Shoulder

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Adhesive Capsulitis

Adhesive Capsulitis, also known as Frozen Shoulder, is a condition where the capsule of the shoulder joint becomes inflamed and results in scarring down and tightening of the capsule. The capsule of the shoulder joint is the soft tissue surrounding the joint that holds the joint together at its deepest layer. The true cause of frozen shoulder is still unknown, but risk factors include: minor traumas, hyperthyroidism, diabetes, post-surgical states and prolonged immobilization; with prevalence in diagnosis seen in females ages 40-65.

Frozen shoulder is classified in three stages: the freezing stage, frozen stage and thawing stage; where the shoulder will grow stiffer, then there is loss of motion, followed by regain in motion over time. Frozen shoulder is a self-limiting disease where it can resolve itself over time, typically over a 1 to 3 year time span. While frozen shoulder can resolve on its own, physical therapy can assist with progressing through the stages quicker to regain function and return to normal activities of failing living sooner.

Physical therapy treatments for Frozen Shoulder consist of:
– Patient education of the disease process, progression and activity modification
– Passive range of motion; both to prevent further loss and to improve available range
– Mobilizations of joint; for pain reduction and improvement in motion
– Active motion/strengthening to improve activity tolerance
– Corticosteroids may be used by Physicians for short-term relief to help reduce inflammation to improve range and tolerance to physical therapy treatments.

Possible Treatments

  • Active Assistive Range of Motion
  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Heat Pack
  • Isometric Exercise
  • Proprioceptive Neuromuscular Facilitation (PNF)
  • Shoulder Active Range of Motion
  • Shoulder Joint Mobilization
  • Shoulder Passive Range of Motion
  • Shoulder Resistive Range of Motion
  • Posture Training
  • Soft Tissue Mobilization
  • Physical Agents
  • Stretching/Flexibility Exercise

Possible Treatment Goals

  • Decrease Risk of Reoccurrence
  • Improve Function
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Proprioception
  • Improve Range of Motion
  • Improve Relaxation
  • Self-care of Symptoms

Shoulder Instability

The shoulder joint (glenohurmeral joint) is a ball and socket joint which is very mobile, and therefore, susceptible to having too much motion. Static and dynamic structures normally work to stabilize the ball of the joint (humeral head) within the socket (glenoid fossa). Multidirectional instability of the shoulder refers to a general laxity (looseness) of the shoulder, allowing the humeral head to be able to more excessively forward, backward and/or downwards within the socket. This may cause the humeral head to come out partially of the socket (subluxation) or all the way out of the socket (dislocation). This may occur due to damage or weakness to static structures including the lining of the socket (labrum), ligaments (structures that connect the bones), or joint capsule (tissue that surrounds the joint), or dynamic structures, specifically the muscles and tendons around the shoulder called the rotator cuff muscles. Certain individuals may also have a genetic condition or previous diagnosis that causes hyper laxity (looseness of the joints), which can predispose them to multidirectional instability. Multidirectional instability is often seen in individuals who perform repetitive overhead movements, including overhead athletes.

Individuals with this condition may experience symptoms including pain, weakness, and clunking or clicking. A medical professional will perform a battery of tests to assess for excessive movement of the shoulder joint in order to help diagnosis multidirectional instability. Treatment most often involves long term conservative, non surgical treatment via physical therapy and/or sports specific rehabilitation. Physical therapy includes exercises to help strengthen the rotator cuff muscles, as well as the shoulder blade (scapular) muscles, to improve stability of the shoulder joint. Treatment will also focus on improving specific movement techniques that may have contributed to injury. The majority of people will respond well to a conservative program and will not require surgery. However, certain surgical procedures that help further stabilize the shoulder joint may be indicated if an individual continues with pain symptoms following rehabilitation.

Possible Treatments

  • Active Assistive Range of Motion
  • Aerobic/Endurance Exercise
  • Core Strengthening
  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Heat Pack
  • Isometric Exercise
  • Proprioceptive Neuromuscular Facilitation (PNF)
  • Shoulder Active Range of Motion
  • Shoulder Joint Mobilization
  • Shoulder Passive Range of Motion
  • Shoulder Resistive Range of Motion
  • Posture Training
  • Soft Tissue Mobilization
  • Physical Agents
  • Stretching/Flexibility Exercise

Possible Treatment Goals

  • Decrease Risk of Reoccurrence
  • Improve Function
  • Improve Fitness
  • Optimize Joint Alignment
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Proprioception
  • Decrease Postoperative Complications
  • Improve Relaxation
  • Self-care of Symptoms
  • Improve Safety
  • Improve Tolerance for Prolonged Activities

Reoccurring Dislocations

After an initial dislocation of a shoulder, the shoulder is more vulnerable to repeat injuries and dislocations. This initial dislocation and continued dislocation can cause injuries to the muscles, tendons, ligaments and joint itself. Reoccurring dislocations are sometimes caused by repetitive overhead motions in sports like baseball/softball, swimming, tennis or volleyball Conservative treatment is the first course of action when patients begin to have shoulder dislocations. Activity modification and physical therapy can help strengthen and stabilize the shoulder to prevent further dislocations.

Possible Treatments

  • Active Assistive Range of Motion
  • Aerobic/Endurance Exercise
  • Core Strengthening
  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Heat Pack
  • Isometric Exercise
  • Proprioceptive Neuromuscular Facilitation (PNF)
  • Shoulder Active Range of Motion
  • Shoulder Joint Mobilization
  • Shoulder Passive Range of Motion
  • Shoulder Resistive Range of Motion
  • Posture Training
  • Soft Tissue Mobilization
  • Physical Agents
  • Stretching/Flexibility Exercise

Possible Treatment Goals

  • Decrease Risk of Reoccurrence
  • Improve Function
  • Improve Fitness
  • Optimize Joint Alignment
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Proprioception
  • Decrease Postoperative Complications
  • Improve Relaxation
  • Self-care of Symptoms
  • Improve Safety
  • Improve Tolerance for Prolonged Activities

Additional Resources

Posterior Dislocation

Posterior dislocations account for only 3% of shoulder dislocations. They occur when there is a force from the front of the shoulder, pushing the humerus backwards. This is most often caused by falling on an outstretched hand (FOOSH injury). Posterior dislocations often have concurrent labral or RTC pathology.

A recurrent dislocation in young individuals is extremely high and may require surgery for those that are highly active. If surgery is required, patients typically require a period of immobilization followed by physical therapy to restore normal shoulder function. The risk of redislocation is much lower in middle-aged and older adults and conservative treatment with physical therapy is often indicated initially.

Possible Treatments

  • Active Assistive Range of Motion
  • Aerobic/Endurance Exercise
  • Core Strengthening
  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Heat Pack
  • Isometric Exercise
  • Proprioceptive Neuromuscular Facilitation (PNF)
  • Shoulder Active Range of Motion
  • Shoulder Joint Mobilization
  • Shoulder Passive Range of Motion
  • Shoulder Resistive Range of Motion
  • Posture Training
  • Soft Tissue Mobilization
  • Physical Agents
  • Stretching/Flexibility Exercise

Possible Treatment Goals

  • Decrease Risk of Reoccurrence
  • Improve Function
  • Improve Fitness
  • Optimize Joint Alignment
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Proprioception
  • Self-care of Symptoms
  • Improve Safety
  • Improve Tolerance for Prolonged Activities

Shoulder Tendonitis and Impingement

Shoulder impingement occurs when one of the structures of the shoulder (most often the supraspinatus muscle or subacrominal bursa) become compressed between the bones that make up the shoulder joint typically when reaching over head or behind your back. This compression causes damage to these structures resulting in shoulder tendonitis. Common symptoms include localized shoulder pain, tenderness to the touch, shoulder weakness, and stiffness. Treatment typically consists of ice, pain medications and exercise. In physical therapy patients’ strength, range of motion, pain severity and posture all are addressed through the use of specific exercises as well as modalities such as ice, heat etc. Surgery is not typically indicated.

Possible Treatments

  • Active Assistive Range of Motion
  • Aerobic/Endurance Exercise
  • Core Strengthening
  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Heat Pack
  • Isometric Exercise
  • Proprioceptive Neuromuscular Facilitation (PNF)
  • Shoulder Active Range of Motion
  • Shoulder Joint Mobilization
  • Shoulder Passive Range of Motion
  • Shoulder Resistive Range of Motion
  • Posture Training
  • Soft Tissue Mobilization
  • Physical Agents
  • Stretching/Flexibility Exercise

Possible Treatment Goals

  • Decrease Risk of Reoccurrence
  • Improve Function
  • Improve Fitness
  • Optimize Joint Alignment
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Proprioception
  • Decrease Postoperative Complications
  • Improve Relaxation
  • Self-care of Symptoms
  • Improve Safety
  • Improve Tolerance for Prolonged Activities

Rotator Cuff Tears

Rotator cuff tears are a common cause of pain and disability in the adult population. A torn rotator cuff is usually the result of trauma to the shoulder, such as a fall, or overuse. Overhead athletes, people over the age of 40, and people who perform overhead work are at a greater risk. These are four rotator cuff muscles that help to stabilize the shoulder joint: the supraspinatus, ingfraspinatus, teres minor and subscapularis. The supraspinatus is the most commonly torn of the four muscles.

Rotator cuffs can be partial or full tears, full tears defined by the tendon fully removed from the bone. Rotator cuffs can be diagnosed by a physical therapist using special tests, but are often diagnosed with MRI or ultrasound.

Rotator cuff tears are often treated non-surgically with physical therapy to reduce pain and improve shoulder function. Physical therapy involves education, activity modification, rest, and therapeutic exercises to strengthen shoulder musculature. Rotator cuff tears may also be treated with pain medication or injections to reduce pain and inflammation.

If surgery is indicated, physical therapy will begin soon after the surgical date and begin with gentle range of motion exercises and progress slowly toward shoulder strengthening and functional activities.

Possible Treatments

  • Active Assistive Range of Motion
  • Aerobic/Endurance Exercise
  • Core Strengthening
  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Heat Pack
  • Isometric Exercise
  • Proprioceptive Neuromuscular Facilitation (PNF)
  • Shoulder Active Range of Motion
  • Shoulder Joint Mobilization
  • Shoulder Passive Range of Motion
  • Shoulder Resistive Range of Motion
  • Posture Training
  • Soft Tissue Mobilization
  • Physical Agents
  • Stretching/Flexibility Exercise

Possible Treatment Goals

  • Decrease Risk of Reoccurrence
  • Improve Function
  • Improve Fitness
  • Optimize Joint Alignment
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Proprioception
  • Decrease Postoperative Complications
  • Improve Relaxation
  • Self-care of Symptoms
  • Improve Safety
  • Improve Tolerance for Prolonged Activities

Additional Resources

Acromioclavicular Separation (Separated Shoulder)

An acromioclavicular (AC) separation is when there is an injury to the junction between the acromion (bone on the shoulder blade) and the clavicle (collar bone). This is typically the result of trauma such as falling onto your shoulder or a motor vehicle accident. If severe enough this could cause a “step down” deformity where the clavicle protrudes upwards. Common symptoms of a separated shoulder include shoulder pain, swelling, reduced shoulder strength as well as reduced shoulder range of motion. Treatment typically consists of ice, pain medication, rest initially and physical therapy. In physical therapy patient’s strength, range of motion, pain severity and posture are all addressed through the use of specific exercises as well as modalities such as ice/heat/etc. Surgery is not typically included unless the ligaments holding the joint together are compromised.

Possible Treatments

  • Active Assistive Range of Motion
  • Aerobic/Endurance Exercise
  • Core Strengthening
  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Heat Pack
  • Isometric Exercise
  • Proprioceptive Neuromuscular Facilitation (PNF)
  • Shoulder Active Range of Motion
  • Shoulder Joint Mobilization
  • Shoulder Passive Range of Motion
  • Shoulder Resistive Range of Motion
  • Posture Training
  • Soft Tissue Mobilization
  • Physical Agents
  • Stretching/Flexibility Exercise

Possible Treatment Goals

  • Improve Function
  • Improve Fitness
  • Optimize Joint Alignment
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Proprioception
  • Decrease Postoperative Complications
  • Improve Relaxation
  • Self-care of Symptoms
  • Improve Safety
  • Improve Tolerance for Prolonged Activities

Shoulder Labral Tears

The labrum is a piece of fibrocartilarge (rubbery tissue) which attaches to the rim of the shoulder socket. This helps keep the ball of the shoulder joint (head of humerus) in place. Traumatic injury and wear and tear from repetitive motion of the upper arm can both cause labral tears. This can include a fall on an outstretch arm, a direct hit to the shoulder, a violent blow while reaching overhead or a sudden tug on the arm. Symptoms can include painful clicking, locking, popping and instability. Diagnosis may include a medical exam and a CT scan or MRI. Labral tears are often treated with rest, over the counter medication and physical therapy. Physical therapy can help strengthen the muscles of the shoulder, especially the rotator cuff muscles. In addition, your PT will show you what activities to avoid as well as gentle stretching exercises to do at home. Physical therapy can last 4-8 weeks depending on the severity of the injury.

Possible Treatments

  • Core Strengthening
  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Isometric Exercise
  • Proprioceptive Neuromuscular Facilitation (PNF)
  • Physical Agents
  • Stretching/Flexibility Exercise

Possible Treatment Goals

  • Improve Function
  • Improve Fitness
  • Optimize Joint Alignment
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Proprioception
  • Improve Relaxation
  • Self-care of Symptoms

Additional Resources

  • Adhesive Capsulitis

    Adhesive Capsulitis, also known as Frozen Shoulder, is a condition where the capsule of the shoulder joint becomes inflamed and results in scarring down and tightening of the capsule. The capsule of the shoulder joint is the soft tissue surrounding the joint that holds the joint together at its deepest layer. The true cause of frozen shoulder is still unknown, but risk factors include: minor traumas, hyperthyroidism, diabetes, post-surgical states and prolonged immobilization; with prevalence in diagnosis seen in females ages 40-65.

    Frozen shoulder is classified in three stages: the freezing stage, frozen stage and thawing stage; where the shoulder will grow stiffer, then there is loss of motion, followed by regain in motion over time. Frozen shoulder is a self-limiting disease where it can resolve itself over time, typically over a 1 to 3 year time span. While frozen shoulder can resolve on its own, physical therapy can assist with progressing through the stages quicker to regain function and return to normal activities of failing living sooner.

    Physical therapy treatments for Frozen Shoulder consist of:
    – Patient education of the disease process, progression and activity modification
    – Passive range of motion; both to prevent further loss and to improve available range
    – Mobilizations of joint; for pain reduction and improvement in motion
    – Active motion/strengthening to improve activity tolerance
    – Corticosteroids may be used by Physicians for short-term relief to help reduce inflammation to improve range and tolerance to physical therapy treatments.

    Treatments

    Active Assistive Range of Motion

    Patient or therapist-assisted active range of motion. This is usually prescribed for gentle stretching or strengthening for a very weak body part.

    Cryotherapy or Cold Therapy

    Cold therapy is used to cause vasoconstriction (the blood vessels constrict or decrease their diameter) to reduce the amount of fluid that leaks out of the capillaries into the tissue spaces (swelling) in response to injury of tissue. Ice or cold is used most frequently in acute injuries, but also an effective pain reliever for even the most chronic pain. Cold therapy may be administered by using a cold pack or an ice massage as seen in the above video.

    Electrotherapeutic Modalities

    Possible Treatments

    • Neuromuscular Electrical Stimulation
    • Transcutaneous Electrical Nerve Stimulation (TENS)
    • Iontophoresis
    Heat Pack

    Heat is recommended to decrease chronic pain, relax muscles, and for pain relief. It should not be used with an acute or “new” injury.

    Isometric Exercise

    An isometric exercise is a muscle contraction without joint movement. Isometrics are usually prescribed for gentle nerve and muscle reeducation. They are typically used for strengthening with arthritis patients, post-surgical patients, or as an introductory muscle strengthening exercise. A usual progression is from isometrics to active and resistive exercises that involve joint movement.

    Proprioceptive Neuromuscular Facilitation (PNF)

    Performed in diagonal patterns that mimic functional movements. Initially this technique was used in developmentally and neurologically impaired patients. Today, PNF (or a variation of it)is commonly used for almost every aspect of neuromuscular retraining. It can be used on the professional athlete or someone in a nursing home.

    Shoulder Active Range of Motion

    The movement of the shoulder, by the patient, through a range of motion against gravity. AROM is usually prescribed for arthritis, initial recovery of joint motion and/or gentle strengthening without trauma to joints.

    Shoulder Joint Mobilization

    Hands-on therapeutic procedures intended to increase soft tissue or shoulder joint mobility. Mobilization is usually prescribed to increase mobility, decrease joint stiffness, and to relieve pain. There are many types of mobilization techniques including Grimsby, Maitland, Kaltenborn, Isometric Mobilizations, etc.

    Shoulder Passive Range of Motion

    The movement of the shoulder by the patient or therapist through a range of motion without the use of the muscles that “actively” move the joint(s).

    Shoulder Resistive Range of Motion

    Exercises that gradually increase in resistance (weights) and in repetitions. PRE is usually prescribed for reeducation of muscles and strengthening. Weights, rubber bands, and body weight can be used as resistance.

    Posture Training

    Instruction in the correct biomechanical alignment of the body to reduce undue strain on muscles, joints, ligaments, discs, and other soft tissues. There is an ideal posture but most do not have it. Therapists educate patients about the importance of improving posture and body mechanics with daily activities. Stretching and strengthening exercises may be prescribed to facilitate postural improvement and to prevent further disability and future recurrences of problems.

    Soft Tissue Mobilization

    Therapeutic massage of body tissue, performed with the hands. Soft tissue mobilization may be used for muscle relaxation, to decrease swelling, to decrease scar tissue adhesions, and for pain relief.

    Physical Agents

    Possible Treatments

    • Cryotherapy or Cold Therapy
    • Heat Pack
    • Ultrasound
    Stretching/Flexibility Exercise

    Exercise designed to lengthen a muscle(s) or soft tissue. Stretching exercises are usually prescribed to improve the flexibility of muscles that have tightened due to disuse or in compensation to pain, spasm or immobilization.

    Goals

    • Decrease Risk of Reoccurrence
    • Improve Function
    • Improve Muscle Strength and Power
    • Increase Oxygen to Tissues
    • Improve Proprioception
    • Improve Range of Motion
    • Improve Relaxation
    • Self-care of Symptoms

    Resources

  • Shoulder Instability

    The shoulder joint (glenohurmeral joint) is a ball and socket joint which is very mobile, and therefore, susceptible to having too much motion. Static and dynamic structures normally work to stabilize the ball of the joint (humeral head) within the socket (glenoid fossa). Multidirectional instability of the shoulder refers to a general laxity (looseness) of the shoulder, allowing the humeral head to be able to more excessively forward, backward and/or downwards within the socket. This may cause the humeral head to come out partially of the socket (subluxation) or all the way out of the socket (dislocation). This may occur due to damage or weakness to static structures including the lining of the socket (labrum), ligaments (structures that connect the bones), or joint capsule (tissue that surrounds the joint), or dynamic structures, specifically the muscles and tendons around the shoulder called the rotator cuff muscles. Certain individuals may also have a genetic condition or previous diagnosis that causes hyper laxity (looseness of the joints), which can predispose them to multidirectional instability. Multidirectional instability is often seen in individuals who perform repetitive overhead movements, including overhead athletes.

    Individuals with this condition may experience symptoms including pain, weakness, and clunking or clicking. A medical professional will perform a battery of tests to assess for excessive movement of the shoulder joint in order to help diagnosis multidirectional instability. Treatment most often involves long term conservative, non surgical treatment via physical therapy and/or sports specific rehabilitation. Physical therapy includes exercises to help strengthen the rotator cuff muscles, as well as the shoulder blade (scapular) muscles, to improve stability of the shoulder joint. Treatment will also focus on improving specific movement techniques that may have contributed to injury. The majority of people will respond well to a conservative program and will not require surgery. However, certain surgical procedures that help further stabilize the shoulder joint may be indicated if an individual continues with pain symptoms following rehabilitation.

    Treatments

    Active Assistive Range of Motion

    Patient or therapist-assisted active range of motion. This is usually prescribed for gentle stretching or strengthening for a very weak body part.

    Aerobic/Endurance Exercise

    Stationary cycling is usually prescribed for improving the strength and/or range of motion of the hips, knees, ankles as well as cardio-vascular endurance.

    Core Strengthening

    The trunk and its associated muscles make up the core. The extremities are the arms, forearms, hands, thighs, legs, ankles/feet. Strong core muscles provide a foundation for the extremities to attach to and work more efficiently. It is hypothesized that a weak core can cause excessive stress on the extremity muscles, tendons, ligaments and joints. Core strengthening is a multi-joint exercise, involving larger muscle groups such as the chest, back, abdominals, back, hip/thigh, and shoulder blade muscles. Core strengthening is often incorporated as part of a low back or neck rehabilitation program. Because recovery or enhancement of core strength provides a stable base for the extremities, it is also commonly part of an arm, forearm, thigh, leg or ankle program.

    Cryotherapy or Cold Therapy

    Cold therapy is used to cause vasoconstriction (the blood vessels constrict or decrease their diameter) to reduce the amount of fluid that leaks out of the capillaries into the tissue spaces (swelling) in response to injury of tissue. Ice or cold is used most frequently in acute injuries, but also an effective pain reliever for even the most chronic pain. Cold therapy may be administered by using a cold pack or an ice massage as seen in the above video.

    Electrotherapeutic Modalities

    Possible Treatments

    • Neuromuscular Electrical Stimulation
    • Transcutaneous Electrical Nerve Stimulation (TENS)
    • Iontophoresis
    Heat Pack

    Heat is recommended to decrease chronic pain, relax muscles, and for pain relief. It should not be used with an acute or “new” injury.

    Isometric Exercise

    An isometric exercise is a muscle contraction without joint movement. Isometrics are usually prescribed for gentle nerve and muscle reeducation. They are typically used for strengthening with arthritis patients, post-surgical patients, or as an introductory muscle strengthening exercise. A usual progression is from isometrics to active and resistive exercises that involve joint movement.

    Proprioceptive Neuromuscular Facilitation (PNF)

    Performed in diagonal patterns that mimic functional movements. Initially this technique was used in developmentally and neurologically impaired patients. Today, PNF (or a variation of it)is commonly used for almost every aspect of neuromuscular retraining. It can be used on the professional athlete or someone in a nursing home.

    Shoulder Active Range of Motion

    The movement of the shoulder, by the patient, through a range of motion against gravity. AROM is usually prescribed for arthritis, initial recovery of joint motion and/or gentle strengthening without trauma to joints.

    Shoulder Joint Mobilization

    Hands-on therapeutic procedures intended to increase soft tissue or shoulder joint mobility. Mobilization is usually prescribed to increase mobility, decrease joint stiffness, and to relieve pain. There are many types of mobilization techniques including Grimsby, Maitland, Kaltenborn, Isometric Mobilizations, etc.

    Shoulder Passive Range of Motion

    The movement of the shoulder by the patient or therapist through a range of motion without the use of the muscles that “actively” move the joint(s).

    Shoulder Resistive Range of Motion

    Exercises that gradually increase in resistance (weights) and in repetitions. PRE is usually prescribed for reeducation of muscles and strengthening. Weights, rubber bands, and body weight can be used as resistance.

    Posture Training

    Instruction in the correct biomechanical alignment of the body to reduce undue strain on muscles, joints, ligaments, discs, and other soft tissues. There is an ideal posture but most do not have it. Therapists educate patients about the importance of improving posture and body mechanics with daily activities. Stretching and strengthening exercises may be prescribed to facilitate postural improvement and to prevent further disability and future recurrences of problems.

    Soft Tissue Mobilization

    Therapeutic massage of body tissue, performed with the hands. Soft tissue mobilization may be used for muscle relaxation, to decrease swelling, to decrease scar tissue adhesions, and for pain relief.

    Physical Agents

    Possible Treatments

    • Cryotherapy or Cold Therapy
    • Heat Pack
    • Ultrasound
    Stretching/Flexibility Exercise

    Exercise designed to lengthen a muscle(s) or soft tissue. Stretching exercises are usually prescribed to improve the flexibility of muscles that have tightened due to disuse or in compensation to pain, spasm or immobilization.

    Goals

    • Decrease Risk of Reoccurrence
    • Improve Function
    • Improve Fitness
    • Optimize Joint Alignment
    • Improve Muscle Strength and Power
    • Increase Oxygen to Tissues
    • Improve Proprioception
    • Decrease Postoperative Complications
    • Improve Relaxation
    • Self-care of Symptoms
    • Improve Safety
    • Improve Tolerance for Prolonged Activities

    Resources

  • Reoccurring Dislocations

    After an initial dislocation of a shoulder, the shoulder is more vulnerable to repeat injuries and dislocations. This initial dislocation and continued dislocation can cause injuries to the muscles, tendons, ligaments and joint itself. Reoccurring dislocations are sometimes caused by repetitive overhead motions in sports like baseball/softball, swimming, tennis or volleyball Conservative treatment is the first course of action when patients begin to have shoulder dislocations. Activity modification and physical therapy can help strengthen and stabilize the shoulder to prevent further dislocations.

    Treatments

    Active Assistive Range of Motion

    Patient or therapist-assisted active range of motion. This is usually prescribed for gentle stretching or strengthening for a very weak body part.

    Aerobic/Endurance Exercise

    Stationary cycling is usually prescribed for improving the strength and/or range of motion of the hips, knees, ankles as well as cardio-vascular endurance.

    Core Strengthening

    The trunk and its associated muscles make up the core. The extremities are the arms, forearms, hands, thighs, legs, ankles/feet. Strong core muscles provide a foundation for the extremities to attach to and work more efficiently. It is hypothesized that a weak core can cause excessive stress on the extremity muscles, tendons, ligaments and joints. Core strengthening is a multi-joint exercise, involving larger muscle groups such as the chest, back, abdominals, back, hip/thigh, and shoulder blade muscles. Core strengthening is often incorporated as part of a low back or neck rehabilitation program. Because recovery or enhancement of core strength provides a stable base for the extremities, it is also commonly part of an arm, forearm, thigh, leg or ankle program.

    Cryotherapy or Cold Therapy

    Cold therapy is used to cause vasoconstriction (the blood vessels constrict or decrease their diameter) to reduce the amount of fluid that leaks out of the capillaries into the tissue spaces (swelling) in response to injury of tissue. Ice or cold is used most frequently in acute injuries, but also an effective pain reliever for even the most chronic pain. Cold therapy may be administered by using a cold pack or an ice massage as seen in the above video.

    Electrotherapeutic Modalities

    Possible Treatments

    • Neuromuscular Electrical Stimulation
    • Transcutaneous Electrical Nerve Stimulation (TENS)
    • Iontophoresis
    Heat Pack

    Heat is recommended to decrease chronic pain, relax muscles, and for pain relief. It should not be used with an acute or “new” injury.

    Isometric Exercise

    An isometric exercise is a muscle contraction without joint movement. Isometrics are usually prescribed for gentle nerve and muscle reeducation. They are typically used for strengthening with arthritis patients, post-surgical patients, or as an introductory muscle strengthening exercise. A usual progression is from isometrics to active and resistive exercises that involve joint movement.

    Proprioceptive Neuromuscular Facilitation (PNF)

    Performed in diagonal patterns that mimic functional movements. Initially this technique was used in developmentally and neurologically impaired patients. Today, PNF (or a variation of it)is commonly used for almost every aspect of neuromuscular retraining. It can be used on the professional athlete or someone in a nursing home.

    Shoulder Active Range of Motion

    The movement of the shoulder, by the patient, through a range of motion against gravity. AROM is usually prescribed for arthritis, initial recovery of joint motion and/or gentle strengthening without trauma to joints.

    Shoulder Joint Mobilization

    Hands-on therapeutic procedures intended to increase soft tissue or shoulder joint mobility. Mobilization is usually prescribed to increase mobility, decrease joint stiffness, and to relieve pain. There are many types of mobilization techniques including Grimsby, Maitland, Kaltenborn, Isometric Mobilizations, etc.

    Shoulder Passive Range of Motion

    The movement of the shoulder by the patient or therapist through a range of motion without the use of the muscles that “actively” move the joint(s).

    Shoulder Resistive Range of Motion

    Exercises that gradually increase in resistance (weights) and in repetitions. PRE is usually prescribed for reeducation of muscles and strengthening. Weights, rubber bands, and body weight can be used as resistance.

    Posture Training

    Instruction in the correct biomechanical alignment of the body to reduce undue strain on muscles, joints, ligaments, discs, and other soft tissues. There is an ideal posture but most do not have it. Therapists educate patients about the importance of improving posture and body mechanics with daily activities. Stretching and strengthening exercises may be prescribed to facilitate postural improvement and to prevent further disability and future recurrences of problems.

    Soft Tissue Mobilization

    Therapeutic massage of body tissue, performed with the hands. Soft tissue mobilization may be used for muscle relaxation, to decrease swelling, to decrease scar tissue adhesions, and for pain relief.

    Physical Agents

    Possible Treatments

    • Cryotherapy or Cold Therapy
    • Heat Pack
    • Ultrasound
    Stretching/Flexibility Exercise

    Exercise designed to lengthen a muscle(s) or soft tissue. Stretching exercises are usually prescribed to improve the flexibility of muscles that have tightened due to disuse or in compensation to pain, spasm or immobilization.

    Goals

    • Decrease Risk of Reoccurrence
    • Improve Function
    • Improve Fitness
    • Optimize Joint Alignment
    • Improve Muscle Strength and Power
    • Increase Oxygen to Tissues
    • Improve Proprioception
    • Decrease Postoperative Complications
    • Improve Relaxation
    • Self-care of Symptoms
    • Improve Safety
    • Improve Tolerance for Prolonged Activities

    Resources

  • Posterior Dislocation

    Posterior dislocations account for only 3% of shoulder dislocations. They occur when there is a force from the front of the shoulder, pushing the humerus backwards. This is most often caused by falling on an outstretched hand (FOOSH injury). Posterior dislocations often have concurrent labral or RTC pathology.

    A recurrent dislocation in young individuals is extremely high and may require surgery for those that are highly active. If surgery is required, patients typically require a period of immobilization followed by physical therapy to restore normal shoulder function. The risk of redislocation is much lower in middle-aged and older adults and conservative treatment with physical therapy is often indicated initially.

    Treatments

    Active Assistive Range of Motion

    Patient or therapist-assisted active range of motion. This is usually prescribed for gentle stretching or strengthening for a very weak body part.

    Aerobic/Endurance Exercise

    Stationary cycling is usually prescribed for improving the strength and/or range of motion of the hips, knees, ankles as well as cardio-vascular endurance.

    Core Strengthening

    The trunk and its associated muscles make up the core. The extremities are the arms, forearms, hands, thighs, legs, ankles/feet. Strong core muscles provide a foundation for the extremities to attach to and work more efficiently. It is hypothesized that a weak core can cause excessive stress on the extremity muscles, tendons, ligaments and joints. Core strengthening is a multi-joint exercise, involving larger muscle groups such as the chest, back, abdominals, back, hip/thigh, and shoulder blade muscles. Core strengthening is often incorporated as part of a low back or neck rehabilitation program. Because recovery or enhancement of core strength provides a stable base for the extremities, it is also commonly part of an arm, forearm, thigh, leg or ankle program.

    Cryotherapy or Cold Therapy

    Cold therapy is used to cause vasoconstriction (the blood vessels constrict or decrease their diameter) to reduce the amount of fluid that leaks out of the capillaries into the tissue spaces (swelling) in response to injury of tissue. Ice or cold is used most frequently in acute injuries, but also an effective pain reliever for even the most chronic pain. Cold therapy may be administered by using a cold pack or an ice massage as seen in the above video.

    Electrotherapeutic Modalities

    Possible Treatments

    • Neuromuscular Electrical Stimulation
    • Transcutaneous Electrical Nerve Stimulation (TENS)
    • Iontophoresis
    Heat Pack

    Heat is recommended to decrease chronic pain, relax muscles, and for pain relief. It should not be used with an acute or “new” injury.

    Isometric Exercise

    An isometric exercise is a muscle contraction without joint movement. Isometrics are usually prescribed for gentle nerve and muscle reeducation. They are typically used for strengthening with arthritis patients, post-surgical patients, or as an introductory muscle strengthening exercise. A usual progression is from isometrics to active and resistive exercises that involve joint movement.

    Proprioceptive Neuromuscular Facilitation (PNF)

    Performed in diagonal patterns that mimic functional movements. Initially this technique was used in developmentally and neurologically impaired patients. Today, PNF (or a variation of it)is commonly used for almost every aspect of neuromuscular retraining. It can be used on the professional athlete or someone in a nursing home.

    Shoulder Active Range of Motion

    The movement of the shoulder, by the patient, through a range of motion against gravity. AROM is usually prescribed for arthritis, initial recovery of joint motion and/or gentle strengthening without trauma to joints.

    Shoulder Joint Mobilization

    Hands-on therapeutic procedures intended to increase soft tissue or shoulder joint mobility. Mobilization is usually prescribed to increase mobility, decrease joint stiffness, and to relieve pain. There are many types of mobilization techniques including Grimsby, Maitland, Kaltenborn, Isometric Mobilizations, etc.

    Shoulder Passive Range of Motion

    The movement of the shoulder by the patient or therapist through a range of motion without the use of the muscles that “actively” move the joint(s).

    Shoulder Resistive Range of Motion

    Exercises that gradually increase in resistance (weights) and in repetitions. PRE is usually prescribed for reeducation of muscles and strengthening. Weights, rubber bands, and body weight can be used as resistance.

    Posture Training

    Instruction in the correct biomechanical alignment of the body to reduce undue strain on muscles, joints, ligaments, discs, and other soft tissues. There is an ideal posture but most do not have it. Therapists educate patients about the importance of improving posture and body mechanics with daily activities. Stretching and strengthening exercises may be prescribed to facilitate postural improvement and to prevent further disability and future recurrences of problems.

    Soft Tissue Mobilization

    Therapeutic massage of body tissue, performed with the hands. Soft tissue mobilization may be used for muscle relaxation, to decrease swelling, to decrease scar tissue adhesions, and for pain relief.

    Physical Agents

    Possible Treatments

    • Cryotherapy or Cold Therapy
    • Heat Pack
    • Ultrasound
    Stretching/Flexibility Exercise

    Exercise designed to lengthen a muscle(s) or soft tissue. Stretching exercises are usually prescribed to improve the flexibility of muscles that have tightened due to disuse or in compensation to pain, spasm or immobilization.

    Goals

    • Decrease Risk of Reoccurrence
    • Improve Function
    • Improve Fitness
    • Optimize Joint Alignment
    • Improve Muscle Strength and Power
    • Increase Oxygen to Tissues
    • Improve Proprioception
    • Self-care of Symptoms
    • Improve Safety
    • Improve Tolerance for Prolonged Activities
  • Shoulder Tendonitis and Impingement

    Shoulder impingement occurs when one of the structures of the shoulder (most often the supraspinatus muscle or subacrominal bursa) become compressed between the bones that make up the shoulder joint typically when reaching over head or behind your back. This compression causes damage to these structures resulting in shoulder tendonitis. Common symptoms include localized shoulder pain, tenderness to the touch, shoulder weakness, and stiffness. Treatment typically consists of ice, pain medications and exercise. In physical therapy patients’ strength, range of motion, pain severity and posture all are addressed through the use of specific exercises as well as modalities such as ice, heat etc. Surgery is not typically indicated.

    Treatments

    Active Assistive Range of Motion

    Patient or therapist-assisted active range of motion. This is usually prescribed for gentle stretching or strengthening for a very weak body part.

    Aerobic/Endurance Exercise

    Stationary cycling is usually prescribed for improving the strength and/or range of motion of the hips, knees, ankles as well as cardio-vascular endurance.

    Core Strengthening

    The trunk and its associated muscles make up the core. The extremities are the arms, forearms, hands, thighs, legs, ankles/feet. Strong core muscles provide a foundation for the extremities to attach to and work more efficiently. It is hypothesized that a weak core can cause excessive stress on the extremity muscles, tendons, ligaments and joints. Core strengthening is a multi-joint exercise, involving larger muscle groups such as the chest, back, abdominals, back, hip/thigh, and shoulder blade muscles. Core strengthening is often incorporated as part of a low back or neck rehabilitation program. Because recovery or enhancement of core strength provides a stable base for the extremities, it is also commonly part of an arm, forearm, thigh, leg or ankle program.

    Cryotherapy or Cold Therapy

    Cold therapy is used to cause vasoconstriction (the blood vessels constrict or decrease their diameter) to reduce the amount of fluid that leaks out of the capillaries into the tissue spaces (swelling) in response to injury of tissue. Ice or cold is used most frequently in acute injuries, but also an effective pain reliever for even the most chronic pain. Cold therapy may be administered by using a cold pack or an ice massage as seen in the above video.

    Electrotherapeutic Modalities

    Possible Treatments

    • Neuromuscular Electrical Stimulation
    • Transcutaneous Electrical Nerve Stimulation (TENS)
    • Iontophoresis
    Heat Pack

    Heat is recommended to decrease chronic pain, relax muscles, and for pain relief. It should not be used with an acute or “new” injury.

    Isometric Exercise

    An isometric exercise is a muscle contraction without joint movement. Isometrics are usually prescribed for gentle nerve and muscle reeducation. They are typically used for strengthening with arthritis patients, post-surgical patients, or as an introductory muscle strengthening exercise. A usual progression is from isometrics to active and resistive exercises that involve joint movement.

    Proprioceptive Neuromuscular Facilitation (PNF)

    Performed in diagonal patterns that mimic functional movements. Initially this technique was used in developmentally and neurologically impaired patients. Today, PNF (or a variation of it)is commonly used for almost every aspect of neuromuscular retraining. It can be used on the professional athlete or someone in a nursing home.

    Shoulder Active Range of Motion

    The movement of the shoulder, by the patient, through a range of motion against gravity. AROM is usually prescribed for arthritis, initial recovery of joint motion and/or gentle strengthening without trauma to joints.

    Shoulder Joint Mobilization

    Hands-on therapeutic procedures intended to increase soft tissue or shoulder joint mobility. Mobilization is usually prescribed to increase mobility, decrease joint stiffness, and to relieve pain. There are many types of mobilization techniques including Grimsby, Maitland, Kaltenborn, Isometric Mobilizations, etc.

    Shoulder Passive Range of Motion

    The movement of the shoulder by the patient or therapist through a range of motion without the use of the muscles that “actively” move the joint(s).

    Shoulder Resistive Range of Motion

    Exercises that gradually increase in resistance (weights) and in repetitions. PRE is usually prescribed for reeducation of muscles and strengthening. Weights, rubber bands, and body weight can be used as resistance.

    Posture Training

    Instruction in the correct biomechanical alignment of the body to reduce undue strain on muscles, joints, ligaments, discs, and other soft tissues. There is an ideal posture but most do not have it. Therapists educate patients about the importance of improving posture and body mechanics with daily activities. Stretching and strengthening exercises may be prescribed to facilitate postural improvement and to prevent further disability and future recurrences of problems.

    Soft Tissue Mobilization

    Therapeutic massage of body tissue, performed with the hands. Soft tissue mobilization may be used for muscle relaxation, to decrease swelling, to decrease scar tissue adhesions, and for pain relief.

    Physical Agents

    Possible Treatments

    • Cryotherapy or Cold Therapy
    • Heat Pack
    • Ultrasound
    Stretching/Flexibility Exercise

    Exercise designed to lengthen a muscle(s) or soft tissue. Stretching exercises are usually prescribed to improve the flexibility of muscles that have tightened due to disuse or in compensation to pain, spasm or immobilization.

    Goals

    • Decrease Risk of Reoccurrence
    • Improve Function
    • Improve Fitness
    • Optimize Joint Alignment
    • Improve Muscle Strength and Power
    • Increase Oxygen to Tissues
    • Improve Proprioception
    • Decrease Postoperative Complications
    • Improve Relaxation
    • Self-care of Symptoms
    • Improve Safety
    • Improve Tolerance for Prolonged Activities

    Resources

  • Rotator Cuff Tears

    Rotator cuff tears are a common cause of pain and disability in the adult population. A torn rotator cuff is usually the result of trauma to the shoulder, such as a fall, or overuse. Overhead athletes, people over the age of 40, and people who perform overhead work are at a greater risk. These are four rotator cuff muscles that help to stabilize the shoulder joint: the supraspinatus, ingfraspinatus, teres minor and subscapularis. The supraspinatus is the most commonly torn of the four muscles.

    Rotator cuffs can be partial or full tears, full tears defined by the tendon fully removed from the bone. Rotator cuffs can be diagnosed by a physical therapist using special tests, but are often diagnosed with MRI or ultrasound.

    Rotator cuff tears are often treated non-surgically with physical therapy to reduce pain and improve shoulder function. Physical therapy involves education, activity modification, rest, and therapeutic exercises to strengthen shoulder musculature. Rotator cuff tears may also be treated with pain medication or injections to reduce pain and inflammation.

    If surgery is indicated, physical therapy will begin soon after the surgical date and begin with gentle range of motion exercises and progress slowly toward shoulder strengthening and functional activities.

    Treatments

    Active Assistive Range of Motion

    Patient or therapist-assisted active range of motion. This is usually prescribed for gentle stretching or strengthening for a very weak body part.

    Aerobic/Endurance Exercise

    Stationary cycling is usually prescribed for improving the strength and/or range of motion of the hips, knees, ankles as well as cardio-vascular endurance.

    Core Strengthening

    The trunk and its associated muscles make up the core. The extremities are the arms, forearms, hands, thighs, legs, ankles/feet. Strong core muscles provide a foundation for the extremities to attach to and work more efficiently. It is hypothesized that a weak core can cause excessive stress on the extremity muscles, tendons, ligaments and joints. Core strengthening is a multi-joint exercise, involving larger muscle groups such as the chest, back, abdominals, back, hip/thigh, and shoulder blade muscles. Core strengthening is often incorporated as part of a low back or neck rehabilitation program. Because recovery or enhancement of core strength provides a stable base for the extremities, it is also commonly part of an arm, forearm, thigh, leg or ankle program.

    Cryotherapy or Cold Therapy

    Cold therapy is used to cause vasoconstriction (the blood vessels constrict or decrease their diameter) to reduce the amount of fluid that leaks out of the capillaries into the tissue spaces (swelling) in response to injury of tissue. Ice or cold is used most frequently in acute injuries, but also an effective pain reliever for even the most chronic pain. Cold therapy may be administered by using a cold pack or an ice massage as seen in the above video.

    Electrotherapeutic Modalities

    Possible Treatments

    • Neuromuscular Electrical Stimulation
    • Transcutaneous Electrical Nerve Stimulation (TENS)
    • Iontophoresis
    Heat Pack

    Heat is recommended to decrease chronic pain, relax muscles, and for pain relief. It should not be used with an acute or “new” injury.

    Isometric Exercise

    An isometric exercise is a muscle contraction without joint movement. Isometrics are usually prescribed for gentle nerve and muscle reeducation. They are typically used for strengthening with arthritis patients, post-surgical patients, or as an introductory muscle strengthening exercise. A usual progression is from isometrics to active and resistive exercises that involve joint movement.

    Proprioceptive Neuromuscular Facilitation (PNF)

    Performed in diagonal patterns that mimic functional movements. Initially this technique was used in developmentally and neurologically impaired patients. Today, PNF (or a variation of it)is commonly used for almost every aspect of neuromuscular retraining. It can be used on the professional athlete or someone in a nursing home.

    Shoulder Active Range of Motion

    The movement of the shoulder, by the patient, through a range of motion against gravity. AROM is usually prescribed for arthritis, initial recovery of joint motion and/or gentle strengthening without trauma to joints.

    Shoulder Joint Mobilization

    Hands-on therapeutic procedures intended to increase soft tissue or shoulder joint mobility. Mobilization is usually prescribed to increase mobility, decrease joint stiffness, and to relieve pain. There are many types of mobilization techniques including Grimsby, Maitland, Kaltenborn, Isometric Mobilizations, etc.

    Shoulder Passive Range of Motion

    The movement of the shoulder by the patient or therapist through a range of motion without the use of the muscles that “actively” move the joint(s).

    Shoulder Resistive Range of Motion

    Exercises that gradually increase in resistance (weights) and in repetitions. PRE is usually prescribed for reeducation of muscles and strengthening. Weights, rubber bands, and body weight can be used as resistance.

    Posture Training

    Instruction in the correct biomechanical alignment of the body to reduce undue strain on muscles, joints, ligaments, discs, and other soft tissues. There is an ideal posture but most do not have it. Therapists educate patients about the importance of improving posture and body mechanics with daily activities. Stretching and strengthening exercises may be prescribed to facilitate postural improvement and to prevent further disability and future recurrences of problems.

    Soft Tissue Mobilization

    Therapeutic massage of body tissue, performed with the hands. Soft tissue mobilization may be used for muscle relaxation, to decrease swelling, to decrease scar tissue adhesions, and for pain relief.

    Physical Agents

    Possible Treatments

    • Cryotherapy or Cold Therapy
    • Heat Pack
    • Ultrasound
    Stretching/Flexibility Exercise

    Exercise designed to lengthen a muscle(s) or soft tissue. Stretching exercises are usually prescribed to improve the flexibility of muscles that have tightened due to disuse or in compensation to pain, spasm or immobilization.

    Goals

    • Decrease Risk of Reoccurrence
    • Improve Function
    • Improve Fitness
    • Optimize Joint Alignment
    • Improve Muscle Strength and Power
    • Increase Oxygen to Tissues
    • Improve Proprioception
    • Decrease Postoperative Complications
    • Improve Relaxation
    • Self-care of Symptoms
    • Improve Safety
    • Improve Tolerance for Prolonged Activities

    Resources

  • Acromioclavicular Separation (Separated Shoulder)

    An acromioclavicular (AC) separation is when there is an injury to the junction between the acromion (bone on the shoulder blade) and the clavicle (collar bone). This is typically the result of trauma such as falling onto your shoulder or a motor vehicle accident. If severe enough this could cause a “step down” deformity where the clavicle protrudes upwards. Common symptoms of a separated shoulder include shoulder pain, swelling, reduced shoulder strength as well as reduced shoulder range of motion. Treatment typically consists of ice, pain medication, rest initially and physical therapy. In physical therapy patient’s strength, range of motion, pain severity and posture are all addressed through the use of specific exercises as well as modalities such as ice/heat/etc. Surgery is not typically included unless the ligaments holding the joint together are compromised.

    Treatments

    Active Assistive Range of Motion

    Patient or therapist-assisted active range of motion. This is usually prescribed for gentle stretching or strengthening for a very weak body part.

    Aerobic/Endurance Exercise

    Stationary cycling is usually prescribed for improving the strength and/or range of motion of the hips, knees, ankles as well as cardio-vascular endurance.

    Core Strengthening

    The trunk and its associated muscles make up the core. The extremities are the arms, forearms, hands, thighs, legs, ankles/feet. Strong core muscles provide a foundation for the extremities to attach to and work more efficiently. It is hypothesized that a weak core can cause excessive stress on the extremity muscles, tendons, ligaments and joints. Core strengthening is a multi-joint exercise, involving larger muscle groups such as the chest, back, abdominals, back, hip/thigh, and shoulder blade muscles. Core strengthening is often incorporated as part of a low back or neck rehabilitation program. Because recovery or enhancement of core strength provides a stable base for the extremities, it is also commonly part of an arm, forearm, thigh, leg or ankle program.

    Cryotherapy or Cold Therapy

    Cold therapy is used to cause vasoconstriction (the blood vessels constrict or decrease their diameter) to reduce the amount of fluid that leaks out of the capillaries into the tissue spaces (swelling) in response to injury of tissue. Ice or cold is used most frequently in acute injuries, but also an effective pain reliever for even the most chronic pain. Cold therapy may be administered by using a cold pack or an ice massage as seen in the above video.

    Electrotherapeutic Modalities

    Possible Treatments

    • Neuromuscular Electrical Stimulation
    • Transcutaneous Electrical Nerve Stimulation (TENS)
    • Iontophoresis
    Heat Pack

    Heat is recommended to decrease chronic pain, relax muscles, and for pain relief. It should not be used with an acute or “new” injury.

    Isometric Exercise

    An isometric exercise is a muscle contraction without joint movement. Isometrics are usually prescribed for gentle nerve and muscle reeducation. They are typically used for strengthening with arthritis patients, post-surgical patients, or as an introductory muscle strengthening exercise. A usual progression is from isometrics to active and resistive exercises that involve joint movement.

    Proprioceptive Neuromuscular Facilitation (PNF)

    Performed in diagonal patterns that mimic functional movements. Initially this technique was used in developmentally and neurologically impaired patients. Today, PNF (or a variation of it)is commonly used for almost every aspect of neuromuscular retraining. It can be used on the professional athlete or someone in a nursing home.

    Shoulder Active Range of Motion

    The movement of the shoulder, by the patient, through a range of motion against gravity. AROM is usually prescribed for arthritis, initial recovery of joint motion and/or gentle strengthening without trauma to joints.

    Shoulder Joint Mobilization

    Hands-on therapeutic procedures intended to increase soft tissue or shoulder joint mobility. Mobilization is usually prescribed to increase mobility, decrease joint stiffness, and to relieve pain. There are many types of mobilization techniques including Grimsby, Maitland, Kaltenborn, Isometric Mobilizations, etc.

    Shoulder Passive Range of Motion

    The movement of the shoulder by the patient or therapist through a range of motion without the use of the muscles that “actively” move the joint(s).

    Shoulder Resistive Range of Motion

    Exercises that gradually increase in resistance (weights) and in repetitions. PRE is usually prescribed for reeducation of muscles and strengthening. Weights, rubber bands, and body weight can be used as resistance.

    Posture Training

    Instruction in the correct biomechanical alignment of the body to reduce undue strain on muscles, joints, ligaments, discs, and other soft tissues. There is an ideal posture but most do not have it. Therapists educate patients about the importance of improving posture and body mechanics with daily activities. Stretching and strengthening exercises may be prescribed to facilitate postural improvement and to prevent further disability and future recurrences of problems.

    Soft Tissue Mobilization

    Therapeutic massage of body tissue, performed with the hands. Soft tissue mobilization may be used for muscle relaxation, to decrease swelling, to decrease scar tissue adhesions, and for pain relief.

    Physical Agents

    Possible Treatments

    • Cryotherapy or Cold Therapy
    • Heat Pack
    • Ultrasound
    Stretching/Flexibility Exercise

    Exercise designed to lengthen a muscle(s) or soft tissue. Stretching exercises are usually prescribed to improve the flexibility of muscles that have tightened due to disuse or in compensation to pain, spasm or immobilization.

    Goals

    • Improve Function
    • Improve Fitness
    • Optimize Joint Alignment
    • Improve Muscle Strength and Power
    • Increase Oxygen to Tissues
    • Improve Proprioception
    • Decrease Postoperative Complications
    • Improve Relaxation
    • Self-care of Symptoms
    • Improve Safety
    • Improve Tolerance for Prolonged Activities

    Resources

  • Shoulder Labral Tears

    The labrum is a piece of fibrocartilarge (rubbery tissue) which attaches to the rim of the shoulder socket. This helps keep the ball of the shoulder joint (head of humerus) in place. Traumatic injury and wear and tear from repetitive motion of the upper arm can both cause labral tears. This can include a fall on an outstretch arm, a direct hit to the shoulder, a violent blow while reaching overhead or a sudden tug on the arm. Symptoms can include painful clicking, locking, popping and instability. Diagnosis may include a medical exam and a CT scan or MRI. Labral tears are often treated with rest, over the counter medication and physical therapy. Physical therapy can help strengthen the muscles of the shoulder, especially the rotator cuff muscles. In addition, your PT will show you what activities to avoid as well as gentle stretching exercises to do at home. Physical therapy can last 4-8 weeks depending on the severity of the injury.

    Treatments

    Core Strengthening

    The trunk and its associated muscles make up the core. The extremities are the arms, forearms, hands, thighs, legs, ankles/feet. Strong core muscles provide a foundation for the extremities to attach to and work more efficiently. It is hypothesized that a weak core can cause excessive stress on the extremity muscles, tendons, ligaments and joints. Core strengthening is a multi-joint exercise, involving larger muscle groups such as the chest, back, abdominals, back, hip/thigh, and shoulder blade muscles. Core strengthening is often incorporated as part of a low back or neck rehabilitation program. Because recovery or enhancement of core strength provides a stable base for the extremities, it is also commonly part of an arm, forearm, thigh, leg or ankle program.

    Cryotherapy or Cold Therapy

    Cold therapy is used to cause vasoconstriction (the blood vessels constrict or decrease their diameter) to reduce the amount of fluid that leaks out of the capillaries into the tissue spaces (swelling) in response to injury of tissue. Ice or cold is used most frequently in acute injuries, but also an effective pain reliever for even the most chronic pain. Cold therapy may be administered by using a cold pack or an ice massage as seen in the above video.

    Electrotherapeutic Modalities

    Possible Treatments

    • Neuromuscular Electrical Stimulation
    • Transcutaneous Electrical Nerve Stimulation (TENS)
    • Iontophoresis
    Isometric Exercise

    An isometric exercise is a muscle contraction without joint movement. Isometrics are usually prescribed for gentle nerve and muscle reeducation. They are typically used for strengthening with arthritis patients, post-surgical patients, or as an introductory muscle strengthening exercise. A usual progression is from isometrics to active and resistive exercises that involve joint movement.

    Proprioceptive Neuromuscular Facilitation (PNF)

    Performed in diagonal patterns that mimic functional movements. Initially this technique was used in developmentally and neurologically impaired patients. Today, PNF (or a variation of it)is commonly used for almost every aspect of neuromuscular retraining. It can be used on the professional athlete or someone in a nursing home.

    Physical Agents

    Possible Treatments

    • Cryotherapy or Cold Therapy
    • Heat Pack
    • Ultrasound
    Stretching/Flexibility Exercise

    Exercise designed to lengthen a muscle(s) or soft tissue. Stretching exercises are usually prescribed to improve the flexibility of muscles that have tightened due to disuse or in compensation to pain, spasm or immobilization.

    Goals

    • Improve Function
    • Improve Fitness
    • Optimize Joint Alignment
    • Improve Muscle Strength and Power
    • Increase Oxygen to Tissues
    • Improve Proprioception
    • Improve Relaxation
    • Self-care of Symptoms

    Resources