Shoulder impingement is a common cause of shoulder pain that responds well to active, therapeutic exercise. A more passive “shockwave treatment” has recently been used to treat impingement. This passive modality was compared with an active exercise treatment in shoulder impingement patients in Norway. The study published in the British Medical Journal compared 12 weeks of physiotherapy and home exercise using elastic tubing with 4 to 6 treatments of Radial Extracorporeal Shockwave Treatment (REST).

64% of the exercise patients and only 36% of the shockwave treatment patients had significant improvement in pain and disability, and more patients in the exercise group returned to work. Interestingly however, there were no significant differences between groups in function or range of motion.

This study is consistent with the findings of other studies that show elastic resistance exercises are effective as part of an active care approach to shoulder impingement that includes both clinic- and home-based exercises. Thera-Band® elastic resistance and patient kits are ideal to facilitate both clinical and home exercise programs.

Engebretsen K, et al. Radial extracorporeal shockwave treatment compared with supervised exercises in patients with subacromial pain syndrome: single blind randomised study. BMJ. 2009;339:b3360.

Visit the Thera-Band Academy Shoulder Impingement Center Here

Muscle strengthening activities

Colado JC, Triplett NT. 2008. Effects of a short-term resistance program using elastic bands versus weight machines for sedentary middle-aged women . J Strength Cond Res: 22(5):1441-1448.

Visit the Thera-Band elastic resistance web portal here

An interdisciplinary group of researchers and clinicians reviewed 11 systematic research reviews to develop a ‘toolkit’ for clinicians to apply the best evidence for treating neck pain. The “Cervical Overview Group” created a clinical practice guideline that includes a therapeutic home exercise program for neck pain. The full article was published in the Journal of Orthopedic and Sports Physical Therapy in May, 2009.  The 3-phase “Evidence-based Home Neck Care Program” includes the use of elastic tubing as an integral part of the home program.

Visit the Thera-Band Academy Neck/Cervical Spine resource center to find more articles and exercises for neck pain.

Functional Exercise Progressions

Each regional chapter reviews relevant functional anatomy and describes appropriate functional tests with normative data. The normative data can be used to set goals for the athletes’ rehabilitation, which can be very helpful to practicing clinicians. Exercises are grouped into specific progressions and labeled with different stages in the progression. The exercises start with isolated, joint-specific exercises and progress to more functional movements. Some exercises also include “Pearls of Performance,” which provide additional hints on performing and progressing the exercise.  The 3 chapters also include interval programs that provide specific exercise protocols for returning to sports such as tennis, baseball, football, soccer, and basketball.  The exercises include easy to use and convenient equipment such as elastic tubing, dumbbells, and exercise balls, making them accessible to virtually anyone.

Online Exercise Database

One of the best features of this book is the ability to access electronic versions of each exercise image in the book for PowerPoint presentations or patient handouts.  This provides a great tool for therapists, athletic trainers, or fitness trainers who give written exercise programs to their patients and clients.  Too often, exercises depicted in books are not readily available to create patient handouts; however, with the evolution toward electronic media in book publishing, this resource from Human Kinetics helps solve that problem.

A Great Resource for Sports Rehabilitation

Effective Functional Progressions in Sport Rehabilitation is a great resource for athletic trainers and physical therapists, including those who specialize in sports rehabilitation, and those who don’t. Those without sports rehabilitation experience may benefit from a little more review of the biomechanics of specific sports found in other textbooks.  Even readers with years of experience will learn a few new exercises from 3 great sports physical therapists. Ellenbecker, De Carlo, and DeRosa have done a great job bringing evidence to practice. Although more research is needed on specific protocols and outcomes for sports rehabilitation, such research will serve well for the next edition.

1. There is very little scientific evidence on elastic resistance. FALSE!
There are over 100 published randomized, clinical trials (the highest level of evidence) that have used elastic resistance. In addition, there are over 60 basic and applied studies that have been published to describe the scientific foundation for elastic resistance, including electromyographic (EMG) evidence and biomechanical analysis. The most comprehensive and updated list of these references is available at www.Thera-BandAcademy.com.

2. Isotonic or machine-based resistance is more safe & effective than elastic resistance. FALSE!
The injuries and rates reported with using elastic resistance in the literature are as small if not smaller than using isotonic resistance. Scientific evidence proves that the resistance provided by elastics is very similar to isotonic resistance in physiologic response, strength outcomes, and patterns of muscle activation.

Thera-Band Torque, compared to isotonic weights

3. In contrast to isotonic resistance, the strength curve (torque at the joint) of elastic resistance is linear & ascending. FALSE!
Many people confuse FORCE (resistance) with TORQUE (force x distance). This has led to the misperception that isotonic resistance is more “functional” to the strength capacity of muscles than elastic resistance. The FORCE produced by elastic resistance is linear and ascending, meaning that resistance increases proportional to amount the band is stretched (percent elongation). This increasing force curve is relatively flat within the clinical elongations (25-300%), and increases exponentially at elongations beyond 500%. The TORQUE (strength curve) of elastic resistance is actually bell-shaped (ascending-descending), similar to human strength curves and isotonic resistance

4. The resistance of bands increases with range of motion, making it difficult to complete the end of the exercise. FALSE!
Even though the resistance of the band increases with range of motion during elongation, the torque produced by the bands at the joint is “bell-shaped”, meaning that at the beginning and end ranges, the strength curve profile accommodates the strength curve profile of human strength curves. The change in torque occurs as a result of the changing angle between the band and lever arm, known as the “force angle.” As the range of motion increases, the force angle decreases, thus changing torque production.

5. The band must be perpendicular to the arm for maximum torque production. FALSE!
The torque (strength curve) of an exercise is determined using the formula, Torque = Force x Distance perpendicular to the Lever arm). This takes the vertical direction of gravity into account in addition to the resistance. The distance perpendicular to the lever arm changes as range of motion increases, and the maximum torque is generally produced where the lever arm is perpendicular to the resistance (as in isotonic resistance). However, unlike isotonic resistance, elastic resistance is not reliant on gravity. Therefore, instead of the distance perpendicular, the sine of the “force angle” (angle between the band and the lever arm) is used to quantify torque in the formula, Torque = Force x Distance x sine (Force Angle). Since the resistance of the band increases and the force angle decreases with increasing range of motion, the maximum torque is often noted at mid-range with proper positioning.

6. The resistance of bands and tubing is not predictable or quantifiable. FALSE!
The force production of Thera-Band resistance is consistent and quantifiable. The force can be determined by knowing the percent elongation. For example, Thera-Band® bands stretched to 100% (double resting length) provide the following resistances: Yellow= 3#; Red= 4#; Green= 5#; Blue= 7#; Black= 9.5#. It’s important to note that different colors from different manufacturers may not be as consistent as Thera-Band® resistive bands. Properly positioning the patient will ensure that the strength curve of an isotonic exercise will be similar to the strength curve of the same exercise performed with elastic resistance.

7. Elastic bands stretch out over time with repeated use, thus decreasing the force. FALSE!
Elastic bands and tubing only increase their resting length after the first few pulls with normal use. Once the material has been “pre-stretched” to about 200%, the length of the material is “set”. Therefore, bands experience a small decrease in force after the few pulls, but do not stretch out after the initial setting of the resting length. Patterson et al. (2001), after pre-stretching bands, noted no significant difference in pull force after over 5000 repetitions.

8. The initial length of the band determines the force produced. FALSE!
The force of the band depends directly on the percent change from the resting length (elongation), regardless of the resting length of the band. For example, a 1 foot length of red Thera-Band resistance band that is stretched to 2 feet (100% elongation) will have the same force (4 pounds) as a 2 foot length of band stretched to 4 feet (100% elongation = 4 pounds of force for red bands).

9. Elastic resistance doesn’t offer enough stimulus to increase strength. FALSE!
In nearly every clinical trial in the literature, elastic resistance has been shown to increase strength. This increase ranges from 10 to 130%, and occurs in a variety of populations, from athletes to older adults. They key is to dose the appropriate resistance levels with the individual, rather than prescribing the same resistance for everyone, since everyone’s strength capacity is different. In addition, elastic resistance training has been reported to increase gait and mobility, balance, function, and reduced pain.

10. The best way to progress an exercise resistance is by “shortening-up” on the band. FALSE!
While “shortening-up” on the band does increase the resistance of the exercise, it will also change the overall strength curve of the exercise. Simoneau (2001) demonstrated that grasping the band closer to it’s attachment in order to increase the resistance changed the torque of the movement, thus creating a different strength curve for the exercise. In order to maintain the appropriate biomechanics of an exercise, we should retain the same position of the patient while simply using the next color level of resistance band or tubing.

For complete references or more information on elastic resistance, including Frequently-Asked Questions, visit the most comprehensive resource for research and education on elastic resistance in the world: www.Thera-BandAcademy.com

The Scientific and Clinical Application of Elastic Resistance

More detail is available in the text, The Scientific and Clinical Application of Elastic Resistance, edited by Phil Page PT & Todd Ellenbecker PT from Human Kinetics.