Shoulders are one of the most complex parts of the body and can be difficult to rehabilitate correctly, especially when you don’t understand the true cause of the injury. Traditionally, physical therapists rehabilitate shoulders in isolation from the rest of the body. Unfortunately, this approach won’t resolve any of your patient’s dysfunction or the underlying issues that contributed to their injuries.
In this blog, we’ll review what you need to know when it comes to rehabilitating a shoulder after surgery, and factors to consider when you’re working to achieve a greater range of motion.
The Rest of the Body Affects the Shoulder (and Vice Versa)
Traditional rehabilitation typically isolates the injured body part from the rest of the body, even when parts, like a shoulder, are closely connected to and affected by neighboring regions. At Gray Institute®, we know that human movement causes a Chain Reaction® throughout our body. To fully resolve your patient’s pain and limited range of motion, you need to identify all the sources of dysfunction.
For instance, you can’t ignore the impact of the thoracic spine on shoulder function. Even seemingly unrelated, uninjured parts, like the hips, can have a tremendous effect on shoulder health. From a Chain Reaction perspective, it doesn’t make sense to isolate the injured part from the rest of the body’s resources that help itself heal.
What to Remember When You Want to Increase Shoulder Range of Motion After Surgery
When you’re working with a patient who’s recovering from shoulder surgery, here are a few factors and approaches to consider.
The Strengthening Process Should Be Integrated and Gradual
When you’re working with a patient recovering from surgery to a complicated part like the shoulder, it’s important to gradually introduce integrated movement in the healing process. Full rest for too long makes tissues weaker, so when your patient has healed enough to begin moving again, it’s a good idea to introduce movement, but not so much that it’s harmful. Our goal is always to accelerate healing, not interfere with it.
Identify the Cause of the Dysfunction Using Chain Reaction Principles
When you analyze and identify what’s happening in the spine, hips, and even the feet, you can understand more of how the shoulder was injured in the first place. Once you have that understanding, you’ll be able to more completely rehabilitate it by addressing issues in other areas and avoid re-injuring the shoulder in the future.
Treat Your Patient as an Individual
When you’re assigning exercises to a patient, keep in mind who they are as an individual and how they hurt their shoulder. You will inevitably need to treat a 75-year-old grandmother differently than a 23-year-old baseball pitcher. Ask yourself the following questions:
- What other factors contributed to their injury?
- What unique strategies can you employ to accelerate their healing?
- What are their range-of-motion goals?
- Do they want to return to baseball or be able to work in their garden again?
Using the 10 Observational Essentials from our and Chain Reaction courses, you’ll be able to create exercise assignments that meet your patients where they are and empower their recovery.
Gray Institute: Using Applied Functional Science to Assess Dysfunction
When you’re rehabilitating complex shoulder injuries, we understand how tempting and natural it can feel to only look at the shoulder and not the rest of the body. It’s what you were taught in school, and it can make your job feel a lot simpler. However, the truths of Applied Functional Science tell us that there are more factors at play in the body. To do your patient justice, you need to consider what else in the body could impact their injury and healing. Often, this includes the thoracic spine, the hips, and the feet.
To identify dysfunction in these or other areas, you need a reliable assessment tool. One of our flagship courses, , is a movement analysis certification that empowers you with the skills you need to identify, understand, and address the root causes of an injury. If you’re not sure why you’re assigning certain exercises, don’t know which treatment approach is right for your patient, or don’t feel like your current approaches address real-life function, it’s time to consider enrolling in 3DMAPS.
3DMAPS uses lunges and arm swings to allow the joints of the body to demonstrate mobility in all three planes of motion. For someone who has a shoulder injury or is coming off shoulder surgery, it would not make much sense to inflict pain while moving. However, it would make solid sense to get them moving in a way that both contributes to the shoulder (getting the feet, hips, and thoracic spine to move) while protecting the shoulder (not having the arms swing at all). 3DMAPS does this with a simple tweak: use the trunk as a driver instead of the arms.
Here is what the modification would look like:
- Keep your arms crossed at your chest (or involved shoulder in a sling) throughout all movements.
- Lunge forward and comfortably, extending your trunk backward.
- Lunge backward and comfortably, flexing your trunk downwards.
- Lunge to the same side and comfortably, flexing your trunk in the opposite direction of your lunging foot. For example, lunge your right foot to the right and flex, while bending your trunk to the left.
- Lunge to the opposite side and comfortably, flexing your trunk in the opposite direction of your lunging foot.
- Lunge rotationally back to the same side and comfortably, rotating your trunk in the same direction of your lunging foot. For example, lunge your right foot rotationally back to the right and rotate your trunk to the right.
- Lunge rotationally forward to the opposite side and comfortably rotate your trunk in the same direction of your lunging foot.
Here is what it would feel like:
- Your feet move in all three planes of motion (ankle dorsiflexion and plantar flexion; subtalar eversion, inversion, abduction, and adduction).
- Your hips move in all three planes of motion (flexion, extension, abduction, adduction, external rotation, and internal rotation).
- Your thoracic spine moves in all three planes of motion (flexion, extension, right lateral flexion, left lateral flexion, right rotation, and left rotation).
Here is what you would likely see: limited motions that likely impact the shoulder!
Are You Ready to Fill in the Gaps in Your Education? Enroll at Gray Institute Today
If you’re ready to learn how to assess your patient’s functionality to help accelerate their healing, you’re in the right place. For over 40 years, Gray Institute has been empowering physical therapists and movement professionals with the tools they need to provide their patients and clients with world-class care. Feel free to review our 3DMAPS course offerings or send us an email to learn more about which Gray Institute course is right for you.
We look forward to hearing from you!