All Upper Quarter

Kettle Bell Shoulder Integration – Supine

in 3 Movement Tests Upper Quarter, 5 Home Exercise Strategy, All Home Exercises, All Upper Quarter, Functional Integration, Scapular Depression, Scapular Stabilization, Shoulder Abduction

Kettle Bell Shoulder Integration – Supine

To promote stability of the R shoulder:

The patient is lying on their R side and they grasp a kettle bell with both hands with the R hand inside the loop of the bell and the L hand on top.
Instruct the patient to keep the bell close to their body as they roll onto their back.
Once on their back have the patient straighten their L leg and secure the kettle bell with their R hand only. Then have the patient exhale as they press the kettle bell up towards the ceiling keeping their wrist in a neutral position.
Once the elbow is fully extended instruct the patient to find the sweet spot for stabilization of their shoulder by drawing the humeral head back down into the glenoid fossa to “pack” the shoulder.
While holding this position have the patient turn their head slowly to the R and L and internally and externally rotate their arm 3-5 times each way without losing the packing of the shoulder.
The patient should keep their neck relaxed and avoid holding their breath.
Once they have completed the exercise have them bring the kettle bell back down to the chest, grasp the bell with both hands and keeping the bell close to their body they roll back onto their R side and place the kettle bell down.
Have them repeat the exercise on the other side for the L shoulder.

Seated Bilateral UE D2 Flexion Diagonals

in 3 Movement Tests Upper Quarter, 5 Home Exercise Strategy, All Home Exercises, All Upper Quarter, Functional Integration, Retraining, Scapular Depression, Scapular Stabilization, Supine Shoulder Flexion

Seated Bilateral UE D2 Flexion Diagonals

The patient is sitting in a chair with their feet supported on the ground or small stool.
Instruct the patient to cross their arms, bend their elbows, pronate the forearms, flex the wrists and make a fist with both hands.
Ask the patient to slump and look down towards the floor.
Instruct the patient to inhale and bring both shoulder blades towards their opposite back pocket while they raise their arms up and diagonally across the body to end with their arms externally rotated, elbows extended forearms supinated and wrist and fingers extended. The head and upper trunk extend as they look up to the ceiling at the end of the movement.
Then the patient exhales and slowly returns their arms back to the starting position.
They repeat 6-8 times.

Seated UE D1 Flexion/Extension Diagonals

in 3 Movement Tests Upper Quarter, 5 Home Exercise Strategy, All Home Exercises, All Upper Quarter, Functional Integration, Retraining, Scapular Depression, Scapular Stabilization, Shoulder Abduction, Supine Shoulder Flexion

Seated UE D1 Flexion/Extension Diagonals

The patient is sitting in a chair with their feet supported on the ground or small stool.
The patient starts with the right hand down toward the floor next to their right upper thigh with their elbow extended and their arm internally rotated. Their palm should be facing away from them with their eyes directed down towards their right hand.
Ask the patient to inhale as they lift their right arm up and diagonally across their body to end with their elbow flexed, their arm externally rotated and their fist closed and facing inward. Instruct the patient to follow their R hand with their eyes throughout this exercise.
Have them exhale and slowly return their R hand back to the starting position by extending the elbow, internally rotating the arm and extending the wrist and fingers.
They perform 6-8 repetitions and then repeat on the other side.
Once they are able to perform this pattern correctly, you can add resistive bands held in the hands to increase the level of difficulty of this exercise.

Seated UE D2 Flexion Diagonals

in 3 Movement Tests Upper Quarter, 5 Home Exercise Strategy, All Home Exercises, All Upper Quarter, Functional Integration, Retraining, Scapular Depression, Scapular Stabilization, Shoulder Abduction, Supine Shoulder Flexion

Seated UE D2 Flexion Diagonals

The patient is sitting in chair with their feet supported on the ground or small stool.
Instruct them to reach their R hand across the body, making a fist so the palm of their hand faces the outside of the left upper thigh and they are looking down at their right hand.
Ask the patient to inhale and bring their right shoulder blade towards their L back pocket while they raise the R arm up and diagonally across their body ending up with the elbow and wrist extended, the palm open and the thumb facing backward. Instruct the patient to follow their R arm with their eyes throughout the exercise.
The patient exhales as they slowly lower their arm back to the starting position.
Have the patient repeat this sequence 6-8 times then switch sides.
Once they are able to perform this pattern correctly, you can add resistive bands that are held in the hands to increase the difficulty of this exercise.

D1 Flexion UE Diagonals with a Dumbbell

in 3 Movement Tests Upper Quarter, 5 Home Exercise Strategy, All Home Exercises, All Upper Quarter, Retraining, Scapular Depression, Scapular Stabilization, Shoulder Abduction

D1 Flexion UE Diagonals with a Dumbbell

Note: This exercise has been shown to elicit the highest % of MVIC (100%) for the seratus anterior of any of 10 commonly prescribed exercises for the serratus anterior and trapezius muscles (Ekstrom, Donatelli, Soderberg, 2003).

To Strengthen the Right Serratus Anterior:

The patient is standing with the feet hip width apart and a dumbbell held in the right hand.
They start with the right arm slightly abducted and internally rotated. Then ask the patient to bring the arm up and across their body turning the palm of the hand towards them as they cross the midline.
The movement is a combination of shoulder flexion, horizontal adduction and supination of the forearm.
They slowly lower the arm back to the original starting position.
Have them repeat 3-5 times initially, increasing to 10 repetitions and up to 3 sets as their strength improves.

Prone Press Ups with a Plus

in 3 Movement Tests Upper Quarter, All Upper Quarter, Shoulder Abduction

Prone Press Ups with a Plus

The patient is lying prone and up on their toes with the hands positioned directly beneath the shoulders.
Instruct the patient to press up with their arms initially keeping their spine as straight as possible.
Once their elbows are fully straightened ask the patient to press their back upwards towards the ceiling as they protract their shoulders.
They hold the position for 10 seconds and repeat 3-5 times gradually increasing up to 10 repetitions as their strength improves.

Scapular Stabilization in Hands and Knees

in 3 Movement Tests Upper Quarter, All Upper Quarter, Scapular Depression, Scapular Stabilization, Shoulder Abduction

Scapular Stabilization in Hands and Knees

Retraining of the Right Serratus Anterior:

The patient assumes a hands and knees position with the hips centered over the knees and the shoulders centered over the hands.
Have the patient bend their elbows so that the shoulders are the same height as the hips and their head is held straight in line with the spine.
Instruct the patient to find a neutral lumbar spine position by rotating the pelvis anteriorly and posteriorly and positioning the spine in mid range. Then the patient draws the belly in without raising the back.
They hold the position for 5-10 seconds and repeat 3-5 times, increasing repetitions as their strength improves.
Watch the patient to make sure that the hips stay centered over the knees and the shoulders stay centered over their hands.
To increase the resistance, ask the patient to lift the L hand off the table slightly and hold for 5-10 seconds. Make sure that the patient keeps the right arm bent at the elbow as the tendency is to straighten the arm.

Wall Press with a Plus

in 3 Movement Tests Upper Quarter, 5 Home Exercise Strategy, All Home Exercises, All Upper Quarter, Self-mobilization

Wall Press with a Plus

Serratus anterior retraining exercise:

Have the patient standing approximately three feet from a wall with their hands on the wall at shoulder height.
Instruct the patient to drop their head down and straighten their elbows by pushing their arms against the wall and rounding their upper, but not their lower back. Make sure that the apex for spinal flexion is in the upper thoracic spine and not lower down the spine.
The patient should feel a stretch between the shoulder blades.
When their arms are extended fully the patient can rotate their head to the R to place an emphasis on the L serratus or rotate their head to the L to place an emphasis on engaging their R serratus.
Have them hold the stretch for 5-10 seconds.
Then ask the patient to stand up straight and lean into the wall maintaining a neutral low back. Have them try to touch the wall with their forehead.
The shoulder blades should draw close together as they move towards the wall.
They hold this position for 5-10 seconds then repeat the whole sequence 3 -5 times.
The patient needs to relearn that the spine normally moves into flexion and that the scapulae abduct during shoulder protraction and the spine moves towards extension and the scapulae adduct with shoulder retraction.

Ludewig et al., 2004 found that the standard push-up is an optimal exercise to recruit the serratus anterior while keeping the activation of the upper trapezius low. However, for patient’s early in their rehabilitation the wall push-up with a plus is an ideal exercise to begin with before progressing to kneeling push-ups and eventually prone push-ups.

Y,T,W,L Exercises over a Swiss Ball

in 3 Movement Tests Upper Quarter, 5 Home Exercise Strategy, All Home Exercises, All Upper Quarter, Retraining, Scapular Depression, Scapular Stabilization, Shoulder Abduction

Y,T,W,L Exercises over a Swiss Ball

The patient is lying over a ball with their knees touching the floor. Instruct the patient to raise their arms up overhead with the thumbs pointing up towards the ceiling to make the letter Y. They hold for 5 seconds and repeat 5 times.
Then have the patient bring their arms up out to the side with the thumbs up to make the letter T. They hold for 5 seconds and repeat 5 times.
Next have the patient bring their elbows down towards their sides and raise the arms up to make the letter W. They hold for 5 seconds and repeat 5 times.
Finally, have the patient bring their elbows straight up towards the ceiling with the fingers pointing down towards the floor then ask them to externally rotate their arms and point the thumbs towards the ceiling to make the letter L. They hold for 5 seconds and repeat 5 times.
During each exercise the thumbs should be pointing up towards the ceiling with the arms parallel to their body during the holding period. Instruct the patient to gradually work up to one set of 10 repetitions of each exercise with the eventual goal being 2 sets of 10 repetitions of each exercise for a total of 80 repetitions.

Kneeling Lower Trapezius Strengthening

in 3 Movement Tests Upper Quarter, 5 Home Exercise Strategy, All Home Exercises, All Upper Quarter, Retraining, Scapular Depression, Scapular Stabilization, Shoulder Abduction

Kneeling Lower Trapezius Strengthening

The patient is kneeling with their hands placed on top of a bench or chair. Have the patient move their hips back until they are flexed to about 90º.
Instruct the patient to drop their chest down towards the floor so that their back is parallel to the floor (like a table top).
Their arms should be fully straight and their head in line with the trunk.
Ask the patient to lift their right hand off the bench with their thumb up (external rotation) and hold for 5-10 seconds.
They repeat 3-5 times initially, alternating arms. They gradually work up to 10 repetitions with each arm.
Watch to make sure that the patient does not raise up their back and/or drop their head when they lift the arm.
If with this exercise the patient reports feeling pain in the shoulder of their support arm, have them move their knees closer to the bench to unload the shoulder before they lift their other arm.

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