The shoulders are the most mobile of all joints. This mobility is achieved by a small glenoid cup and a large head of the humerus bone. Thus it can move practically in a 360-degree circle around our shoulders. This wide range of motion is achieved by the interplay of quite a good number of muscles and ligaments around the shoulder. The rotators are Teres Minor, Subscapularis who are internal rotators, and the Supraspinati group, who are external rotators. The deltoid, Biceps are the main abductors and the latissimus dorsi and the triceps are the adductors.
Diseases of shoulder is cahracterised by injury either partial or total of these muscles or inflammation of bursa which are fluid filled tissue sacs that prevent friction of a muscle or tendon over a bone. Notable painful conditiopns are frozen shoulder (aka adhesive capsulitis), Rotator Cuff Tears, Impingement Syndromes & Glenohumeral Osteoarthritis.
An important and integral part of management of these diseases is scientific and guided physical therapy that can increase mobility around the joint and strengthens the muscles around the joint. This article depicts the needful exercises for shoulder pain syndromes.
1. Pendulum Exercise:
This is the simplest exercise which is easy to do.
- Stand with your legs wide apart , one in the front and other in the back and bend down over an edge of a table and let your right arm hang loose with fingers pointing towards the floor.
- Now swing the hand from the elbow in a rotatory fashion first clockwise and then counter clockwise. Gradually increase the radius of the circular motion. Do this step for at least 25 to 30 times in each direction and with each hand.
2. Shoulder shrugging:
This exercise increases the power of the trapezius muscles. The trapezius muscles are the strong muscles which are visible just over the shoulder by the side of the neck.
- One has to simply shrug his shoulder upwards and hold it for a count of 10 and then relax back. It can be done in a sitting posture as well. Keep doing this for atleast 25 times in each sitting.
3. Wall climbing:
Most of the readers I think are well aware of this exercise.
- Simply stand facing a wall at a distance of approximately a foot.
- Crawl your fingers over the wall as you climb upwards towards the ceiling. Stretch as much as possible and as long as you do not have pain.
- Maintain the stretched posture for some time and then climb down.
- Keep doing this at least 25 times per sitting.
4. Active and Passive Shoulder Movement:
- This therapy needs an assistant. The assistant or the physical therapist stands by the side of your bed or chair while you maintain a sitting posture. Gradually he holds you by your hand and elbow and flexes the arm around the shoulder.
- Tell him to stop when you feel pain. The motion will be executed in all possible directions.
- The active movement is carried out by the patient himself without any support from the assistant. Instead, the assistant will provide resistance halfway to any of the motions so that muscles are strengthened.
- Talk to a qualified Physical Therapist for the best results.
5. Backward Wall Slide:
This is similar to wall climbing but it is done in a posture where the back of the torso is supported to the wall
- Turn your back to the wall and lean on it.
- Flex your knees a bit and then extend your arms on the wall so that the elbow and the back of your forearm is in contact with the wall.
- Gradually climb up the wall by the back of your palm and reach a maximum permissible height.
- Maintain the posture for 10 seconds and come down again.
6. Corner Stretch:
- Find a corner of a wall where the two walls of a room are meeting at a right angle
- Stand facing the wall corner and place both the arms on the walls of either side in a way that the elbows and the ventral part of the arm and the palm is in contact with the wall surface.
- Gradually move forwards towards the corner of the wall so that the arms are strained backward and maintain the posture for 10 seconds.
- Relax back and keep repeating at least 10 times before moving to the next exercise.
7. External Rotation :
- In an erect posture, flex your elbow at 90 degrees as the palm faces the ceiling. In a word begging posture.
- If you move the forearm outwards without moving the elbow, it is called external rotation.
- Use a flexible exercise band and hold both hands in the center and try to stretch it outwards keeping your elbows flexed at 90 degrees and unmoved beside your trunk.
- External Rotation against resistance increases the power of the rotator calf muscles.
8. Internal Rotation:
- This is exactly the reverse of the external rotation exercise.
- You have to move the forearm towards your umbilicus keeping the elbow fixed at the side of the trunk and flexed at 90 degrees.
- The forearm should be parallel to the ground.
9. Abduction against Resistance:
- You need a stretchable exercise band for this exercise.
- Follow the figure and you will understand what needs to be done.
- Hold one end of the exercise band by your feet on the ground in an erect posture and try to stretch the exercise band outwards and upwards by extending the hand from the shoulder joint.
- Mainatin an extended posture for 10 seconds and repeat.
10. Adduction against resistance:
- It is the exact opposite of the abduction against resistance.
- Follow the figure and get guidance from a physical therapist for the exercise.
Notes:
- Pain may hinder the individual to accomplish these exercises.
- This problem can be overcome by doing some physical therapeutic maneuvers e.g. Ultrasonic Therapy or Interferential Therapy.
- Rotator Cuff tears and Impingement syndromes can be managed by administering Ultrasound-guided injection of Anesthetic + Depot Corticosteroid Injection which can give pain relief for a period of 3 to 4 months and sometimes once and for all
- Serious painful disorders need evaluation by an MRI scan
