Shoulder

Sleeper Stretch

The sleeper stretch is a focused stretch of the posterior and inferior shoulder capsule. The patient lies on their affected side with the sore shoulder and elbow flexed to 90 degrees. The scapula (shoulder blade) can be stabilised by leaning against a wall. The shoulder is then internally rotated (hand pressed towards the ground) using pressure from arm not being stretched to the hand of the arm being stretched. Hold in the stretched position for about thirty seconds. This should be painless but should feel like a firm 'stretch'.

This stretch is excellent for overhead athletes such as pitchers and tennis players to help prevent injury. It is also an essential part of the rehabilitation plan for many shoulder injuries.

Shoulder

Frozen Shoulder

A frozen shoulder is a condition characterized by inflammation, scarring and tightening of the connective tissue around the shoulder joint. The shoulder joint is a ball and socket joint. The shoulder blade gives rise to the socket of the shoulder, whilst the ball arises from the top of the humerus. Surrounding the ball and socket joint is strong connective tissue holding the bones together known as the joint capsule. Occasionally, the shoulder joint capsule may become inflamed with subsequent tightening and scarring. When this occurs the condition is known as a frozen shoulder and usually results in a marked loss of shoulder range of movement. They can generally be divided into 3 phases, each of which can last a number of months:

  1. Acute / freezing / painful phase: gradual onset of shoulder pain at rest with sharp pain at extremes of motion, and pain at night with sleep interruption.
  2. Adhesive / frozen / stiffening phase: Pain starts to subside, progressive loss of glenohumeral motion in capsular pattern.
  3. Resolution/thawing phase: Spontaneous, progressive improvement in functional range of motion.
Physiotherapy for a frozen shoulder
  • Education
  • Advice on pain relieving modalities
  • Activity modification advice
  • Postural advice and correction of movement patterns
  • Exercises to improve flexibility, strength and posture
  • Soft tissue massage
  • Joint mobilization
  • Acupuncture
  • Devising and monitoring an appropriate return to activity plan

Despite appropriate physiotherapy management, some patients with this condition do not improve adequately or require other intervention to ensure an optimal outcome. When this occurs the treating physiotherapist can advise on the best course of management.

Exercises for a frozen shoulder

Exercises are commonly prescribed to patients with this condition in the second phase. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to intermediate and advanced exercises.

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