Therapeutic Exercises for Shoulder Rehab | PT7711 Study Set

Mobility

ROM of the injured joint/soft tissue.

Stability

Strengthening (begin with low load and high reps/isometric).

Isometrics → low load, low reps → low load, high reps → high load, low reps

What is the progression for strengthening exercises?

Mobility

You can move away from isometrics (in most cases) once ____________________ is regained.

Controlled mobility

Coordinated movement; focus is on timing of contractions.

Proximal; distal

____________________ stability, ____________________ mobility.

Skill development

Depends on what the goals of the patient are and the deficits that have developed.

PROM → AAROM → AROM → resisted ROM (strength)

What is the progression for mobility?

Combine

You should _____________________ as much as is appropriate between mobility, strength, controlled mobility, and skill.

- Lat pull down

- Press up

- Push up

- Horizontal adduction

- PNF (D1 and D2)

What are some good exercises to increase IR and adduction strength at GH joint?

- Shoulder press

- Scaption with ER (thumbs toward ceiling) → flexion, side-lying abduction

- Push up +

- Prone horizontal abduction (TIWY)

- Prone 90° ER

- Standing 90/90° ER

- Side-lying ER

What are some good exercises to increase ER and abduction strength at GH joint?

- Scaption (IR/ER) → abduction, flexion

- Horizontal abduction (ER)

- Rowing

What are some good exercises to strength scapulothoracic joint muscles (trapezius, rhomboids, levator scap, serratus anterior)?

Lower; mid trap

Low rows can be used to target ___________________ and ____________________.

Empty can

Scaption with IR; could cause impingement pain.

Full can

Scaption with ER.

Body blade

Form of dynamic stabilization using the equipment in same positions of the GH joint.

Rhythmic stabilization

Form of dynamic stabilization in which you start with predictable and slow perturbations.

Faster; less

Progress rhythmic stabilization with ____________________ and ____________________ predictable perturbations.

Scaption IR and scaption ER

What two exercises are best for anterior deltoid?

Scaption IR and horizontal abduction ER

What two exercises are best for middle deltoid?

Horizontal abduction IR and horizontal abduction ER

What two exercises are best for posterior deltoid?

Press-up and push-up (hands apart)

What two exercises are best for pectoralis major?

Press-up

What exercise is best for latissimus dorsi?

Military press and scaption IR

What two exercises are best for supraspinatus?

Horizontal abduction ER and ER

What two exercises are best for infrapsinatus?

ER and horizontal abduction ER

What two exercises are best for teres muscles?

Scaption IR and military press

What two exercises are best for subscapularis?

Rowing and military press

What two exercises are best for upper trap?

Horizontal abduction and horizontal abduction ER

What two exercises are best for middle trap?

Abduction and rowing

What two exercises are best for lower trap?

Rowing and horizontal abduction

What two exercises are best for levator scap?

Horizontal abduction and scaption

What two exercises are best for rhomboids?

Flexion and abduction

What two exercises are best for middle serratus anterior?

Scaption and abduction

What two exercises are best for lower serratus anterior?

Press up and push-up w/ plus

What two exercises are best for pectoralis minor?

- Scaption

- Press up

- Push up +

- Rowing

- 90/90° ER

What are the big 5 shoulder impingement exercises?

Upper trap and serratus anterior

Many have contributed the imbalance of muscle activity (___________________) to impingement and a painful arc.

Temporal association

Timing of recruitment for the serratus anterior and the lower/middle trapezius.

Elevated; less

Upper trap activity is ____________________ in subacromial impingement and the serratus anterior activity is ______________________ in subacromial impingement.

Postural (length tension) relationship

Scapulohumeral mechanics are more variable in patients with subacromial impingement compared to those without.

Push-up plus (knee push-up plus, elbow push-up plus, wall push-up plus)

What exercise allows for the best upper trap:serratus anterior ratio?

- Side-lying ER

- Side-lying forward flexion

- Prone horizontal abduction with ER

What exercises allow for the best upper trap:lower trap ratio?

- Side-lying ER

- Side-lying forward flexion

- Prone extension

What exercises allow for the best upper trap:middle trap ratio?

Not; one-arm push-up

Supraspinatus:

- Weight bearing positions did _____________________ significantly stress.

- All but ____________________ would be considered low activity.

Increasing; one-arm push-up

Infraspinatus:

- Progressively ____________________ activity.

- Very high activity for _____________________.

Increased

As the load increased, the percentage of muscle activity also _____________________.

Increased

One arm activities _____________________ the posterior shoulder musculature.

Increase

An increase in compliant surface does not appear to significantly ______________________ muscle activity of the scapular stabilizers.

Fatigue

______________________ may play a role as muscles fatigued over time.

Decrease

Anterior deltoid, serratus anterior, and lower trapezius all had a ____________________ in EMG activity on the unstable surface.

Protraction/retraction

There was some question on the normalization methods for this study (electrode placement and non-descriptive on how MVIC was performed). Researchers did not control the amount of _______________________ in the study.

Proximal-to-distal; trunk

Shoulder rehab links the shoulder to the trunk/lower body to address the ____________________ approach. → Initiated by the __________________ then scapula, allows more force production

Shoulder dump

What exercise is this?

Row to thoracic extension/scapular retraction

What exercise is this?

Core/hips

This person is maintaining athletic stance to engage the _____________________.

This person is initiating the movement from the ____________________ on a wall slide.

Low (<20% MVIC); pulley; aquatics; CKC

Maximal protection phase:

- EMG activity should be ____________________ in muscles that are painful or have been surgically repaired.

- PROM → CPM → bar raises → __________________?

- Slow and controlled contralateral arm movement

- ____________________ (slow movements but can progress to faster movements)

- ____________________: prayer and quadruped are okay during this level.

Moderate to high (21-50%); strength; endurance

Goals of moderate protection phase:

- Should have achieved staged ROM goals

- Increase demand from the exercises → EMG _____________________ activity.

- Begin to develop _____________________ and muscular ______________________.

Elevation; CKC

Activities that would be appropriate for moderate protection phase:

- Active forward ______________________ progression → Step backs, cane exercises/pulley (assisted elevation), scaption/overhead wall taps (unassisted elevation)

- Add progressive _______________________ activities in progression but stay below desired EMG level: Tripod → pointer → push-up

Full; return; high to very high

Goals of minimal protection phase:

- Progress towards _________________ strength, endurance, and power.

- _________________ to full work, ADL, or sport.

- Maximize the demand from the exercises → EMG ____________________ activity.

Strengthening; one-arm push up; core

Activities that would be appropriate for minimal protection phase:

- ______________________ should also become more functional/sport specific.

- CKC: Push-up feet elevated → ___________________.

- Focus on _________________ stability and whole body coordinated movements.

Isokinetic

"Same speed"; excellent way to assess as well treat.

30/30/30 position and 90° position

What are good positions for isokinetic shoulder rehab?

66%

ER:IR concentric ration should be ____________________.

75%

Rehab may need to be increased to ____________________ for the overhead athlete.

Functional ratio

The ratio of concentric IR to eccentric ER. How much force they're brining the ball forward with and how much they can control speed after release.