Physical Therapy Exercises for Frozen Shoulder

Frozen shoulder is used to describe stiffness and pain in the shoulder joint. One of the common causes of frozen shoulder is immobility of the shoulder as a result of other injuries or illness when the connective tissue around the shoulder thickens and tightens around the shoulder joint.

Treatment of frozen shoulder typically involves physical therapy exercises. Steroid injections and arthroscopic surgery is occasionally required to treat the frozen shoulder.

The Harvard Medical School and University of Washington Orthopaedics and Sports Medicine have recommended home exercises for the stiff and frozen shoulder. We’ve added their exercises into a Home Exercise Program (HEP) using the PT-Helper CONNECT platform and presented on the PT-Helper mobile app. These sample exercises can be quickly downloaded into the PT-Helper mobile app using

HEP code: 3AED5619

You can also find these exercises in the Shoulder category in the PT-Helper mobile app to add to your Favorites which allows you to customize each exercise’s repetitions, sets, and hold time.

Reminder: Please consult your physician or physical therapist before engaging in any physical activity and stop if you experience pain or discomfort.

The recommended exercises include:

Passive Range of Motion Flexion - Sit alongside a table with your forearm resting on a smooth surface. Use a pillow case or towel under your arm to make sliding easier. Your thumb should be pointing up. Lean your body forward by bowing at the waist to slide your arm passively until you feel a comfortable stretch. Hold. Slowly sit back up dragging your arm along the table to starting position.

Towel Stretch for Internal Rotation v2 - Place a towel over your unaffected shoulder. Hold the front end of a towel with your un-involved hand in front of your chest. Reach behind your back with your involved arm and grasp the other end of the towel with your thumb up. Pull the towel forward and down with your un-involved arm pulling your other arm further up behind your back causing a stretch in your shoulder. Hold and return the towel to its starting position. Repeat.

Active Assisted Supine Flexion - While lying down on your back, grasp your hand or forearm with your opposite hand. Raise arms up and overhead as far as comfortable to feel a stretch in the affected shoulder. Hold, then return to starting position.

Wand External/Internal Rotation - While lying on your back, hold a wand with your involved side palm up and un-involved side palm down, elbows bent. Using your un-involved hand, move the wand away from your body while keeping your elbow of your involved side at your side until you feel s stretch. Hold then pull the staff back across your body with your un-involved hand. Hold then repeat.

ROM Pendulum (Circular - Clockwise) - Let arm move in a clockwise circle by rocking your upper body in a circular pattern.

Wall Climbs Abduction - Place your involved arm straight out against a wall at your side. Slowly walk up the wall with your fingers as high as you can until you feel a stretch. Your arm should be slightly in front of you (about a 30 degree angle). Try to keep your elbow straight and shoulder depressed. Step in towards the wall as needed. Hold at the top. Slowly walk fingers back down the wall and lower arm to the side.

Posterior Capsule Stretch - Cross one arm over your body and grasp at elbow with opposite arm. Gently pull hand towards opposite shoulder. Hold, then gently release. Your therapist may advise you to perform laying on your side, or leaning against a wall. Do not perform this exercise if you feel a sharp pinch in the front of your shoulder. Stretch should be felt in the back of your shoulder.

External Rotation 30 degrees - Attach exercise band to stationary point at waist height. Place towel roll under armpit. Hold the exercise bands with forearm across your body, thumb up, elbow bent at 90 degrees. Smoothly rotate your forearm outward across your body. Pause, then return your arm to the starting position.

Internal Rotation 30 degrees - Attach exercise band to stationary point at waist height. Place towel roll under armpit. Hold the exercise bands with forearm out perpendicular to your body, thumb up, elbow bent at 90 degrees. Smoothly rotate your forearm in across your body. Pause, then return your arm to the starting position.

Reminder: Please consult your physician before engaging in any physical activity and stop if you experience pain or discomfort.

Start your Free 30-day Trial of the PT-Helper CONNECT tool for physical therapists and other therapy providers, so you too may create and prescribe Home Exercise Programs like the one shown above.

Core Weakness Is The Root Of All Evil

Guest blog by Julie McGee

As a physical therapist, this is my motto. This also applies to runners. In running, the idea is to move quickly to propel the body forward while being upright. If you are running, and you core is weak, while your legs are strong you are going to run into some issues. You are going to hurt yourself.

Think of a pogo stick, that toy from our childhood. A pogo stick is basically a spring attached to a post that is surrounded by a stable base with handles and footrests. If the base is made of a strong, stable material such as steel, or aluminum, the user can propel themselves upwards, and if skillful enough, hop along. If the base is made of a less stable material such as cardboard, it is going to buckle and fold as the user tries to use it to hop and propel themselves forward.

         

Now apply the concept of a pogo stick, with a strong spring and post to your body. Even if your legs are strong, if your base is weak, when you try to propel yourself forward, your base (aka, your core) is going to buckle. As a result your body will make a lot of aberrant movements that over time will wear down on your body and result in injury.

There is evidence that core strength may help to prevent injuries in certain athlete groups (here). There is also research to suggest that a good core strength and stability exercise program can help to prevent lower extremity injury in a more general population (here). Specific to those suffering from patellafemoral pain syndrome, is some evidence that improved core strength may help with knee pain (here).

Before I get too carried away with exercise, let me speak a little about core strength, core stability, and the difference between the two. Core strength is the strength of the muscles in your trunk and hips. Core stability is the ability of those muscles to work effectively in stabilizing the trunk for one to perform functional movement (think lifting, running, and day to day activities).

Endurance athletes doing longer workouts, may have difficulty fitting core exercises in to their routine. If you only have 45 minutes, or an hour to workout on a weekday, you may choose to spend that time doing the endurance workout of your choice (for me, it’s typically running, biking, or swimming). However, spending a few of those minutes on your core may pay dividends over the course of time as you may experience fewer injuries, and be able to run a little faster.

Here are a few favorites:

• Quadraped progression
• Front and side plank
• Front and side plank with a leg lifted

As a challenge, planks can also be done with an exercise ball:

Since there is a rotational component to running, exercises that involve rotation, and work the obliques can also be effective:

Supine rotation: Lie on your back, with your arms out to the side so that you look like the letter, “T.” Lift your legs so that your hips and knees are bent. While keeping your shoulder blades on the ground, let your legs fall over to one side. Remember! Keep your shoulder blades on the ground! Otherwise you are just rolling around. Once you get to your limit, bring your legs back to he middle, and repeat on the other side.

Plank rotations with the exercise ball: Start off on a plank position where the exercise ball is under your feet. Lift one leg up and behind you. Then bring that leg down, and across your midline – almost as though you were going to tap the ground next to the other side of the ball. Repeat, as many times as you can tolerate. Then switch sides.

There are many more exercises out there. Classes such as yoga and pilates can also help to improve core strength. So look around you, and maybe grab an exercise ball.

About Julie McGee, PT, DPT, CEAS

Julie McGee is a physical therapist with over 10 years of experience. During that time she has worked in acute rehab, worker’s comp, outpatient orthopedics, and home health. Through her work, Julie has found that she is passionate about writing and educating others whether they are patients or clinicians.

Julie received her B.S in Exercise Science in 2003. She then went on to receive her MSPT and DPT from the University of California, San Francisco/ San Francisco State University Graduate Program in Physical Therapy in 2007 and 2008 respectively.

Julie has had her writing published in Medium, NewGradPT.com, and CovalentCareers.com. She also writes for, and manages runningfrominjury.com, a blog that focuses on running related injuries and their prevention.

When she is not writing or treating patients, Julie can be found running, cycling, swimming, doing yoga, and reading a good book.

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Julie has recommended some of her favorite core exercises which we have added into a home exercise program on the PT-Helper CONNECT platform and presented on the PT-Helper mobile app. These sample exercises can be quickly downloaded into the PT-Helper mobile app using

HEP code: 5FB98480

You can also find these exercises in the Fitness - Core category in the PT-Helper mobile app to add to your Favorites which allows you to customize each exercise’s repetitions, sets, and hold time.

Reminder: Please consult your physician before engaging in any physical activity and stop if you experience pain or discomfort.

Start your Free 30-day Trial of the PT-Helper CONNECT tool for physical therapists and other therapy providers, so you too may create and prescribe Home Exercise Programs like the one shown above.

Click here to view Fitness - Core exercises currently available within the PT-Helper Exercise Library.

PT-Helper's July Blog Posts for Physical Therapists

In-Home Physical Therapy Exercises for Fall Risk and Prevention
Published On July 17, 2018
According to the U.S. Centers for Disease Control and Prevention, one in every four Americans age 65+ fall each year. Working with your physical therapist can identify strength imbalances and weaknesses to prevent falls and improve independence. PartnerMD Health Coach created a simple exercise plan that can easily be done in your home to improve leg strength. 

This home exercise plan can be found in the PT-Helper mobile app by using this HEP code: 2974C248
.
Reminder: Please consult your physician before engaging in any physical activity and stop if you experience pain or discomfort. 

Creating a Simple Exercise in PT-Helper CONNECT

Published On July 10, 2018
PT-Helper provides an easy mechanism for the physical therapist or wellness professional to create their own exercises. This blog will walk through the process of creating a stretch exercise and a dynamic motion exercise.


How YOU Can Benefit from Physical Therapy
Published On July 3, 2018
By guest writer Ben Shatto, PT, DPT, OCS. 
Physical therapists can help guide you through any array of recovery or rehabilitation: return to work, sport, running, and CrossFit.  Whatever your desired activity may be, a physical therapist can help you get moving and “living” again!  Fundamentally, movement is life!


Subscribe to the PT-Helper Blog here so you don’t miss these helpful compilations and BONUS, you’ll receive Our Secret Guide, unveiling the secrets your patients are keeping from you.

In-Home Physical Therapy Exercises for Fall Risk and Prevention

Physical Therapy is often prescribed for rehabilitation after an injury or surgery. However, physical therapy can also be useful prior to surgery to maintain strength, mobility and flexibility. Another area that physical therapy can be applied is Fall Risk and Prevention.

Fall Risk and Prevention

According to the U.S. Centers for Disease Control and Prevention, one in every four Americans age 65+ fall each year.

Working with your physical therapist can identify strength imbalances and weaknesses to prevent falls and improve independence.

PartnerMD Health Coach created a simple exercise plan that can easily be done in your home to improve leg strength. We’ve added their exercises into a Home Exercise Program (HEP) using the PT-Helper CONNECT platform and presented on the PT-Helper mobile app. These sample exercises can be quickly downloaded into the PT-Helper mobile app using

HEP code: 2974C248

You can also find these exercises in the Knee and Hip category in the PT-Helper mobile app to add to your Favorites which allows you to customize each exercise’s repetitions, sets, and hold time.

Reminder: Please consult your physician or physical therapist before engaging in any physical activity and stop if you experience pain or discomfort.

The recommended exercises include:

1. Knee Extension (sitting)


While sitting, raise your leg by straightening your knee fully while contracting your quad. Slowly lower your leg. Weights may be placed around your ankle.


2. Seated Knee Flexion


Sit on the edge of a chair or bench. Extend one leg to the front so that your foot is further out in front of the remaining bent leg. While pushing your foot down into the ground, drag your extended foot back towards your other foot. Repeat.


3. Chair Rise


Sit on the edge of a chair with both feet flat on the floor. Stand upright without using your hands. Return back to the seated position using the "nose over toes" posture, leaning forward so that your nose is over your toes while slowly bending your knees.


4. Hip Abduction with Support


Stand with good posture beside a solid table, bench or kitchen sink. Look straight ahead. Rest your hand on the bench. Keep both thighs tight. Kick out to the side keeping toes straight ahead and both legs straight, then return to starting point. If you loose balance, grasp the table, bench or kitchen sink to regain your balance.


5. Leg Cross


Stand with good posture beside a solid table, bench or kitchen sink. Look straight ahead. Rest your hand on the bench. Lift one foot off the ground slightly in front of you. Cross your lifted foot across the mid-line of your body so that it is on the outside of the planted foot. Hold. Return to your starting point. Repeat. If you loose balance, grasp the table, bench or kitchen sink to regain your balance.

Start your Free 30-day Trial of the PT-Helper CONNECT tool for physical therapists and other therapy providers, so you too may create and prescribe Home Exercise Programs like the one shown above.

Creating a Simple Exercise in PT-Helper CONNECT

PT-Helper provides an easy mechanism for the physical therapist or wellness professional to create their own exercises. This blog will walk through the process of creating a stretch exercise and a dynamic motion exercise.

Stretch Exercises

Simple stretch exercises include a starting position, a stretch (Hold) position, and a recovery position between stretches. For exercises consisting of multiple sets, the starting position is also used as the resting position between sets.

Using Gastrocnemius Stair Stretch as an example, we’ve created 3 illustrations to indicate (1) starting position, (2) hold position, and (3) recovery position as shown below. The PT-Helper mobile app will use these illustrations (from left to right) to walk the user through the Gastrocnemius Stair Stretch.

For this example, we have set the Hold Time to 3 sec, Recovery Time to 2 sec, and Rest Time to 4 sec. The exercise will include 2 repetitions and 2 sets. The behavior of the mobile app is shown below to help the patient or client complete their home exercise.

When creating your own stretch exercises, you can use photos instead of illustrations.

Dynamic Exercises

Dynamic exercises are similar to stretch exercises with a starting position, a concentric (Hold) motion, and an eccentric (Recovery) motion.  For exercises consisting of multiple sets, the starting position is also used as the resting position between sets.

Using the Abduction exercise as an example, we’ve created 3 illustrations to indicate (1) starting position, (2) concentric motion, and (3) eccentric motion as shown below. The PT-Helper mobile app will use these illustrations (from left to right) to walk the user through the Abduction exercise.

For dynamic exercises, we can utilize the Hold Time and Recovery Time to slow down the motion of the exercise. In this example, we have set the Hold Time to 5 sec, Recovery Time to 2 sec, and Rest Time to 5 sec. The exercise will include 2 repetitions and 2 sets. Slowing down the rate of motion of the exercise can prevent injury in the user or build strength during the eccentric phase of an exercise.

The behavior of the mobile app is shown below to help the patient or client complete their home exercise.

When creating your own dynamic exercises, you can use photos instead of illustrations.

Videos

PT-Helper does not use videos within our exercise app as videos don’t provide the ability to modify exercise parameters for each user. The goal of the mobile app is to have the user follow along with the app to actually do their exercises.

If you have a video of the exercise that you are creating, you can include the URL link within the exercise’s description or the PT Comment field. The user will be able to click on the link to watch the video before doing their exercises.

All user created exercises on PT-Helper CONNECT will be kept private to subscribers and will not be shared with other users.

We hope this helps you create your own exercises to help your patients and clients complete their exercises.

Start your Free 30-day Trial of the PT-Helper CONNECT tool for physical therapists and other therapy providers, so you can create and prescribe Home Exercise Programs.

How YOU Can Benefit from Physical Therapy

By guest writer Ben Shatto, PT, DPT, OCS

I can’t tell you how many times someone will ask me what I do for a living, and upon hearing that I am a physical therapist, he or she will immediately divulge his/her complex personal medical history about a health issue or describe some past experience with a physical therapist (PT).  The stories are usually exceedingly positive or as one may expect, very negative and unfortunate.  This in no way upsets me to hear about one’s personal experiences or medical history.  However, it is concerning that so many people live with chronic aches and pains and (apparently) aren’t able to resolve the problem.  I can’t promise that physical therapy is the panacea of all cures for what ails you, but I have seen it work miracles in people’s lives.  The most amazing thing is the diversity of people I have had the privilege to interact with and help!

Often the answer or treatment plan for a person’s particular issue is not what is expected.  For example, a common complaint is shoulder pain.  Many people struggle to lift overhead properly and often have shoulder pain.  This pain is typically from what is known as shoulder impingement syndrome leading to tendonitis of the rotator cuff.

There are many “standard” treatments for this ailment depending on the medical practitioner you ask.  For example, a physician is likely to offer pain medications (and possibly an anti-inflammatory medication); advice on icing and taking it easy; and if particularly progressive, a physician may even provide a hand out regarding elastic band exercises.  Some physical therapists would likely offer similar advice, such as icing and elastic band exercises to strengthen a muscle group known as the rotator cuff muscles.  (The rotator cuff is a group of four muscles that are important in the movement and stability of the shoulder.)

Time and time again, after a thorough examination of the client, I understand why the shoulder is hurting.  The person has no thoracic mobility likely due from: years of poor posture; office work; washing dishes; taking care of children; or sitting watching TV for hours.  Maybe these activities have led to a very rigid and immobile thoracic spine.

Poor thoracic mobility is a big deal when it comes to shoulder mobility.  The shoulder joint is made up of the scapula (shoulder blade) and humerus (the arm bone to the elbow).  The shoulder blade and the thoracic spine also make a type of joint.  If the thoracic spine is stiff, the shoulder blade is unable to rotate correctly–affecting the way the ball of the humerus spins in the socket of the shoulder blade.  This leads to impingement of the rotator cuff and biceps tendon which causes pain.  If you don’t treat the lack of thoracic mobility, it will be very difficult to ever resolve the shoulder pain.

This real and all too common example of why a person develops shoulder pain is to illustrate why seeing a physical therapist is so valuable.  How would a person know the real cause of the shoulder pain if he or she didn’t ask a physical therapist?  The answer is that he or she wouldn’t know.  Unfortunately, he or she would likely go round and round from one treatment to the next without fully recovering or understanding the real reason why the pain developed in the first place.

Worse yet, as the shoulder pain worsens so does one’s ability to function and his/her quality of life.  In an older adult, this so often begins a downward spiral away from healthy aging and toward an abnormal aging process.  This same example is seen in many of the most common orthopaedic complaints from foot and ankle pain to knee or low back pain.

The dichotomy of the human body is that it is very simple and fragile, yet a complex and robust machine!  The body is truly remarkable and full of surprises.  Many of the most common aches and pains a person may have can be described in a similar scenario like mentioned above. 

Physical therapy can help!  Some issues are not so black and white.  Many issues are like peeling an onion with many layers to the problem.  I believe it is crucial to have a physical therapist on your team to help you live a long, happy life performing the activities that you want for as long as you want!

Age is relative, and movement is the key to healthy living. The goal for health aging is to improve health span, which means the length of time that a person is healthy and thriving in his or her life and not just alive.  Physical therapy can help with healthy aging by improving health span and assisting in a more successful aging process.  We are all capable of successfully aging if we are intentional about the process.

Physical therapists can help you improve, restore or maintain your ability to move and function in your daily life.  As a physical therapist, I help people participate in life, whatever that may be for each individual.  To learn more about physical therapists, visit the American Physical Therapy Association (APTA).

How Can Physical Therapy Benefit You?

• Assist in recovery from a surgery (assisting in complete recovery and integration back into daily life or sport)
• Assist in recovery from a stroke or heart attack
• Assist in improving strength or endurance after an illness or prolonged inactivity
• Assist in improving balance and walking ability to prevent falls
• Maintain independence
• Pain management including low back pain, shoulder pain, hip or knee pain and/or arthritis pain
• Improve athletic performance by optimizing movement patterns
• Health and injury prevention in sport and in life (work or play)

Physical therapists can help guide you through any array of recovery or rehabilitation: return to work, sport, running, and CrossFit.  Whatever your desired activity may be, a physical therapist can help you get moving and “living” again!  Fundamentally, movement is life!

Editor’s Note:  This article was written by Ben Shatto, PT, DPT, OCS.  Ben is Director of Operations at MultiCare Home Health & Personal Care Services, founder and editor of the website www.thePhysicalTherapyAdvisor.com, and owner of The Medical Fitness Center in Eagle, Idaho.  Ben teaches and helps guide proactive adults how to safely implement the proper exercise prescription to improve quality of life and prevent or manage chronic disease and illness in order to age well.

Why Do Patients Not Know How To Do Their Exercises

We frequently hear stories from physical therapists and physical therapist assistants that their patients can’t seem to remember how to do their home exercises. The typical story goes like this:

Patient comes into the clinic.
PT/PTA,  “Did you do your home exercises this past week?”
Patient, “Yes I did.”
PT/PTA, “Great. Let’s get you started with this exercise.”
Patient stands around looking a little lost.
PT/PTA, “Is there something wrong?”
Patient: “How do I do this exercise again?”

If you’ve experienced this exchange with your patients, you’re not alone. What were your thoughts after this exchange?

Perhaps you would think, 
“Clearly he/she hasn’t been doing their exercises!”

One other thing therapists might think is,
“If I can do a better job of teaching him/her how to do this exercise, then they’ll remember how to do this exercise.”

However, as an ex-patient, I can honestly say that I was able to remember how to do all of my exercises as I left the clinic. I believe that the challenge is when the patient never or doesn't regularly do any of their exercises and then shows up at the clinic the following week. After days without doing their exercises, it is unlikely that the patient is going to remember how to do an exercise even if they had it memorized the previous week.

Since learning how to do an exercise is not the issue, then getting your patients to do their exercises is! 

One of my good friends recently had back surgery 3 months ago. Even though she’s a nurse and fully understands the benefits of doing her home exercises, she confessed to me that she often doesn’t do it as she gets busy and can’t allocate the time to do all of her exercises. She said something always gets in the way. 

I wonder if she’s ever had this discussion with her therapist. I know that she’s made significant progress since the surgery but after standing at a corner of a bike race for a few hours directing riders and traffic, she started to exhibit significant limping and was clearly in pain. 

How can a therapist overcome the excuse of “no time”. Would breaking up her exercise program into multiple shorter sessions allow her the opportunity to complete at least some of her exercises instead of doing none? Maybe reducing the number of exercises in her program would be enough to overcome her no time excuse.

Each patient is different and may also have different behaviors depending upon how far away their injury or surgery occurred. Keep an open communication channel with your patient to stay on top of how well they are completing their home exercises.

… and if they tell you they’ve been doing their home exercises, they just might not be telling you the truth…

Start your Free 30-day Trial of the PT-Helper CONNECT tool for physical therapists and other therapy providers, so you may create and prescribe a Home Exercise Programs. Share the HEP program with your patients using the PT-Helper mobile app.

Photo by Jon Flobrant on Unsplash