We previously published a blog post about a study by Baumgarten, Osborn, Schweinle, Zens, and Helsper which compared Pulley Exercises to a well-known rehabilitative exercise, Jackins exercise. For the first 6 weeks, there was an emphasis on protection of the repair. Due to the need to protect the repair, patients were asked to use a shoulder sling whenever they were not doing exercises or hygiene activities, such as bathing. In Long et al, simulations were done that suggested that exercises with less than 15% of maximum activity measured by mean maximum voluntary isometric contraction (MVIC) are safe to use during early stages of shoulder rehabilitation. Using this number as a guide, numbers slightly higher than the 15% mean MVIC benchmark include shoulder pulleys in the sagittal plane, but barely so (13-18.5% depending on reference). Due to this evidence that pulleys activate the supraspinatus muscle, and due to concerns about protecting the repair, the authors did not have participants use pulleys or carry out Jackins exercise until 6 weeks post-operative.
All patients did joint range of motion (ROM) exercises and muscle activation exercises during the initial 6-week rehabilitation period. ROM exercises included pendulum exercises in the sagittal and transverse planes, passive supine elevation using either the non-operated arm or another person to assist, passive external rotation using a wand assisted by another person, in addition to hand, wrist and elbow ROM and progressive resistance exercises. Muscle activation exercises were done twice a day, and included scapular active range of motion, isometric and stabilization exercises in pain-free range, and deltoid isometric exercises.
Pulley exercises were performed after 6 weeks. First, seated pulley exercises were done with the operated arm and side next to the door, using the non-operated arm to pull the other up, and kept at the highest point in range of motion for 15-30 seconds. This exercise was repeated 10-15 times per day. This exercise is similar to the Abduction II exercise found in our shoulder exercise guide. When range of motion exceeded 110 degrees, an additional exercise was used. In this exercise, the chair is sat with the back against the door. The pulley is over the operated shoulder, and the non-operated arm pulls down to bring the operated arm up to the highest point in their range of motion, and held for 15-30 seconds. This exercise was repeated 10-15 times, twice a day. This exercise is similar to Abduction I found in our shoulder exercise guide. Again, all patients were advised to only do exercises within their pain-free range of motion.
Baumgarten KM, Osborn R, Schweinle WE Jr, Zens MJ, Helsper EA. Are Pulley Exercises Initiated 6 Weeks After Rotator Cuff Repair a Safe and Effective Rehabilitative Treatment? A Randomized Controlled Trial. Am J Sports Med. 2016 Jul;44(7):1844-51. doi: 10.1177/0363546516640763. Epub 2016 Apr 26. PubMed PMID: 27159310. Article and Appendices A-C.
Jackins S. Postoperative shoulder rehabilitation. Phys Med Rehabil Clin North Am. 2004;15(3):vi, 643-682. Doi: 10.1016/j.pmr.2004.01.002.
Long JL, Ruberte Thiele RA, Skendzel JG, Jeon J, Hughes RE, Miller BS, Carpenter JE. Activation of the shoulder musculature during pendulum exercises and light activities. J Orthop Sports Phys Ther. 2010 Apr;40(4):230-7. doi: 10.2519/jospt.2010.3095. Abstract.
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