A healthy shoulder possesses impressive mobility. Movements of the shoulder joint that are initiated and controlled by the muscles of the shoulder itself are called active movements. Movements that are initiated and controlled by external forces are called passive movements. After a surgery or after an injury to a shoulder muscle or tendon, passive range of motion exercises may be recommended to preserve or regain shoulder mobility while the muscles are resting and healing. Passive shoulder range of motion exercises may be performed with a therapist or alone using an assisting device or by creatively moving the body in relation to the relaxed shoulder.
Shoulder motions are described in specific directions, or planes, when assessing function, impairment or rehabilitation needs. These planes include flexion, extension, abduction, adduction, internal rotation and external rotation. Flexing the shoulder means raising the arm in a forward direction as though hailing a taxi. Extension is a backward reach of the arm. Abduction is raising the arm to the side as with a jumping jack motion. Adduction describes moving the arm down toward or across the center of the body. If the arm is hanging at the side of the body, external rotation is used to turn the arm out to the side. Internal rotation turns the backside of the hand toward the hip. Daily activities require combinations of shoulder motion. Combing the hair requires elements of flexion, abduction and external rotation. Retrieving a wallet from a back pocket combines extension and internal rotation. Each of these movement patterns can be performed passively with a little creative effort.
Using a Partner
Working with a therapist or a skilled partner is an excellent way to exercise the shoulder through its passive ranges of motion. The partner firmly grasps the arm and slowly moves the shoulder through its various ranges, while the "patient" -- either seated or lying down -- allows the arm to be mobilized. According to research published in November 1998 in the journal "Orthopedics," partner-assisted mobilization of the shoulder may facilitate better relaxation of the patient than other methods of mobilization. This may increase the margin of safety for passive range of motion exercises when the muscles or tendons may be fragile. This method requires careful communication between the patient and the partner. The partner must be careful to avoid abrupt movements and should restrict the movements to nonpainful ranges.
Using an Assisting Device
A household item such as a broomstick or a hand towel makes a handy assisting device for passive shoulder exercises. Upward motions of flexion and abduction are accomplished by taking a loose grip toward the top end of the broomstick on the side to be exercised. The free hand grasps the broomstick at a lower point and pushes the stick upward. Forward and outward angles will vary the flexion and abduction components of this motion. The involved arm remains loose and relaxed. To facilitate the type of motion necessary to reach into a hip pocket or scratch the lower back, one end of a hand towel is grasped by the hand of the involved side. The arm hangs loosely at the side. The free hand reaches behind the back to grasp the other end of the towel. Gentle pulling on the towel with the active arm will take the involved, passive shoulder through controlled extension and internal rotation.
Using the Body
In their book "Management of Common Musculoskeletal Disorders," Randolph Kessler and Darlene Hertling suggest an approach that moves the body in relation to the arm instead of moving the arm in relation to the body. For example, by resting the hand on a countertop, flexion of the shoulder is achieved by squatting or pushing the hips back in a simulated bowing motion. Various angles of adduction, abduction and internal or external rotation are achieved by rotating the orientation of the body in relation to the countertop. Kessler and Hertling believe this approach provides better stability to the joint and facilitates a more normal pattern of shoulder movement than other types of passive exercises. These exercises are also easy to do at home.
- Royal National Orthopaedic Hospital: Rehabilitation Guidelines for Post-Operative Stiff Shoulder
- Guides to the Evaluation of Permanent Impairment, 6th Edition; Linda Cocchiarella and Gunnar B.J. Andersson (eds.)
- Orthopedics: Electromyography of the Shoulder -- An Analysis of Passive Modes of Exercise; M. Dockery, T. Wright and P. LaStayo
- Management of Common Musculoskeletal Disorders; Randolph M. Kessler and Darlene Hertling