Thursday, August 16, 2018

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.





    Tuesday, August 7, 2018

    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.

    --

    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.