5 Home Exercise Strategy

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.

Snow Angels

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

Snow Angels

To restore full shoulder flexion and abduction:

  • The patient is lying on their back with their hips and knees bent and feet resting flat on the floor. Their arms are at their sides with palms up.
  • Ask the patient to slowly bring the arms up along the floor keeping the shoulders and the backs of the hands always in contact with the floor.
  • They only raise the arms up as far as they can as long as they maintain contact with the floor.
  • If either hand or shoulder rises off the floor, the patient is told to stop and drop the arms back down a little. Then reach out with the arm on the restricted side to provide a longitudinal stretch before returning the arms back to the sides.
  • They repeat 3-5 times trying to bring the arms further up each time.
  • Goal: be able to sweep the arms along the floor with the shoulders and backs of the hands maintaining contact with the floor and the hands able to touch overhead.

Prone Lower Trapezius Strengthening – Bent Arm Overhead

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

Prone Lower Trapezius Strengthening – Bent Arm Overhead

To strengthen the right lower trapezius:

  • The patient is lying prone with their right arm bent and the palm of their right hand lying on the table above their head
  • Have them rest their forehead in the palm of their left hand
  • Instruct the patient to raise their right hand off the table as far as they can keeping their elbow and upper arm resting on the table/floor
  • They hold for 10 seconds and repeat initially 3-5 times increasing to 10 repetitions as they get stronger
  • The patient can be instructed to advance this exercise by raising the entire bent R arm off the table and hold for 10 seconds.
  • Tapping along the origin of the lower trapezius may help the patient “find” the muscle.
  • An alternative position is to have the shoulder abducted to 90 degrees with the elbow flexed to 90 degrees and the elbow resting on the table. From this position the patient externally rotates the shoulder lifting the hand off the table. This isolates the lower trapezius from the upper and middle trapezius better than any other exercise and avoids impingement of the shoulder that can occur in more elevated positions of the humerus (Ekstrom, Donatelli, Soderberg, 2003).

Lower Trapezius Retraining – Arm Down at the Side

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

Lower Trapezius Retraining – Arm Down at the Side

To retrain and strengthen the right lower trapezius:

  • The patient is lying prone with their left hand under their forehead and their right arm down at the side with the palm facing the ceiling.
  • Ask the patient to slowly lift their R shoulder up off the table/floor by bringing the shoulder blade down and back until their shoulder feels level with their back. The R hand remains on the table.
  • Make sure that the patient does not pinch their shoulder blades together, but that they draw the right shoulder blade down and back aiming towards their left back hip pocket.
  • They hold for 5-10 seconds and repeat 3-5 times initially. They add repetitions as their strength improves.
  • Make sure that the patient doesn’t depress the shoulder by using the latissimus dorsi.

Low Row-Scapular Retraction/Depression

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Low Row-Scapular Retraction/Depression

To Strengthen the Right Lower Trapezius:

  • The patient is standing tall with an erect posture with the palm of their R hand facing behind them. Instruct the patient to gently push their R hand back into the edge of an immovable object such as a chair.
  • Ask the patient to inhale, then exhale as they push their R hand back into the chair, slightly extending through their mid-spine as they bring their R shoulder blade down and back. Do not let them overextend their lower or upper back.
  • Make sure that they keep their neck relaxed and they don’t hold their breath during the exercise.
  • Have them relax & slowly release and repeat 3-5 times initially, gradually increasing to 10 repetitions.

Self Mobilization for Adverse Neural Tension in the Cervical Spine

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

Self Mobilization for Adverse Neural Tension in the Cervical Spine

To treat the right side of the neck:

  • The patient is lying on their back and places their left hand under the neck with their fingers wrapping around to the right side of the neck. The therapist instructs the patient as to the specific location for the patient to place their finger contact.
  • Tell the patient to gently pull their neck to the left using their left hand and hold this position.
  • The patient’s R arm is down at their side with the palm facing the ceiling.
  • Have the patient slowly abduct their arm as far as they can without allowing the cervical spine to translate back to the R.
  • The patient returns the R arm back down to the side and is instructed to take up any slack that they feel for additional R to L translation and repeat again.
  • The patient repeats the movement 8-10 times holding their neck still and translated to the L as they try to abduct their R arm higher with each successive repetition.

Scalene Self-Stretch

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

Scalene Self-Stretch

To stretch the right scalenes:

  • Instruct the patient to sit up tall and place their left hand over the right first rib and clavicle to stabilize. The patient’s right hand grasps the bench or chair to further stabilize the neck.
  • Keeping their chin down, ask the patient to bring their head straight back into extension, side bend the head to the left and rotate back to the right.
  • They should feel a stretch through the front of their neck on the right side.
  • They hold for 30 seconds and repeat 2-3 times.
  • Then have the patient repeat the stretch on the L side.

Self-Stretch of the Pectorals

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Self-Stretch of the Pectorals

To stretch the right pectorals:

  • Initially the patient stands facing the wall and places their outstretched right hand on the wall at shoulder height.
  • Ask them to turn their trunk to the left so that their feet are parallel to the wall.
  • Have them bend their right elbow as they bring the right shoulder blade down and back.
  • Instruct the patient to place their left hand on the wall to help turn the trunk further to the left.
  • Make sure they hold the right shoulder down and back so that the right shoulder is no higher than the left.
  • Instruct the patient to lean into the wall to increase the stretch.
  • They should feel a stretch through the front of the chest and right shoulder.
  • Have them hold for 30 seconds and repeat 2-3 times.
  • Then have them repeat on the opposite side.

Posterior Capsule Self Stretch

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Posterior Capsule Self Stretch

In comparing the sleeper stretch with the cross body stretch in a group of asymptomatic recreational athletes the cross body stretch improved IR ROM better and the results lasted longer (McClure et al., 2007). However, they performed the cross body stretch with the shoulder internally rotated which we believe can lead to impingement and therefore we prefer to have the patient perform the stretch with ER of the shoulder and emphasize contralateral upper thoracic spinal rotation instead. We believe that it is the mobilization of the thoracic spine for contralateral rotation that explains the superior results with the cross body stretch.

To stretch the left posterior capsule:

  • The patient is seated and is instructed to bring their left arm up until parallel to the floor with their fingers pointing up towards the ceiling and the left elbow bent to 90 degrees.
  • They place their right hand on the outside of the left elbow.
  • Instruct the patient to use their right hand to pull their left elbow across in front of them keeping the left elbow bent and their left palm facing behind them.
  • Have the patient rotate their trunk as far as they can to the right to enhance the stretch and increase upper thoracic spinal rotation to the right.
  • The patient is instructed to hold for 30 seconds and repeat 2-3 times.
  • It’s important that you watch to make sure that the patient does not slump as they rotate to the right.