Physical therapy (or physiotherapy) literally means “attempted remediation of a health problem that is related to the body (as opposed to the mind).” It involves the use of exercises, assistive devices and other methods (such as massage or electrotherapy) for the preservation, enhancement or restoration of movement and physical function. Conditions involving the shoulder joint benefit tremendously from physical therapy. Likewise, physical therapy is essential to optimize the outcome of shoulder surgery. Although physical therapists provide invaluable help to millions of individuals across the globe, if access to a professional is limited, many of the exercises for shoulder physical therapy may be learned and practiced by any of you,… provided access to adequate educational material!
A little bit of history
Physical therapy evolved from gymnastics (from Greek, γυμνασία – to exercise naked). In the early nineteenth century, Per H. Ling (Sweden) first promoted the formal use of gymnastic exercises for better health. Physical therapy continued to develop in the twentieth century to aid with the management of both poliomyelitis and World War I and II injuries. Shoulder surgeons soon realized that physical therapy exercises were effective in improving many shoulder conditions, and also paramount after surgery. The value of physical therapy exercises for the shoulder joint cannot be overemphasized.
Shoulder exercises 101
In very basic terms, shoulder physical therapy may be condensed in three separate buckets: Protection, Motion and Strengthening. Protection is mostly achieved by use of shoulder slings or immobilizers and avoidance of certain active motions. Motion may need to be maintained, restored, or improved. Strengthening is typically recommended once motion has been restored to some extent. Obviously, shoulder physical therapy is much more complex, and may also incorporate massage, exercises for improved coordination, and may other modalities mastered by professional physical therapists.
Shoulder specialists use specific to describe planes of motion. Raising your hand up in the air may be described as flexion (up straight in front of you), abduction (up to the side), or elevation (in between); since motion of the shoulder blade (scapula) on the chest wall is essential to raise the arm, some prefer the word scaption [scap(ular)(eleva)tion]. External and internal rotation mean moving your arm out to the side, and behind your back, respectively. All these motions may be performed using your own muscles (active motion) or you can let someone else move the shoulder for you (passive motion); active-assisted motion is in between: your muscles do some of the motion, helped by someone else or your other arm. All these terms are used in the descriptions and videos below.
Equipment at home
The equipment necessary to complete most shoulder physical therapy programs is relatively simple. The most sophisticated pieces of equipment include a wand, a rope and pulley, and elastic bands ot tubes. These items can be easily ordered on line. Some people choose to use a broom or umbrella as a wand. Some exercises are best performed lying on your back, which can be easily achieved by using a couch or bed. Elbow support is also needed for some exercises. Use of fluffy pillows to support the elbow is discouraged; it is better to use a stack of blankets or towels. Free weights have a limited role in shoulder physical therapy, but may be used selectively. And finally, after certain surgical procedures, a companion (your husband or wife, a son or a daughter, a friend) is important too!
- Wand (example, RangeMaster ShoulderWand)
- Pulley (example, RangeMaster Over the Door Shoulder Pulley)
- Elastic bands (example, Fit Simplify Resistance Loop Exercise Bands)
Mayo Clinic has published a number of videos that may be streamed to your smartphone, computer, or smart television to facilitate your shoulder physical therapy. Links are provided below.
Exercises to maintain or improve motion
Passive motion exercises
These exercises are recommended when protection of healing structures is essential. They are typically used as a first group of exercises after sustaining certain fractures, or after surgery for repair of a rotator cuff tear, shoulder replacement and other procedures. Your will need help from your companion or a physical therapist. These exercises are commonly abbreviated passive ROM (range of motion) exercises. To review passive motion exercises click here (passive motion exercises).
Active assisted motion exercises
These exercises are recommended once structures are partially healed but still in need of some protection. Most of these exercises are completed with the help of your other arm, or use of a wand or pulley. These exercises are commonly abbreviated AAROM (active assisted range of motion) exercises. To review active assisted range of motion exercises click here (AAROM exercises).
Stretching exercises are used to loosen up the shoulder joint. In certain situations (frozen shoulder, some rotator cuff repairs, after fracture) thick scar tissue may limit motion. Gentle and persistent stretch of the scar tissue through exercises may help restore motion over time. Do not be discouraged: shoulder stretching takes some time. To review stretching exercises click here (stretching exercises).
Exercises for strength
Isometric strengthening exercises
Isometric (from Greek “isos” [equal] + “metria” [measuring]) refers to exercises that lead to contraction of a muscle without movement of the joint. The distance (measuring) between the origin and insertion of the muscle does not change as the muscle contracts. These exercises provide a very safe method to initiate strengthening when healing structures still need some protection. To review isometric strengthening exercises, click here (isometrics).
Strengthening exercises with bands or weights
Elastic bands are perfect for shoulder physical therapy. As the band is stretched, it increases its resistance, providing a very gradual and safe method to strengthen your muscles. These bands or tubes are color coded according to their resistance. Free weights may be useful too, but they must be used with caution, especially when structures are still healing. To review band and weight strengthening click here (strengthening with bands and weights).
Too often forgotten: the shoulder blade
The exercises reviewed above are centered on the main shoulder joint. However, the shoulder blade is essential also for shoulder function. Much too often, exercises for muscles attached to the shoulder blade are neglected. The term scapular stabilizing exercises is used to describe physical therapy directed to the muscles around the shoulder blade. So called clock exercises provide a good baseline routine: picture your back as the face of a clock try to move your shoulder blade up (12 o’clock), down (6 o’clock) and to the 3 and 9 o’clock positions.
A recipe for each condition
All the exercises described above may be compared to ingredients for recipes. Depending on the shoulder condition being managed, these exercises are recommended in various combinations and times.
Much like in the kitchen, where different chefs create their own recipes depending on seasonal ingredients and their own cooking style, shoulder specialists combine exercises in programs individualized for each of you depending on not only the nature of your condition, but also how severe it was, how surgery went, and other factors.
Providing an individualized program for each shoulder condition exceeds our goals, but we would like to offer our recommendations for common physical therapy programs used in our practice.
And a final thank you…
As a shoulder and elbow surgeon, I want to sincerely thank all of you physical therapists that dedicate your professional life to understand the musculoskeletal system and help patients and surgeons with the management of shoulder conditions. Collaboration with physical therapists is essential for a successful shoulder surgical practice.