Thursday, August 25, 2011

How to stretch and how not to stretch

Some patients have had difficulty maintaining their range of motion after shoulder arthroplasty.
Sometimes the issue is that they are not correctly monitoring their range of elevation.
Ideally the range should be monitored weekly by a consistent physical therapist for the first 6 to 12 weeks after surgery. The therapist can report to the surgeon if there is any question about the onset of stiffness or the loss of range of motion.
Alternatively, the patient may use photos taken from the side to compare to those shown in this link to make sure they are attaining at least 150 degrees of elevation (the angle between the body and the arm).

Some very motivated patients still need coaching on the best stretching technique. We like to avoid a lot of quick stretches because they result in temporary 'elastic' lengthening of the tissue that returns immediately to the pre stretching length as illustrated by stretching the bungee in the video below.

Other well motivated patients stretch their shoulder too roughly, so that tissue is torn giving rise to pain and additional scar tissue. This is illustrated by pulling on a stick of cold chewing gum in the video below.

Ideally, stretches should be comfortable and held for a long time (one or two minutes for each repetition) so that 'plastic' or permanent lengthening of the tissues is achieved. This is shown in the video below as I stretch some bubble wrap (note that I had to take out some of the stretching time so the video would fit). Note also that the amount of lengthening achieved was definite, but not large. But if a bit of permanent lengthening is achieved each time, the shoulder motion will increase. To prevent 'backsliding' the stretches should be done frequently through the day.



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