methods, a useful program structure can be incorporated as follows: ● Pain level assessment and active ROM measurements (elevation and external rotation). ● Physiologic warm-up: 5 minutes. ● Wand flexion, extension, and external rotation ROM: 1-2 sets of 10 repetitions each. ● Joint mobilization techniques: 10-15 minutes. ● Soft Tissue techniques: 5-10 minutes. ● Modality (Optional): ice massage, ice pack, heat, etc. ● Home Exercise Program Review/Instruction: practice and demonstration of new exercises, starting with ROM and progressing to strengthening exercises when indicated. ● Re-measurement of active ROM. This progression fits the concept of a one-hour visit, applying multiple and varied treatment methods. There is emphasis on therapeutic exercise, manual therapy and neuro-muscular re- education. A key point within this structure is the assessment and documentation of active ROM. The measurements should be taken first rather than after the therapy session, as it is more reflective of actual functional capacity. Reporting the initial daily visit measurement on progress reports avoids a disconnect with measurements performed by other providers in office (i.e., the orthopedist)
The first phase of home exercises should focus on active or active-assistive range of motion within a patient’s pain tolerance. These mobility exercises include: 1. Supine wand flexion (Figure 9). 2. Behind back wand extension. 3. Pendular type exercises applied with wand-shifting technique. (Figure 10). 4. Scapular control/ mobilization exercises (Figures 11 and 12). 5. Wand assisted external rotation (Figure 13). 6. Wand abduction. Overhead pulleys are preferred by some clinicians, although they produce a biomechanical drawback. With a single pulley apparatus, the endpoint of overhead elevation tends to be forced into an internally rotated position which can lead to shoulder impingement. If pulleys are used, a dual axis set-up maintains a more neutral plane of scapula positioning at end- range. Additionally, rolling a physio-ball in different directions against the wall is well-tolerated by many patients. This exercise provides scapular stability from the closed-chain position. Time management for clinical visits is imperative and directly influences the success of any treatment program. When considering all the factors for effective individual treatment
Figure 9
Figure 10
Figure 11
Figure 12
Figure 13
This patient is applying stretch load with assistance from the opposite hip. With early attempts at this exercise, a pillow is placed beneath the elbow.
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Book Code: PTNY1024
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