The shoulder is the most mobile joint in the human body, but certain conditions such as athletic injuries, arthritis, stroke or breast cancer can result in decreased range of motion. It is important to increase shoulder ROM to allow for functional use of the arm and prevent the development of painful conditions, such as frozen shoulder. Physical and occupational therapists perform and prescribe treatment activities to increase shoulder ROM.
Anatomy of the Shoulder
The shoulder joint is a ball-and-socket joint that includes the humerus, or upper arm, and the glenoid fossa of the scapula, or shoulder blade. There are multiple muscles that allow for movement of the shoulder in all planes of motion, including flexion, extension, vertical abduction and adduction, horizontal abduction and adduction, external rotation, internal rotation, protraction, retraction, elevation and depression.
Passive Range of Motion
If you have any restrictions in the tissues of your shoulder, passive ROM may be helpful. A therapist will first assess your ROM and feel the structures of your shoulder joint. Scapular mobilizations can free up a tight shoulder blade and allow for greater ROM. To perform passive ROM, consult a trained therapist to provide individual recommendations. In general, you need another person to help you perform these exercises, but you must give feedback regarding your pain and comfort level.
Active Range of Motion
To perform active ROM, find a position that is comfortable and allows you the greatest movement. If you are just beginning, you may prefer to lie down. When sitting or standing, maintain upright posture and relax the muscles of your face and neck. With your arms straight at your sides, lift up as far as you can, lower, and repeat 10 times to improve flexion. Practice this same move out to the sides for abduction. For external and internal rotation, bend your elbows to 90 degrees, and hold your arms out at shoulder level with palms facing forward. Slowly, flip your arms down so that the front of your hands face forward.
Pendulum Exercise
One of the best and safest exercises to improve motion and relieve pain in the shoulder is known as Codman's pendulum exercise. Perform this by lying prone on your stomach with your arm dangling off the bed, but not touching the floor, or in a standing or sitting position. Find a position that gives you optimal balance and comfort, and let gravity pull your arm down. Keeping all your muscles relaxed, slowly allow your arm to swing back-and-forth similar to a pendulum. Gradually increase the range and move to rotations, but keep the speed slow.
Precautions and Tips
If you have pain that increases with movement or your range is not improving after following these exercises, consult a physician or therapist. Stretch your arm only as much as is comfortable and remember to breathe; this will promote a relaxation response. If you have had prolonged tightness in the shoulder, the scapula may be in a stuck position and require the attention of a trained therapist. Pilates and yoga are good options to regain and maintain shoulder range of motion.
References
- Nicholas Institute of Sports Medicine and Athletic Trauma; Physical Therapy Corner: Shoulder ROM Exercises; 2007
- "Physical Therapy"; Effects of Pilates Exercises on Shoulder Range of Motion, Pain, Mood, and Upper-Extremity Function in Women Living with Breast Cancer: A Pilot Study; Kim S. Keays, et al.; April 2008
