Rehabilitation after Shoulder Arthroplasty.
Last updated Thursday, February 10, 2005
Figure 9 - Progressive supine press Figure 10 - Bench press plus Figure 11 - Shoulder shrug Strengthening
Strengthening of the shoulder after arthroplasty is a vital step in the
restoration of function. However, strengthening exercises early after
the operation are not nearly as important as establishing motion.
Therefore, your doctor is likely to institute strengthening exercises
only after you can achieve excellent motion and shoulder comfort.Shoulders require good muscle strength and posture After your prolonged shoulder arthritis and your shoulder
replacement, your muscles are expected to be weak and sore. In many
cases a period of time for muscle healing is required before
strengthening can be started. Please be sure that you do not do any
strengthening exercises that are painful: this is NOT a "no pain, no
gain" situation. If you have any questions about the advisability of
these strengthening exercises, wait until you have checked with your
doctor.
As you gain strength and coordination, try to carry out
progressively more of your usual activities, concentrating on using
smooth motions. Try to avoid actions that make your shoulder pop, snap,
or catch. Swimming, rowing, and using cross country ski simulators are
all good exercises for developing strength, coordination, and
endurance. They also have the advantage of exercising both shoulders at
the same time.
In general, activities of the shoulder can be increased as the
comfort, range of motion, and strength of the motion allow. It is
essential that these activities be added gradually and progressively so
that there is no risk of straining your muscles. A sudden increase in
activity or abrupt jerky or forceful activities will jeopardize the
comfort and function of your shoulder. Progressive supine press An important exercise is the progressive supine press. It is most
effective for helping you regain the ability to use your arm in an
elevated position. The nice thing about this exercise is that you can
do it by yourself and can adjust your rate of progress according to
what is most comfortable for you.
The exercise proceeds in small steps. Start by lying on your back,
grasping a washcloth with both hands together. Push the cloth straight
up toward the ceiling. At the end of each push, lift your entire
shoulder off the bed or floor. When you can do this 20 times easily,
separate your hands an inch or so when you push the cloth toward the
ceiling. This places slightly more of the load on the muscles of your
weaker shoulder. As the exercise gets easier, separate your hands more
on the washcloth until you can push your hand toward the ceiling
without any assistance from the opposite arm.
Practice this exercise with nothing in your hand until you are able
to repeat it 20 times. Then take an empty pint container and perform
the same movement, pushing it toward the ceiling. Add water to increase
the resistance slowly. When the container is full of water, the weight
is about one pound. Be sure that you can perform the movement
comfortably 20 times at each stage before advancing to the next stage.
When you can press one pound toward the ceiling 20 times, the next step
is to perform the exercise with your back propped up slightly on
pillows or by using a recliner or garden chair. When 20 comfortable
repetitions are possible, increase the degree to which your back is
propped up.
At each level, push the shoulder all the way up. Continue this
process until you are able to push the one pound weight 20 times toward
the ceiling in a sitting position. Work for smooth, slow, controlled
motions. Rotator cuff muscles The rotator cuff muscles are important shoulder muscles. They hold
the ball properly aligned in the socket. They are strengthened by
working against resistance in rotation internally (toward the body) and
externally (away from the body). It is important that your shoulder
have both strength and endurance of internal and external rotation.
This means that you need to carry out at least five exercise sessions
each day, each taking only about five minutes. The muscles of the
rotator cuff are strengthened by exercises in internal rotation and
external rotation. Internal rotation (video) is strengthened by holding
the elbow close to the side and trying to rotate the arm inward against
resistance. This resistance can be isometric (unmoving), such as the
opposite hand, a wall, or another fixed object. You can also use
dynamic exercises against rubber tubing, weights and pulleys, or free
weights while you lie on your side. External rotation (video) is
strengthened by holding the elbow at the side and trying to rotate the
arm outward against either isometric or dynamic resistance.
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Trapezius and scapular muscles A second important group of muscles, the scapular muscles, are those
that control the posture of your shoulder blade on the chest wall. The
purpose of these exercises is to strengthen these scapular muscles and
to eliminate bad habits or posture that your shoulder may have
developed. The largest and most important muscle groups are those which
move your shoulder blade forward (the serratus and pectoralis) and
those which lift the shoulder blade (the trapezius, levator scapulae,
and rhomboids). The first group of muscles are strengthened by a bench
press-type exercise performed while you lie on your back holding the
bar with your hands about a meter (yard) apart. At first only the bar
is used while you concentrate on powering the shoulder blade upward.
When you lift your shoulder blade off the bed or table, we call this
the "press plus." The "plus" is important for training the shoulder
blade muscles. Once you can control the bar alone for 20 repetitions,
add weight to the bar progressively up to about half your body weight.
Never use a weight greater than what you can control for 20
repetitions. Once you feel confident in the shoulder, you can start
doing a one hand press using a 1 lb weight and building up to 20
percent of your body weight.
The second muscle group helps strengthen your shoulder during
lifting at the side. Start with simple shoulder shrugs carried out with
the arms holding some weight at the side, lifting the point of your
shoulders as high as they will go 20 times. It is important that both
shoulders be exercised concurrently. Once the shoulder shrug becomes
easy, add weight 1 lb at a time to each hand, keeping the number of
repetitions at 20. With each shrug, concentrate on lifting the tip of
the shoulder.
The trapezius can also be strengthened by pulling against resistance.
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Disclaimer
This resource has been provided by the University of Washington Department of Orthopaedics and Sports Medicine as general information only. This information may not apply to a specific patient. Additional information may be found at http://www.orthop.washington.edu or by contacting the UW Department of Orthopaedics and Sports Medicine.
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