Friday, March 1, 2019

(Zen and) The Art of Rehabilitating a Shoulder - Part two, strengthening

Writing this reminds us a bit of this book, which may be known to some of you more senior readers. In it, the author explores the meaning and concept of "quality" a phenomenon that exists between the subject and the object. You'll have to decide whether you prefer the "classical" or the "romantic" approaches that he describes. Here is our "classical" approach to the rehabilitation of most of our total shoulders, ream and runs, cuff tear arthropathy arthroplasties, and hemiarthroplasties.

This rehab program is based on the tenet that the "patient is the method": the patient is the "subject" and the shoulder is the "object". The success of the program will depend on the patient's dedication to it and on the patient's willingness to experiment a bit with the art to see how many repetitions, how much resistance, and what pace of progression works best.

We will assume that the goal is excellent function and that there are no special considerations based on the findings at surgery or on the specifics of the procedure performed. We do not use this approach for reverse total shoulders and, on occasion, need to modify it for anatomic total shoulders or ream and run procedures. Don't even think about launching on this program after an operation without reviewing it in detail with the surgeon.

 We use several "rules of thumb" for our strengthening exercises - best done twice a day, emphasizing resistance low enough that the exercise can be repeated at least 20 times (low load, high rep), making sure that any discomfort from the exercise subsides within 20 minutes after the exercise session, progressing very gradually, and starting with "bent elbow" exercises as shown below. Note that after a shoulder joint replacement these exercises are not started until at least six weeks after surgery and only on the OK of the surgeon. Slow and steady.

(1) Supine press with progressive incline (see this youtube)

(2) Scapular push
(3) External rotation isometrics
(4) External rotation with bands or tubing
(5) Shoulder shrug

(6) Rowing (see this youtube)

(7) Lat pull down (see this youtube)

(8) For at least three months after a joint replacement we avoid internal rotator strengthening and when these exercises are started, they are progressed very slowly to protect the subscapularis repair 

When internal rotation strengthening is started, the first step is isometrics
followed by slowly progressive band exercises, starting with minimal resistance.

We have a new set of shoulder youtubes about the shoulder, check them out at this link.

Be sure to visit "Ream and Run - the state of the art" regarding this radically conservative approach to shoulder arthritis at this link and this link

Use the "Search" box to the right to find other topics of interest to you.