Instructor: Hello. My name is Susan Bass and I’m a physical therapist. Today I’m going to give a little talk on shoulder rehabilitation. The purpose of this talk is to help teach you some exercises to prevent shoulder injury and improve balance and coordination around the joint. First, we are going to go over a little bit of simple shoulder anatomy. The shoulder is the most mobile joint in the body and the most unstable. It gets its stability from muscles, tendons and ligaments around the joint. The most important of these is the rotator cuff and the scapula stabilizers. This is a model of the rotator cuff, which is four muscles that go around the joint. They go from here, here, here and here. The purpose of the rotator cuff, besides allowing you to do certain movements, is it works as what we call a forced couple. Meaning the muscles have to work in balance so that when you raise your arm above your head in the front or the side it pushes the head of your humerus, which is your arm, down in the socket to clear the joint where you see there is the ligament and bone. If for some reason, it’s not working in balance due to habitual poor posture habits, weakness it can ride up and hit this tendon and the bone and lead to inflammation and eventually some tearing.

This is the scapula. The scapula rides on the ribcage in the-on your back and it kind of floats there. It gets its stability by various muscles that attach in various places on your back. These muscles have to have a lot of endurance so that they hold the scapula in the right position when we move. As you can see this is the humerus, the arm. It inserts in a very shallow socket so that if they scapula is not in the right position the humerus is not going to ride the correct way and could lead to injury. Most shoulder injuries do not happen as an isolated event. It’s usually due to habitually poor patterns over long periods of time or weak musculature that finally you start to feel shoulder pain and its because the muscles have been unbalances for longer than you care to think about. We also need to think about the shoulder as not just one isolated joint, it’s related to the entire body as a whole. What we as physical therapists call the kinetic chain. If the areas around your neck, if they’re tight it’s going to pull your shoulders up. If you have tightness in your back and not strong core muscles, it’s also going to affect the way the scapula moves and mesh the shoulder joint and can lead to injury. Now I’m going to use my assistant Tony to help go through some simple exercises to help strengthen the shoulder joint and improve coordinated movement.

Tony is now going to do the exercise we call slump correct. And she’s going to start in this position which most people are in when they’re sitting at a computer for long periods of time. She going to push through her bottom and lengthen her spine and breathe while she is doing this. She’s going to slump down and really really extenuate that curve, push through your bottom and really straighten it. This puts the shoulder at a much better angle with a reduced risk of injury.

The next exercise is called the scapular squeeze where you just squeeze your shoulder blades back and down. Hold for a count of ten seconds, your posture while you are doing this and then you relax. Let’s do this one again, pull back and down. You don’t want your shoulder going up towards your neck. And relax. And this exercise can be done two to three sets of fifteen throughout the day to really work on good posture and start strengthening your muscles of your back here.

Okay the next exercise is called the scapular clock. You’re going to lay on your uninvolved side, with your hand gently placed on the mat, with your hand underneath your head for support. And you think of your shoulder as a clock. You’re gonna move it up to twelve, down to six, back to the center, forward to three, and back to nine. So what you’re trying to do is get coordinated movements. So we’re gonna go up, down, neutral, forward and back. And then you slowly try to rotate trying to keep it as slow as you can cause we are trying to look at coordinated balance movement. And you move backwards the same thing. There is no pain with this at all.

This exercise you can just take a pillowcase and you put your forearms in it. Your elbows are at your side, your sitting in good posture and you’re just pulling your forearms away. Your thumbs are facing the ceiling and you hold this for a count of ten seconds. And this works your external rotators, which are part of your rotator cuff. And relax. And I would do this one to two to three sets of ten seconds each probably twice a day.

The next exercise is you take an elastic band, what we call a theraband. You put a knot on one end and put it in a doorway about eye height and you close the door making sure it’s closed securely. You going to hold the band with your involved side, your elbow is slightly bent, your foot a little bit apart for balance. Lean with your scapula and pull the band down slightly, elbows slightly bent but not too much and back up. And you’re going to move your body a little bit with it because you can’t just separate out your shoulder joint you want a whole body movement. There we go. And slowly back up.

The last exercise is putting your hands against a high counter. I’m using a bar but you can just use a bathroom counter or a kitchen counter. You’re in a slight push up position and what you’re going to do is squeeze your scapulas together, keep your shoulders down and then you think about pushing through your chest and pulling back out so you’re doing a coordinated movement of squeezing and pulling back. Now to make this a little harder you would just take your same theraband, you would put it around your back, put it in your hands and do the same exercise where you squeeze together and then you bring from your chest and push back. And you do these about ten times very slowly and controlled, making sure you keep your shoulders down so you don’t go into your neck musculature.

Remember all these exercises need to be done in good posture, there should be no pain and you want to move slowly. Everybody’s body is unique, so for a more specialized exercise program you would want to get a thorough evaluation by a physical therapist. Thank you.

Dr. Millstein

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