain with or without clicking deep in your shoulder may indicate an injury to your labrum. The glenoid labrum is a layer of cartilage within the socket of your shoulder joint.  It plays an important role in stabilizing your shoulder during pushing movements, overhead reaching and sports that involve throwing.  Repetitive overhead throwing in baseball players often leads to breakdown of the labrum.  Repetitive pressing or pushing movements in the gym can also irritate your labrum.  Trauma such as falling on an outstretched arm or bracing yourself during a motor vehicle accident can injure your labrum.

Surgery is often recommended to repair a torn labrum.  However, exercise can also be a very effective treatment option.  Non-operative management includes non-steroidal anti-inflammatory drugs and steroid injections to decrease pain and inflammation.  Physical therapy and exercise also plays an important role in recovering full function of your shoulder. This article outlines a game plan for rehabilitating your injured shoulder after a labrum injury.

Glenoid labrum tear

Surgery or No Surgery for Glenoid Labrum Tears?

Both surgery and a non-surgical approach can lead to satisfactory results in 66% to 85% of people with labrum tears.  A small study published in The American Journal of Sports Medicine suggests nearly half of those with labrum tears do well with surgery.  The same may be true for those who pursue non-surgical treatment.  Regardless of treatment, it appears that 80 to 85% report satisfactory results 2 to 3 years later.  However, the level of satisfaction and return to sport in overhead athletes is closer to 66%.  This is understandable given the demands baseball pitchers and tennis players place on their shoulders.

Patients with labrum injuries should undergo 3 to 6 months of non-surgical treatment before considering surgery.  If this approach fails your doctor may recommend surgery.  Rehabilitation focuses on improving shoulder range of motion and strengthening the rotator cuff and shoulder blade muscles.  Below are videos of 2 important stretches and 3 commonly prescribed strengthening exercises you can perform in your home.

Cross Body Stretch

This stretch addresses tightness in the back of your shoulder which is often stiff in overhead athletes.  The infraspinatus, teres major, and teres minor muscles can become shortened from repetitive throwing or weight training.  This stretch is performed lying on your side with your hips and knees bent.  Your involved shoulder and elbow are positioned in 90 degrees of flexion.  Your hand of the uninvolved arm grasps your elbow and gently pulls it across the body.  You want to feel a mild stretch on the outside or back of your shoulder.  Hold this position for 30 seconds.  Perform this stretch 2 to 3 times each session.

Sleeper Stretch

The cross-body stretch is superior to the sleeper stretch for improving shoulder range of motion in young baseball players.  However, the sleeper stretch is the more popular of the two stretches.  Start in the same position as the cross-body stretch.  However, with the sleeper stretch, your wrist and forearm are gently moved down towards the table.  You want to feel a mild stretch on the outside or back of your shoulder.  Hold this position for 30 seconds.  Perform 2 to 3 stretches each session.   For most people, both the sleeper and cross-body stretch do not need to be performed.  My personal experience, and the best available evidence, suggests the cross-body stretch is the most beneficial for improving range of motion.  Choose which one works best for you.

Shoulder Flexion in Side-lying

It is important to strengthen your shoulder muscles while limiting stress on your injured labrum.  The biceps tendon attaches to your labrum.  Strong contractions of your biceps muscle can pull on the upper part of your labrum.  Therefore it is best to perform strengthening exercises which minimize biceps activity.  Perform shoulder flexion raises in a side-lying position to minimize biceps activity and reduce strain on your labrum.  Start on your side holding a light dumbbell.  Your elbow remains straight as you raise your arm slightly overhead.  Your arm remains parallel to the floor as you perform the movement.  Perform 3 sets of 10 to 20 repetitions several times per week.

External Rotation Diagonal

Stand holding a resistance band in one hand.  Anchor the band at knee to waist level.  Start with your hand positioned in front of your opposite front hip pocket.  Your elbow remains bent at a right angle throughout the exercise.  Perform the movement by flexing and rotating your arm across your body.  You will end up in a position similar to the arm cocking part of throwing.  Hold this position 1 to 2 seconds.  Reverse the movement back to the starting position.  This is a great exercise for the rotator cuff and lower trapezius muscle.  Perform 3 sets of 12 to 20 repetitions several times per week.

Prone Row to External Rotation

Position yourself on your stomach with your arm hanging over the side of your bed or a treatment table (if available).  Hold a light weight.  Usually 1 or 2 pounds is enough to begin with.  Perform a high row with your elbow in line with your shoulder.  Pause 1 to 2 seconds then rotate your hand upwards towards the ceiling.  Hold this position 1 to 2 seconds.  Reverse the movement back to the starting position.  This is another great exercise for the rotator cuff and lower trapezius muscle.  Perform 3 sets of 8 to 12 repetitions several times per week.

Tips for Getting Started

Symptoms of a labrum injury can range from a minor annoyance to debilitating.  In many people it severely limits overhead activity and the ability to carry out routine daily activities.  The right exercises can help.  For the best results, exercise 3 to 5 times per week.  Infrequent or random exercise will do you little good.  Give these 5 exercises a shot for at least 3 months and see how things go for you.  If you want more help give us a call.  Our physical therapists can help you find additional exercises right for you and supplement these with manual therapy treatments.   You don’t have to keep suffering and you have options other than surgery.