Exercise your Shoulder Pain Free

What Causes Shoulder Pain?
Many of us will experience shoulder pain at some point in our lives, and it is a
very common problem. It is vital to accurately diagnose the pain so the shoulder
can be rehabilitated and treated as soon as possible. Here are some of the more
common causes of shoulder pain, with a brief explanation of each cause.
The following conditions are treatable using my book:
Shoulder impingement syndrome – this is where the supraspinatus tendon
(one of the rotator cuff muscles) gets trapped underneath the acromioclavicular
joint (ACJ). Other names for shoulder impingement syndrome are clinical
impingement syndrome and painful arc syndrome.
Bursitis – inflammation of the bursa (fluid filled sac) that sits underneath one of
the shoulder joints, known as the acromioclavicular joint.
Supraspinatus tendonitis – this is tendonitis of the supraspinatus muscle, one
of the rotator cuff muscles. Most often caused by abrasion underneath the ACJ.
Rotator Cuff Tear – this is where one of the rotator cuff muscles tears. You may
suffer a full thickness tear, or a partial thickness tear. The rotator cuff attach all
around the shoulder and help to stabilise it.
Calcific tendonitis – this is where the rotator cuff tendon becomes calcified due
to a prolonged period of abrasion.
Shoulder Arthritis (of the acromioclavicular joint) – wear and tear changes
under the acromion of the shoulder leading to shoulder impingement syndrome.
This includes bone spurs.
Frozen shoulder – also known as adhesive capsulitis, this is where the shoulder
joint capsule hardens usually in response to trauma or surgery. This results in a
widespread stiffening of the shoulder. Commonly over-diagnosed.
Shoulder Dislocation – the arm bone (humerus) is forced out of the shoulder
joint, usually by trauma.
Shoulder instability – a loose shoulder joint which usually results after dislocation.
Acromioclavicular (AC) Dislocation – the clavicle (collar bone) is forced out of
joint. Usually results from a fall on an outstretched hand.
Labral tear – the rim of the shoulder joint is torn during trauma. Most common in
contact sports such as rugby.
Shoulder Arthritis (of the glenohumeral joint) – degeneration of the head of the
humerus.
Biceps Tendon rupture – the biceps (upper arm muscle with two heads) tendon
pulls off the bone as a result of trauma.

Exercises
I have categorised these exercises in levels 1 – 4. You should perform the levels
in order, and only progress to the next level when you have achieved the
previous level.
In the photographs, Jon has a painful RIGHT shoulder.
You may use the periodisation table in the appendix as a guide to likely time frames
of shoulder exercise progression, but don’t be tempted to rush ahead. Go
at your own pace, and perform the exercises gently and as described.

Level 1 Exercises – Passive Mobilisation:
Level 1 is designed to improve the range of mobility in your stiff shoulder.
Perhaps you want to read that again! Yes, these exercises will finally allow you to
move your arm in a comfortable range of mobility. Great for any stiff shoulder.
The exercises start assisted, so the muscles of the painful shoulder can remain
relaxed while the shoulder is mobilised. We call these passive range of mobility
exercises. Alternatively at this point, if you have a good osteopath or
physiotherapist, they can assist by lifting your arm for you.
When you do these exercises, move the joint slowly, and gently. Avoid the ranges
of movement that give you sharp pain, although feeling minor discomfort should
be expected in certain ranges.
Take the shoulder to the point of mobility which feels comfortable, and then take
it just a fraction further to increase the range of motion. At this point, return the
arm to its resting position.
You will find that every couple of days you will notice some improvement in the
range of mobility of that shoulder and arm. You can compare the movement to
that of the good shoulder to give you an indication of how far you have to go with
the mobility.


1. The Pendulum
• Keep the shoulder completely relaxed
• Let momentum and gravity move it in circles
• Go anti-clockwise and clockwise
• Keep the circles within your comfort zone
• Perform for 2 minutes, 3x per day

2. Rock the baby
• Keep the bad arm relaxed…
• The good arm holds the bad arm
• Keep the movement within your comfort zone
• Rock 15x each side, 3x per day

3. Passive flexion
• The affected shoulder should be relaxed during the movement
• The left arm lifts the right arm
• Keep the movement within your comfort zone
• Perform 15 repetitions, 3x per day.

4. Passive extension
• The right arm stays relaxed during the movement
• The left arm pushes the right arm backwards
• Keep the movement within your comfort zone
• Perform 15 repetitions, 3x per day.

5. Passive abduction 30°
• The right arm stays relaxed during the movement
• The left arm lifts the right arm
• Make sure the arm is lifted at 30°
• Perform 15 repetitions, 3x per day

6. Towel exercise for internal rotation
• The active arm is the left arm, the right arm stays completely
relaxed except to hold the towel
• Straighten the left arm, thus allowing the right arm to come up
the back
• Move up and down within your comfort zone
• Perform 15 repetitions, 3x per day

Level 2 Exercises – Stabilisation:

1. Sitting stabilisation
• Sit on a bench or chair
• Rest your hands by your side
• Gently lean from one hand to the other hand, putting gentle but
increasing weight through the shoulder
• Do not put all your weight through the right shoulder, just lean
into it
• Rock 15x onto the right shoulder, 3x per day.

2. Standing stabilisation
• Start around 1½ feet from a wall
• Lean forwards onto the wall, resting the palms flat against the
wall with the elbows bent (in a standing press-up position)
• Rock gently from side to side, applying pressure to one shoulder
and then the other.
• You can make the exercise more challenging by moving the feet
further away from the wall.
• Hold for 30 seconds, 3x per day

3. Stabilisation in 4 point kneeling
• Start in a 4 point kneeling position
• Rock gently from side to side, applying pressure to one shoulder
and then the other.
• Hold for 30 seconds, 3x per day

Level 3 Exercises: Active Mobilisation:

Level 2 exercises are a natural progression from level 1, because they now rely
on your shoulder muscles to move the joint.
Again, work within your comfort zone… don’t push the shoulder through the pain
barrier. Take it to its comfortable end of range, and then just a fraction further to
get the required mobility.

1. Side-Arm pendulum
• Swing the arm in a pendulum as shown
• Go clockwise and counter-clockwise
• Perform for 30 seconds, 3x per day

2. Shoulder shrugs
• Upwards: lift the shoulders towards the ceiling, and hold for a
couple of seconds, before relaxing.
• Backwards: pull the shoulders backwards by squeezing the
shoulder blades, and hold for a couple of seconds before
relaxing.
• Perform 10 repetitions, 3x per day.

3. Chicken wings
• Resting the hands on the hips, pull the shoulders backwards
and forwards
• Perform 10 repetitions, 3x per day

4. Flexion
• Raise your bad arm as far as is comfortable, then try and take it
just a fraction further
• Hold for a couple of seconds, then lower.
• Perform 10 repetitions, 3x per day

5. Internal rotation “The Brastrap Exercise”
• Reach behind your back, and take the hand as high up the back
as comfortable, then just a fraction further.
• You should feel a gentle pulling feeling at the front of the
shoulder. Hold this position for a couple of seconds
• At first you may find this exercise difficult and uncomfortable,
but persevere, and over a few days you will achieve greater
mobility
• Perform 10 repetitions, 3x per day

6. Stroke the shoulder blade
• Reach behind the opposite/good shoulder and try to stroke the
shoulder blade.
• This is another movement that is likely to be quite painful, but
again keep practising; go to your end of comfort zone, and just
a fraction further.
• Perform 10 repetitions, 3x per day

7. 30° wall crawl
• Make sure the arm is not directly to your side
• Leave it at a 30° angle, as shown in the picture
• Crawl up the wall to your end of comfortable range, then just a
fraction further, and back down the wall.
• Perform 10 repetitions, 3x per day

8. The Drawing of the Sword
• The thumb starts facing downwards, and at the end of the
movement, faces upwards
• Imagine you are drawing a sword out of its sheath
• Perform 10 repetitions, 3x per day

9. Pec Stretch
• A lovely shoulder exercise, great for posture; it will improve
mobility in the anterior capsule of the shoulder
• Rotate the torso, and lean forward, creating a stretch to the
shoulder
• Perform 10 repetitions, 3x per day

10. The Football Supporter
• One of my favourites, but the hardest in this level, so don’t do it
unless you feel comfortable with it
• Holding a towel above your head (imagine it’s a scarf of your
favourite football team), gently move the arms from side to side
• Perform 10 repetitions, 3x per day

Level 4 Exercises: Advanced Stabilisation

1. Swiss Ball Stabilisation 2 hands
• Kneel down, place the hands on a Swiss ball
• The instability of the ball will help the small stabiliser muscles of
the shoulder strengthen
• Progress the exercise by moving the knees further from the ball
• Hold for 30 seconds, 3x per day
• Increase the hold for up to 2 minutes as you get stronger

2. Swiss Ball Stabilisation 1 hand
• The same exercise as the previous, but one handed
• Hold for 30 seconds, 3x per day
• Increase the hold for up to 2 minutes as you get stronger

3. 2-point Kneeling
• Adopt a 4-point kneeling position
• Lift opposite arm and leg 2 inches from the floor, so that your
weight is put through the bad shoulder
• Hold for 30 seconds, 3x per day
• Increase the hold for up to 2 minutes as you get stronger

4. Prone Cobra
• This is a great exercise for scapular stability, and back extensor
strength, helping to keep those shoulders back, thus helping to put the
shoulder in a mechanically advantageous position
• Make sure the thumbs are facing upwards, with the arms turning
outwards (n.b. not inwards). You will notice that turning the arms
outwards opens the chest and shoulders (=good), inwards closes the
chest and shoulders (=bad)
• Hold for 30 seconds, 3x per day
• Increase the hold for up to 2 minutes as you get stronger

JENNY McConnell

Self-treatment system has got bad knees taped

By Derek Mortimer March 18, 2004

Flat strap: Jenny McConnell. Photo: Wade Laube

A simple and inexpensive self-treating program involving the application of tape can provide pain relief and increase mobility for the thousands of people who suffer from osteoarthritis of the knees, a new Australian study has found.
The taping, which can be taught by a physiotherapist in one or two visits, is combined with muscle-strengthening exercises.
The treatment involves taping the patella, or knee cap, which must be held in the correct position as it moves over the knee joint, and taping below the knee cap to take pressure off the fatty tissue. It involves two types of tape: a stretchable under-tape to prevent irritation of the skin, and a rigid sports tape. Both varieties are available from most chemists.
Osteoarthritis of the knees is one of the most common and debilitating diseases of ageing; more than 1 million Australians suffer from it. This number is increasing by about 8 per cent a year.
The World Health Organisation reports that 40 per cent of people over the age of 70 suffer osteoarthritis of the knees and that globally, osteoarthritis ranks fourth in women and eighth for men in terms of disease impact.
Osteoarthritis usually develops from 45 years of age onwards, and all forms of arthritis are increasing, says the Arthritis Foundation of NSW.
The finding on taping follows a study by physiotherapists from the University of Melbourne and claims to provide the first evidence of the effects of knee-taping in the treatment and management of osteoarthritis.
The randomised, blind-control trial involved 87 patients divided into three groups. One group received no taping, a second received placebo taping and the third received therapeutic taping.
The taping covered three weeks, with the the tape being replaced at the ends of the first and second weeks. The patients were then assessed three weeks after the tape was removed. The therapeutic tape group reported a decrease in pain of 38 to 40 per cent.
Dr Kim Bennell, associate professor and director of the Centre for Health Exercise and Sports Medicine at the University of Melbourne, says taping had previously been associated with younger people suffering patellofemoral (front of the knee) pain, generally caused by sporting activity.
She stressed that taping was one part of self-management and treatment of osteoarthritis, and was best combined with exercises to strengthen the quadriceps muscles and improve balance.
The exercises include step-ups, partial squats and similar movements that engage specific muscles of the thigh. They can be performed daily or several times a week, depending on the needs of the patient.
In 1986, Sydney physiotherapist Jenny McConnell pioneered a taping treatment for the management of patellofemoral pain that now bears her name.
McConnell, who was a member of the research team, says that when treating patients for patellofemoral injuries, she found that not only did the taping reduce that pain, it also reduced osteoarthritic pain in some people.
In osteoarthritis the pain comes from the soft tissue below the knee cap, rather than the bone, or cartilage, which has no nerves, says McConnell, although there is an association between lack of joint space - a symptom of osteoarthritis - and pain.
She says taping unloads pressure from the tissue, enabling inflammation to settle down.
The Australian Institute of Health and Welfare reports that the economic cost of musculoskeletal diseases such as osteoarthritis is $3 billion a year.
Editor's note: People shouldn't attempt strapping their knees until assessed by a physiotherapist. This treatment is not appropriate for all arthritis sufferers, and in some cases, can cause more pain.

History of Physical Therapy

History

Physicians like Hippocrates and later Galenus are believed to have been the first practitioners of physical therapy, advocating massage, manual therapy techniques and hydrotherapy to treat people in 460 B.C.[13][verification needed] After the development of orthopedics in the eighteenth century, machines like the Gymnasticon were developed to treat gout and similar diseases by systematic exercise of the joints, similar to later developments in physical therapy.[14]

The earliest documented origins of actual physical therapy as a professional group date back to Per Henrik Ling “Father of Swedish Gymnastics” who founded the Royal Central Institute of Gymnastics (RCIG) in 1813 for massage, manipulation, and exercise. The Swedish word for physical therapist is “sjukgymnast” = “sick-gymnast.” In 1887, PTs were given official registration by Sweden’s National Board of Health and Welfare.

Other countries soon followed. In 1894 four nurses in Great Britain formed the Chartered Society of Physiotherapy.[15] The School of Physiotherapy at the University of Otago in New Zealand in 1913,[16] and the United States' 1914 Reed College in Portland, Oregon, which graduated "reconstruction aides."[17]

Research catalyzed the physical therapy movement. The first physical therapy research was published in the United States in March 1921 in The PT Review. In the same year, Mary McMillan organized the Physical Therapy Association (now called the American Physical Therapy Association (APTA). In 1924, the Georgia Warm Springs Foundation promoted the field by touting physical therapy as a treatment for polio.[18]

Treatment through the 1940s primarily consisted of exercise, massage, and traction. Manipulative procedures to the spine and extremity joints began to be practiced, especially in the British Commonwealth countries, in the early 1950s.[19][20] Later that decade, physical therapists started to move beyond hospital based practice, to outpatient orthopedic clinics, public schools, college/universities, geriatric settings (skilled nursing facilities), rehabilitation centers, hospitals, and medical centers.

Specialization for physical therapy in the U.S. occurred in 1974, with the Orthopaedic Section of the APTA being formed for those physical therapists specializing in orthopaedics. In the same year, the International Federation of Orthopaedic Manipulative Therapy was formed,[21] which has played an important role in advancing manual therapy worldwide since.

PHYSIOTHERAPY DEVELOPMENT

Physiotherapy treatment has evolved over the last 110 years in the UK. It commenced in 1894 when ‘The Society of Trained Masseuses’ was founded by four nurses from The London Hospital. In 1919, this society amalgamated with ‘The Institute of Massage and Remedial Exercises’ established in Manchester and in 1920 the Royal Charter was granted and the two bodies became ‘The Chartered Society of Massage and Medical Gymnastics’. In 1944, the Society in the UK adopted its present name as the ‘Chartered Society of Physiotherapy’. In 1964, Vidler stated that ‘You needed a good educational background to train as a physiotherapist, but when qualifi ed it is wit and observation that give you the ability to judge the effect of your treatment and report on it or discuss it with the doctor’ (Vidler 1964). It was not until 1977 that Chartered Physiotherapists became autonomous clinicians in the UK, with the ability to take selfreferrals, assess, diagnose and treat without a medical referral.

In 1964, Rule 2 of the Code of Conduct stated that registered physiotherapists should confi ne themselves to the recognised fi eld of physiotherapy (Gardiner 1964). Physiotherapy was extremely protective of its core skills of massage, exercises and electrotherapy (added in 1929). At this stage, it lacked the foresight and courage to develop new skills in other areas. Physiotherapists
were generalists and expected to undertake all types of physiotherapy treatment. Gradually, physiotherapy skills have expanded to cover many specialist areas, such as continence. Now, physiotherapists confi ne themselves to areas in which they have had training and in which they are competent. In 1992, the profession became an all-graduate entry profession in the UK.

SALEM DISTRICT

Revenue Divisions                     4
Taluks                                9
Blocks                               20
Corporation & Municipalities          5
Town Panchayats                      33
Revenue Villages                    631
Panchayat Villages                  385

Number of Taluks              9
Number of Revenue Villages  631

Taluk Revenue Villages

Attur        102
Edapady       24
Gangavalli    40
Mettur        46
Omalur        87
Salem        153
Sangagiri     48
Valapady      67
Yercaud       64

Number of Blocks                                         20

Number of Panchayat Villages                   385

Block Panchayat

Villages Block Panchayat Villages

Attur 20                                 Ayodhiyapattinam 32

Gangavalli 14                        Idappadi 10

Kadaiyampatty 17                Kolathur 14

Konganapuram 9                  Macdonald s Choultry 12

Mecheri 17                             Nangavalli 9

Omalur 33                              Panamarathupatti 20

Peddanaickenpalayam 36     Salem 14

Sankari 22                              Talavasal 35

Taramangalam 17                 Valapady 20

Veerapandi 25                       Yercaud 9

Corporations & Municipalities

Municipal Corporations

Salem

Number of Municipalities     4

Attur   Idappadi   Mettur  Narasingapuram

Town Panchayats
Number of Town Panchayats      33
Attayampatti  Ayothiapattinam  Jalakandapuram
Kannankurichi  Kolathur  Konganapuram
Mecheri  Omalur  P.N.Patti
Pethanaickenpalayam   Sankari   Thammampatti
Tharamangalam  Vazhapadi  Veerakkalpudur
Belur   Edaganasalai   Elampillai
Ethapur   Gangavalli   Kadayampatti
Karuppur   Keeripatti   Mallur
Panaimarathupatti   Sentharapatti   Thedavur
Thevur   Veeraganur   Arasiramani
Nangavalli   Poolampatti   Vanavasi

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Important Dates

Important Days

January 9 NRI Day January 10 World Laughter Day January 12 National Youth Day January 15 Army Day January 26 India's Republic Day, International Customs Day January 30 Martyrs' Day; World Leprosy Eradication Day 2nd Sunday of February World Marriage Day February 24 Central Excise Day February 28 National Science Day Second Monday March Commonwealth Day March 8 International Women's Day; Intl. literacy Day March 15 World Disabled Day; World Consumer Rights Day March 18 Ordnance Factories Day (India) March 21 World Forestry Day; International Day for the Elimination of Racial Discrimination March 22 World Day for Water March 23 World Meteorological Day March 24 World TB Day April 5 International Day for Mine Awareness; National Maritime Day April 7 World Health Day April 17 World Haemophilia Day April 18 World Heritage Day April 21 Secretaries' Day  April 22 Earth Day April 23 World Book and Copyright Day May 1 Workers' Day (International Labour Day) May 3 Press Freedom Day; World Asthma Day May 2nd Sunday Mother's Day May 4 Coal Miners' Day May 8 World Red Cross Day May 9 World Thalassaemia Day May 11 National Technology Day May 12 World Hypertension Day; International Nurses Day May 15 International Day of the Family May 17 World Telecommunication Day May 24 Commonwealth Day May 31 Anti-tobacco Day June 4 International Day of Innocent Children Victims of Aggression June 5 World Environment Day June 3rd Sunday Father's Day June 14 World Blood Donor Day June 26 International Day against Drug Abuse and Illicit Trafficking July 1 Doctor's Day July 6 World Zoonoses Day July 11 World Population Day August 3 Internatioal Friendship Day August 6 Hiroshima Day August 8 World Senior Citizen's Day August 9 Quit India Day, Nagasaki Day August 15 Indian Independence Day August 18 IntI. Day of the World's Indigenous Peoples August 19 Photography Day August 29 National Sports Day September 2 Coconut Day September 5 Teachers' Day; Sanskrit Day September 8 World Literacy Day (UNESCO)  September 15 Engineers' Day September 16 World Ozone Day September 21 Alzheimer's Day; Day for Peace & Non-violence (UN) September 22 Rose Day (Welfare of cancer patients) September 26 Day of the Deaf September 27 World Tourism Day October 1 International Day for the Elderly October 2 Gandhi Jayanthi October 3 World Habitat Day October 4 World Animal Welfare Day October 8 Indian Air Force Day October 9 World Post Office Day October 10 National Post Day October 2nd Thursday World Sight Day October 13 UN International Day for Natural Disaster Reduction October 14 World Standards Day October 15 World White Cane Day (guiding the blind) October 16 World Food Day October 24 UN Day; World Development Information Day October 30 World Thrift Day November 9 Legal Services Day November 14 Children's Day; Diabetes Day November 17 National Epilepsy Day November 20 Africa Industrialisation Day November 29 International Day of Solidarity with Palestinian People December 1 World AIDS Day December 3 World Day of the Handicapped December 4 Indian Navy Day December 7 Indian Armed Forces Flag Day December 10 Human Rights Day; IntI. Children's Day of Broadcasting December 18 Minorities Rights Day (India) December 23 Kisan Divas (Farmer's Day) (India)

World Physical Therapy Day

WCPT has designated 8th September, the date WCPT was founded in 1951, as World Physical Therapy Day.

The day marks the unity and solidarity of the physical therapy community from 101 countries around the world. It is an opportunity to recognise the work that physical therapists do for their patients and community. WCPT aims to support member organisations in their efforts to promote the profession and to advance their clinical expertise, using World Physical Therapy Day as a focus.
Celebration of the day is entirely voluntary.  Many WCPT member organisations already have designated national physical therapy days, weeks and months and it is not the intention that these be changed to accommodate the world day. However, organisations that have not designated a day may choose to use 8th September.

World Physical Therapy Day 2009 activities - India

A number of institutions across India celebrated World Physical Therapy Day on 8 September 2009. Details of just some of these events are provided below:

Amity Institute of Physiotherapy, Amity University

Like every year, this year the Amity Institute of Physiotherapy celebrated World Physical Therapy Day at the Amity Campus. A seminar was organised at which distinguished physical therapists presented their views on the vital areas of the profession. The event generated much press coverage highlighting physical therapists’ scope of practice and the role they play in areas such as cardio vascular disease and obesity. Download a report and photos of the events. Read press cuttings [1.76mb].

Physiotherapy Private Practitioners’ Group

The Physiotherapy Private Practitioners’ Group (PPG) in India celebrated World Physical Therapy Day with the following events:

• an article titled ‘Today is World Physical Therapy Day’ was published in an Indian newspaper
• posters were displayed at parks, corporate offices, temples and public buildings, giving details of when to visit a physiotherapist
• seminars on ‘Physiotherapy management & pain prevention” and “Exercises to help delay in aging’ were delivered
• free physiotherapy camps were held

Dr M V Shetty College of Physiotherapy

To celebrate World Physical Therapy Day, the Dr MV Shetty College of Physiotherapy organised a workshop in collaboration with the Sports and Fitness Training Federation of India on 8th September 2009. The topic for the workshop was "Teaching Methodology" and a poster was made to promote the occasion.

McKenzie Institute

McKenzie India celebrated World Physiotherapy Day by organising a McKenzie overview programme in Pune on 5th September, at DY Patil Physiotherapy College, Pimpri. The overview lasted 3 hours and was supported by a PowerPoint presentation from the McKenzie Institute International, New Zealand. The event was well attended and successful.