Once you have been examined in detail by our physician and told that you are ready to start functional exercises, you can follow the following exercise program to exercise the shoulder joint in stages.
Functional exercise of the shoulder joint is hard work. To be effective, you should feel a significant pull or even pain in your shoulder joint each time you exercise. A more appropriate intensity is one in which the shoulder joint hurts during the exercise, but after the exercise, this painful symptom can be relieved after a certain period of rest. If you have persistent, unrelieved pain after exercise, the intensity may be too high. Then, you can rest for a while. Wait until you no longer feel pain in the shoulder joint before resuming training. If necessary, you can come to our clinic for a review and decide on further physical therapy options.
Functional joint exercises are a long and arduous treatment process. Please make sure you stick to it, because only in this way can you get the best recovery of your shoulder joint function.
Phase I
Passive joint range of motion exercises
1. Pendulum exercise.
The patient bends at 90°, the affected upper limb drops, and holds the affected wrist with the healthy hand. The affected shoulder does not exert force, and the healthy hand pushes and pulls the affected forearm, so that the affected elbow joint can make circles within the maximum range of motion that can be achieved. Stroke 20 circles counterclockwise and 20 circles clockwise each time.
2. Passive forward flexion supination.
The patient should lie flat on the bed, straighten the upper arm on the affected side, and hold the elbow of the affected limb with the healthy hand. In the case of the affected limb does not exert force, by the healthy hand force the affected limb as far as possible up to the maximum angle, and maintain the angle for 2 minutes.
3. Passive lateral external rotation.
The patient lies flat on the bed. The affected elbow is flexed 90° and placed firmly on the body side. The hand on the healthy side is held against the palm of the affected hand with a wooden stick. While maintaining the affected elbow joint firmly against the body side, push the affected hand outward as far as possible and maintain the same for 2 minutes when the maximum limit is reached.
4.Front inversion of the body.
The patient is in a standing position and the affected elbow joint is supported by the healthy hand. After lifting the upper limb of the affected side with force, pull the elbow joint of the affected side toward the chest as much as possible, the closer to the chest the better. Maintain the position closest to the chest for 2 minutes.
5. Passive internal rotation.
The patient stands in a standing position with the affected limb behind the back, while the healthy side hand is behind the head. Both hands hold the ends of a towel. Without exerting force on the affected limb, the affected hand is pulled upward as far as possible by the towel held by the healthy hand and maintained for 2 minutes when the maximum limit is reached.
6. Passive external booth external rotation.
The patient lies flat on the bed. The affected elbow is flexed at 90° and the therapist helps the affected shoulder to abduct at 90° and gradually presses the forearm towards the bed. The same is maintained for 2 minutes when the maximum limit is reached.
Plyometric exercises
Isometric muscle strength exercises.
This means that there should be no movement of the limb during the exercise but only force against it. All of the following isometric exercises are performed without any movement of the limb, with the affected hand pushing against the bed (wall) or the healthy hand. The requirement is to exert force each time, but at the same time there should be no movement of the limb.
1. Anterior deltoid isometric contraction exercise
The patient lies flat on the bed. The affected hand makes a fist, the elbow joint is flexed 90° and pressed against the body side. The healthy hand presses down on the affected hand and the affected hand presses up on the healthy hand. The dorsal side of the affected elbow joint should not leave the bed. 10 seconds/each, 10/group.
2.Central deltoid isometric contraction exercise
The patient lies flat on the bed. The elbow joint is flexed 90° and pressed against the side of the body. Use the outer side of the affected upper arm against the wall while doing the action of lifting the affected limb outward. The wall is held outward with force while keeping the body, shoulder joint and upper limb in position. 10 seconds/each, 10/group.
3.Posterior deltoid isometric contraction exercise
The patient lies flat on the bed. The affected elbow joint is flexed 90° and pressed against the side of the body. Hold the forearm on the affected side with the healthy hand and press the bed downward with force on the dorsal side of the affected elbow joint. 10 seconds/each, 10/group.
Isotonic muscle strength exercises.
1, “chest expansion” exercise.
Patients make the healthy hand to hold the affected upper limb hanging on the side of the body. Use force to move the scapulae on both sides to the midline of the back.
2.”Shoulder shrugging” exercise.
The patient should hold the upper limb on the affected side by the healthy hand and hang it on the side of the body. Shrug the shoulders with force.
Phase 2
Assisted active and active joint range of motion exercises
1.Continue the passive ROM training in the first stage
2.Assisted active motion
3.Active movement
Plyometric exercises
Isometric muscle strength exercises.
1.Anterior deltoid isometric contraction exercise
The patient stands facing the wall with the affected limb on the side of the body. The elbow joint is flexed 90°. Use the affected side of the fist to forcefully top the wall in front of you. The strength should be in keeping the body, shoulder joints, elbow joints are not moved by the top of the case to make the maximum force.
2.Central deltoid isometric contraction exercise
The patient stands sideways against the wall. The affected limb hangs on the side of the body. The elbow joint is flexed at 90°. Use the outside of the forearm to hold the wall while doing the action of lifting the affected limb upward and outward. While keeping the body, shoulder joint and upper limb in position, hold the wall outward with maximum force.
3. Posterior deltoid isometric contraction exercise
The patient stands with his back against the wall. The affected limb hangs at the side of the body. The elbow joint is flexed at 90°. The dorsal side of the affected elbow joint is held against the wall. Push back against the wall with the elbow. Hold the wall with maximum force while keeping the body, shoulder joint and upper limb position still.
4. Isometric contraction exercises of the posterior rotator cuff muscles
The patient stands at the wall with the affected elbow joint flexed at 90°. Keep the elbow close to the body. Put the hand against the wall and do the action of making the affected side of the forearm externally rotated.
5. Isometric contraction of the anterior rotator cuff muscles
The patient stands in a standing position. The affected elbow joint is flexed 90°. Keep the elbow joint close to the body. The affected hand is held against the healthy hand to make internal rotation of the forearm. The healthy hand simultaneously exerts force so that the affected hand cannot push it.
Forward flexion supination.
(A) First, the patient is lying flat on his back. Both hands are together and hold a short stick together. Gradually lift the affected upper extremity upward with the healthy upper extremity.
(B) After a period of practice, both hands can hold a longer stick together, with a certain distance between the two hands. Again, the upper limb on the healthy side will drive the upper limb on the affected side to lift together.
(C) After a period of practice of movement B, the patient remains lying flat on the bed and holds a heavy object of about one pound in the affected hand. The affected hand gradually lifts the weight on its own without the help of the able-bodied hand.
(D) After practicing movement C for a period of time, the patient is in bed, in a semi-sitting position, and repeats movement C.
(E) After practicing movement D for a period of time, the patient changes to a standing position to practice gradually lifting a one-pound weight with the affected hand.
Phase III
Joint range of motion exercise
1. Forward flexion and pulling.
The patient sits at the table. Take the affected side near the table. The hand on the affected side is held on the table. The patient gradually bends over while keeping the affected hand on the table as far away as possible. Maintain for 2 minutes while reaching the maximum level.
2.Abduction pulling
The patient approaches with the affected side and stands with the side of the body against the wall. The affected limb is elevated and the hand is held on the wall. Bring the body volume close to the wall and extend the hand as far up as possible. Maintain for 2 minutes while reaching the maximum level.
3.Abduction 90° external rotation pull
Find a door frame slightly wider than the width of the patient’s upper body, lift both arms flat, flex the elbows, hold the forearms bilaterally on the door frame, make the body lean forward as much as possible, and maintain it for 2 minutes when it reaches the maximum degree.
4.Internal rotation pulling
The patient holds the back of a bench with his hands behind his back. Keeping both hands on the back of the chair, the patient gradually squats from a standing position and holds for 2 minutes after reaching the maximum degree of squatting.
Muscular strength exercises
1.Resistance forward bending supination
Patient standing position, affected side hand holding a weight of about 1 pound (or pulling elastic band), elbow straight, upper limb raised to the maximum in front, maintain for 2 minutes.
2.Resistance to internal rotation
Fix a pulley on the wall at a height approximately equal to the height of the elbow joint when the patient is standing. Drop a weight of about one pound through the pulley. The patient stands by the wall. The upper extremity on the affected side is near the wall and the upper extremity on the healthy side is away from the wall. The affected elbow is flexed 90° and kept close to the body. The affected hand holds the end of the rope with the weight attached to it, and the affected forearm is rotated towards the front of the body with force to pull up the weight.
3.Resistance external rotation
The pulley is still fixed as in the case of internal rotation resistance training. This time the patient stands by the wall, so that the upper limb on the healthy side is close to the wall and the upper limb on the affected side is away from the wall. The affected elbow is still flexed at 90° and kept close to the body. The affected hand holds the end of a rope with a heavy object attached to it, and forcefully rotates the affected forearm to the outside of the body.
4.Resistance posterior extension
After the pulley is fixed, the patient stands facing the wall. The affected hand pulls the end of the rope with the weight attached to it and pulls the rope backward with force so that the weight is pulled up.
5.Resistance forward flexion
After the pulley is fixed, the patient stands with his back to the wall. The patient’s side hand pulls the end of the rope with the weight attached and pulls the rope forward with force so that the weight is pulled up.
6.Resistance abduction
After the pulley is fixed, the patient stands laterally to the wall. The affected limb is far away from the wall while the upper limb on the healthy side is close to the wall. The affected side hand holds the end of the rope with a heavy object falling on it and forcefully lifts the affected limb outward to pull the heavy object.
7.Dumbbell prone position resistance training
8.Resistance internal rotation
Fix a pulley on the wall, the height of which is about the same as the height of the elbow joint when the patient is standing. Drop a weight of about one pound through the pulley. The patient stands at the wall. The upper extremity on the affected side is near the wall and the upper extremity on the healthy side is away from the door. The affected elbow is flexed at 90° and kept close to the body. The affected hand holds the end of the rope with the weight attached, and the affected forearm is rotated to the front of the body with force to pull up the weight.
9, resistance to external rotation
The pulley is still fixed as in the internal rotation resistance training. This time the patient stands by the wall, so that the upper limb of the healthy side is close to the wall and the upper limb of the affected side is away from the wall. The affected elbow is still flexed at 90° and kept close to the body, and the affected hand holds the end of a rope with a heavy object attached to it, and the affected forearm is rotated to the outside of the body with force.
10.Patients make bilateral upper limbs hanging on the side of the body
11.The patient lies flat on the bed
The affected limb is straightened forward. Hold a 5-pound weight in your hand and push the weight upward so that your scapulae stand up and reach the state of being perpendicular to the bed.