The 8-week program was performed and supervised by a physiotherapist in a treatment room at the work site twice a week. The patients were assessed for subjective pain and function before and after the program that include the following standardized sequence:

1. Cryotherapy. Ice packs applied to anterior and posterior shoulder for 20 minutes
2. Stretches. 3 sets of 30 seconds with 30 seconds rest between repetitions, performed on both shoulders for upper trapezius, posterior shoulder, and pectoralis minor (corner stretch)
3. Thera-Band strengthening program: performed on both shoulders using progressive Thera-Band color-coded resistance bands .  Participants began with mild tension on the band and stretched to approximately one-third the original resting length with 1 minute rest between sets for 3 sets of 10 repetitions. Click here to see the shoulder impingement exercise protocol.

Patients performed stretching and strengthening exercises on both shoulders since many impingement patients exhibit deficits on both shoulders. They were also given education about reducing loads on the shoulder, as well as the use of ice at home.

After the 2-month intervention, the patients significantly improved their subjective ratings of pain and disability. In addition, 50% of the patients were pain-free, despite an average 2 year length of symptoms. While this study is limited by the lack of a control group and small sample size, these results support the effectiveness of this specific program using Thera-Band resistance bands in workers with shoulder impingement.

In conclusion, the authors noted, “…this therapeutic intervention may be relatively easy to be performed in many industries and may be effective to reduce symptoms and ultimately decrease the amount of sick leave.”.

The Thera-Band Shoulder Rehab kit includes Thera-Band resistance tubing and illustrated exercise manual and DVD, as well as Biofreeze® topical analgesic for pain before and after a shoulder exercise program.

REFERENCE Camargo PR, et al. Effects of strengthening and stretching exercises applied during working hours on pain and physical impairment in workers with subacromial impingement syndrome. Physiother Theory Pract. 2009 Oct;25(7):463-75.

Visit the Thera-Band Academy Shoulder Impingement Resource Center here

“Unlike conventional pulleys, the Thera-Band Shoulder Pulley features a unique rope that’s divided into sections by distinct black marks. By referencing the position of these marks during exercise, patients get immediate feedback on progress. This visual feedback validates that they are improving, which is key to patient motivation,” stated Anna Schrock, Product Manager for Performance Health / Hygenic Corporation. “The marked rope also allows the rehab professional to set precise goals and limitations so that patients know how far to go and where to stop.”

“The ability to move the shoulder joint is vital for functionality in everyday physical activities, and anyone from weekend athletes to gardeners to do-it-yourself painters can experience shoulder problems,” added Phil Page, PhD, PT, ATC, CSCS, director of clinical education and research for the Thera-Band Academy. “We commonly see limited range of motion in post-operative rotator cuff tear repairs, shoulder reconstruction, and frozen shoulder, or ‘adhesive capsulitis’ patients. Physical therapy and therapeutic exercise are the keys to successful outcomes in these patients, and the Thera-Band Shoulder Pulley is a unique tool that offers clinicians and patients visual representation of their progress.”

In addition to the marked rope, other features enhance this exciting new product. The Thera-Band Shoulder Pulley can be anchored at any point along a standard door jamb to accommodate a wide range of exercises. The adjustable rope length offers custom fit and versatility, and the soft foam handles provide superior comfort during use.

The shoulder pulley can be used during clinic visits or as part of a clinician prescribed home exercise program.  Sample exercises videos and additional product information can be viewed at info.Thera-BandAcademy.com/shoulderpulley.

“The Thera-Band System of Progressive exercise is the foundation of our business, and our products have been trusted by rehabilitation professionals for over 30 years,” continued Ms. Schrock. “We are pleased to introduce yet another product to the internationally recognized trusted-progression Thera-Band family.”

Canadian researchers Anderson and Behm have shown that instability training can provide similar muscle activation levels at lower resistance levels compared to training on stable surfaces. Unfortunately, however, unstable surface training also results in a decrease force output of prime movers.
California State University researchers set out to evaluate the electromyographic (EMG) activity of prime movers and core stabilizers during a seated overhead press exercise. 30 healthy, resistance-trained subjects performed an overhead press with dumbbells and barbells while sitting on a stable surface and on an exercise ball. The investigators were interested in looking for differences in EMG levels between the stable load (barbell) and unstable load (dumbbell), on both stable (bench) and unstable surfaces (exercise ball).  Subjects used a 10RM resistance (maximum amount of weight lifted for 10 repetitions) for each of the 4 conditions; thus, each condition had a slightly different absolute load.

As expected, the loads used in each condition decreased with decreasing stability. Most resistance was used with the barbell on the bench (stable load on stable surface), followed by the barbell on the exercise ball (stable on unstable), utilizing 89% of the stable on stable condition. The dumbbell on bench (unstable on stable) utilized 86%, while the dumbbell on the ball (unstable on unstable) used 79% of the stable conditions. The researchers suggested that exercising on unstable surfaces reduces force output approximately 15%.

The upper extremity muscle EMG also decreased as the stability decreased, while the erector spinae muscles had great activation on the exercise ball compared to the stable bench. Interestingly, exercises performed on a stable surface required more abdominal activation, indicating that the abdominals require greater activation with greater loads during an overhead lift.

The authors concluded that exercise balls should not be used during the overhead press exercise when the goal is to increase muscle activation of the arms or abdominals, even with reduced loads. However, performing barbell overhead press on an exercise ball does result in increased activation of the low back muscles.

These results are relatively consistent with other studies that suggest unstable surfaces such as exercise balls should not be used to increase strength of extremities using traditional resistance training exercises. While other studies have shown increased activation of the abdominals with resistance training, these authors did not evaluate the seated overhead press exercise; therefore, preferential activation of certain core muscles may be specific to the exercise performed on the exercise ball.  The Thera-Band exercise ball remains a valuable tool for stabilization training, although its role in core strengthening during traditional resistance exercise remains questionable.

REFERENCE: Kohler JM, Flanagan SP, Whiting WC. Muscle activation patterns while lifting stable and unstable loads on stable and unstable surfaces. J Strength Cond Res. 2010 Feb;24(2):313-21.

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Proprioceptive exercises

A review paper in Athletic Training and Sports Healthcare discussed the adaptations of the sensorimotor system following shoulder rehabilitation. The authors used the PEDro system for inclusion criteria to review 23 articles. The most common techniques the paper reviewed included:

• Joint repositioning
• Closed-kinetic chain exercises
• Proprioceptive Neuromuscular Facilitation (PNF)
• Plyometrics
• Joint Perturbations
• Activation of muscle through elastic tubing, free weights or oscillation

The authors concluded that sensorimotor rehabilitation after shoulder injury is crucial, and that the sensorimotor system is, in fact, trainable. A proprioceptive and sensorimotor training program including Thera-Band® elastic bands and tubing, FlexBar® Oscillation, and closed-kinetic shoulder exercises with Stability Trainers should be included as part of a shoulder rehabilitation or prevention program.

Reference: Myers JB, and Oyama S. 2009. Sensorimotor training for shoulder injury. Athletic Training & Sports Health Care. 1(5):199-208.

Click here to visit the Thera-Band Academy Shoulder Center

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