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Shoulder Abduction with Hip Hiking

in 2 Movement Tests Lower Quarter, 3 Movement Tests Upper Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, All Upper Quarter, Functional Integration, Hip ABD Firing Pattern, Scapular Depression, Scapular Stabilization, Shoulder Abduction

Shoulder Abduction with Hip Hiking

Elongation exercise in sitting:

  • This exercise helps to normalize shoulder abduction by asking the patient to hike up/lift the opposite hip to actively recruit the contralateral quadratus lumborum muscle.
  • The patient is sitting on a firm surface with the feet on the floor and is instructed to lift one arm out to side and up toward the ceiling.
  • At the same time as they are lifting the arm ask them to lift the opposite hip off the table/chair so that they lengthen the spine on the same side as the arm that is being raised. All of their weight should shift to the side of the pelvis that is directly underneath the raised arm.
  • Then they slowly lower their arm and repeat to the opposite side, alternating sides for 6-8 repetitions.
  • Tell the patient to try to coordinate raising the arm with lifting the opposite hip so that they occur simultaneously.

Robbery with or without Resistance Bands

in 2 Movement Tests Lower Quarter, 3 Movement Tests Upper Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, All Upper Quarter, Functional Integration, Hip EXT Firing Pattern, Scapular Depression, Scapular Stabilization, Shoulder Abduction, Supine Hip ABD and ER

Robbery with or without Resistance Bands

  • The patient is standing with their hips and knees slightly bent, elbows straight and hands holding onto resistive bands.
  • Instruct the patient to keep their elbows close to their body as they straighten the knees and hips and move their arms so that their elbows and shoulder blades are pulled down and back towards the opposite back pockets with the palms ultimately facing forward.
  • Their neck should be relaxed and they should not hold their breath during this movement.
  • Ask them to repeat the exercise 3-5 times initially then increase the number of repetitions as their strength improves.

Lawnmower with or without a Resistance Band

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

Lawnmower with or without a Resistance Band

  • The patient is standing bent forward and rotated to the left to grasp a resistance band with their R hand as if they were going to start a lawnmower.
  • Instruct the patient to stand up and pull their R elbow back and to the right, aiming their elbow toward their L back pocket. Emphasis is placed on having the patient pull their shoulder blade down and back with R rotation of their upper body to finish the movement.
  • Have them hold for 5-10 seconds then relax & slowly return to the starting position and repeat 3-5 times to start, gradually increasing to 10 repetitions.

Kettle Bell Shoulder Integration – Sidelying

in 2 Movement Tests Lower Quarter, 3 Movement Tests Upper Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, All Upper Quarter, Functional Integration, Scapular Depression, Scapular Stabilization, Shoulder Abduction

Kettle Bell Shoulder Integration – Sidelying

To promote stability of the R shoulder:

  • Have the patient lie on their L side with their R arm abducted to 90 degrees, their R leg is bent and their L leg is straight.
  • Place a kettle bell into the patient’s R hand and instruct the patient to hold their wrist in a neutral position.
  • Instruct the patient to find the sweet spot for stabilization of their R shoulder by drawing the humeral head back down into the glenoid fossa to “pack” the shoulder.
  • With the shoulder packed have the patient perform the following movements for 3-5 reps each:
    Turn their head to the R and L
    Internally and externally rotate the R arm
    Bend and straighten the R leg
    Rotate the R hip/pelvis forward and backward
  • They should keep their neck relaxed and avoid holding their breath during the exercise.
  • Once they have completed this exercise for the R shoulder you remove the kettle bell from the patient’s hand and have them roll onto their R side to repeat the exercise with the L shoulder.

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.

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.

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