Shoulders are the muscle groups in our body that connect our collarbone, arms, back, and chest. The other name for these muscles is Deltoids. The shoulder is only repaired surgically when the joint moves out of alignment or is fractured.
Pendulum Exercises 1are primarily done after shoulder surgery as a rehabilitation process. The surgeon performs the surgical intervention if the shoulder is dislocated or has suffered a severe injury.
These pendulum exercises include stretching, rotating, and contracting all the muscles covering the shoulder bone. Doing so, the inflammation and stiffness around the shoulder become as flexible and strong as before. The physical therapist examines your body’s range of motion and assists with moving the shoulder in all directions possible.
These exercises can be done right after the day of surgery or during the first week of the post-surgery as prescribed by the surgeon. These movements can help the shoulder’s recovery speed and heal faster.
Promote Gentle Joint Mobility
In my 25+ years of orthopedic surgery experience, I’ve extensively used pendulum exercises as part of rehabilitation programs for patients post-shoulder surgery, notably for conditions such as rotator cuff repairs or shoulder impingements.
The key benefits of these exercises lie in their ability to promote gentle movement in the shoulder joint without overexerting the healing tissues. This is crucial in the early stages of recovery when maintaining mobility without compromising surgical repair is essential.
Pendulum exercises facilitate the natural, gravitational movement of the shoulder, encouraging synovial fluid circulation within the joint2. This fluid acts as a lubricant, which not only helps in reducing stiffness but also promotes healing by delivering essential nutrients to the injured area.
Moreover, these exercises help in maintaining the range of motion and preventing the formation of adhesions—bands of scar tissue that can significantly limit mobility and cause pain.
In one case, a patient recovering from a massive tear repair of the rotator cuff showed remarkable improvement in shoulder mobility and reduction in pain levels after incorporating pendulum exercises into their daily routine.
Initially, the patient exhibited significant stiffness and discomfort during arm elevation, but after consistent practice of these exercises under supervision, we observed a notable enhancement in shoulder flexion and abduction without exacerbating the pain.
Furthermore, pendulum exercises act as a foundational step for more advanced rehabilitation exercises. By safely maintaining shoulder mobility in the initial stages after surgery, patients can transition more effectively into strength-building exercises3 as their recovery progresses.
This phased approach minimizes the risk of re-injury and complications, ensuring a smoother and faster return to daily activities.
In sum, the gentle, controlled movement facilitated by pendulum exercises plays a pivotal role in post-surgery shoulder rehabilitation.4
It effectively maintains joint mobility, promotes healing, and lays the groundwork for more intense physical therapy, significantly enhancing the overall recovery process without risking further injury.
Robert McLaughlin II, MD, President, Boston Concierge Orthopedics
1. Instructions for Pendulum Exercises
Be careful before doing this exercise because one wrong move can result in pain and discomfort. If you are in constant pain during the training, stop immediately and consult with your doctor or physical therapist. Here are the instructions for performing the pendulum exercise.
- Start the Exercise slowly and gently because one wrong move can result in additional injury to the joint.
- You can also wear a supporter around the joint to prevent injury during the exercise.
- After the day of surgery, when your doctor advises you to do the pendulum exercise at a specified time, do it on that day only and do not rush to do it quickly.
- Do not overdo the exercise, as it can cause more harm than cure during the healing period, and do not avoid it when told to do so.
- Repeat the exercise daily for short intervals of 10 to 15 minutes, as recommended by the doctor.
Safe Pendulum Exercises for Post-Surgery Rehab
When incorporating pendulum exercises into post-surgery rehabilitation, it’s crucial to follow specific guidelines to ensure optimal recovery.
Patients should first consult with their healthcare provider to determine if pendulum exercises are appropriate for their condition and where they are in their recovery process.
It’s essential to start with gentle movements and gradually increase the range of motion to avoid overstressing the healing tissues. Maintaining proper posture and alignment during exercises is key to preventing strain or injury.
Patients should listen to their bodies and stop if they experience pain or discomfort. Progress should be gradual, with regular check-ins with a physical therapist or healthcare provider to monitor recovery and adjust the exercise regimen as needed.
Consistency and patience are essential for safe and effective rehabilitation 5without setbacks or complications.
Akshaya Srivatsa, CEO/Co-Founder, Care Better
2. Types of Pendulum Exercises
Various kinds of pendulum exercises can be done to heal up sooner. Our human body is designed to move our joints and muscles in several patterns. Therefore, it provides us with a more excellent range of movement and flexibility as we continue to do it regularly.
Here are the different variations of pendulum exercises :
2.1. Arm Hanging
- Initiate this exercise with your injured arm and lean forward with your unaffected arm on the table as support.
- Leave your arm down and let it hang down straight below.
- When your arm is hanging down, rotate it in a clockwise and anticlockwise direction first.
- Now move your arm backward and forward and then to the right and left side.
- Do not make these movements quickly or with great force; just let it free slowly and gently.
- Practice this exercise daily three times and for a minimum of 5 to 10 minutes.
- Remember to alter the activity for each minute of every movement.
2.2. Front Raises
- Take the back support of a chair while sitting or the support of the wall while standing.
- Slowly raise your shoulder to your chin level and extend it above your head in a straight direction.
- If you feel pain sitting or standing, you can lie on the floor and perform the abovementioned movements.
- The movement gets better over time by practicing it regularly. If your shoulder joint feels stronger, you can add free weights such as dumbells to strengthen the muscles around the deltoids.
2.3. Lateral Raises
- Likewise, you can sit, stand, or lie down with front raises.
- The only difference is that now you have to raise your arms sideways to the chin level and above the head up straight.
- This exercise mainly focuses on the posterior and middle deltoid and trapezius muscles. It also strengthens the neck muscles and corrects spine posture.
Balancing Physical and Psychological Recovery Post-Surgery
Starting up pendulum exercises post-surgery introduces both physical discomfort and psychological challenges. Pain and stiffness are common as is the fear of exacerbating the injury.
Moreover- patients often grapple with the anxiety of re-injury and nervousness about resuming normal life activities. To navigate these hurdles, a balanced approach is key.
On the physical side, effective pain management and tailored exercise modifications, can ease discomfort and encourage safer rehabilitation progress.
Psychologically, setting achievable goals can motivate patients, while mindfulness techniques help manage fear and anxiety. Crucially, the support from healthcare professionals, family, and peer networks offers essential emotional backing.
Staying motivated through rehabilitation hinges on recognizing each small victory and focusing on the broader recovery benefits, like regaining independence and resuming activities you love.
We advocate for integrating physical healing with mental well-being, ensuring a well-rounded path to recovery.
Russell Noga, CEO, Medisupps
2.4. Shoulder-Elbow Stretch
- Sit on a chair and tighten your fist to elevate and fold the arm halfway.
- At this position, move your forearm outside horizontally to contract elbow to shoulder muscles.
- Similarly, lift your arm straight upright and fold your arm inside down vertically.
- You can also lie down on the unaffected shoulder and stretch the elbow-chest from sideways.
2.5. Towel Exercise
- Take a towel and make a roll of it. Grab it with one hand and hang it from the top-back side of your neck.
- With the other hand, grab the hanging towel from the lower back side and stretch it upside down for a certain number of repetitions daily.
- One more movement you can do with the towel is to hold it with both hands on the front side and stretch your chest so that the front anterior deltoid muscle also gets stretched.
Exploring Shoulder Rehabilitation Techniques Post-Surgery
Shoulder injuries after surgeries often necessitate comprehensive rehabilitation to restore function and mobility. Various techniques have been employed with varying degrees of success.
Here are the top five shoulder rehabilitation techniques used post-shoulder surgery compared to pendulum exercises.
Active Range of Motion Exercises
Active range of motion (AROM) exercises are commonly prescribed post-shoulder surgery. They involve the patient actively moving their shoulder through its range of motion without assistance.
The effectiveness of AROM exercises lies in their ability to stimulate muscle activity and improve joint mobility. However, these exercises can be challenging for patients with severe pain or limited strength.
Compared to pendulum exercises, AROM exercises require more effort and active muscle engagement, which may not be suitable for patients in the early stages of recovery.
Battlefield Acupuncture
Battlefield acupuncture is an emerging technique in shoulder rehabilitation. It involves the insertion of semi-permanent needles at specific points in the ear to alleviate pain. This method has shown promising results in pain management post-shoulder surgery.
However, its primary limitation is that it addresses pain rather than improving shoulder mobility or strength. Unlike pendulum exercises, battlefield acupuncture does not directly contribute to functional recovery or increased mobility.
Scapulothoracic Joint Control Training Exercises
These exercises aim to enhance control and stability of the shoulder blade, which is crucial for shoulder function. Scapulothoracic joint exercises have improved rehabilitation outcomes, particularly in patients with shoulder instability.
One limitation, however, is the complexity of these exercises, requiring proper guidance and supervision. In comparison, pendulum exercises are more straightforward to perform but may not provide the same level of scapular control.
Robotic Hybrid Assistive Limb (HAL) Shoulder Exercises
The use of robotic technology in rehabilitation is a cutting-edge approach. Robotic HAL shoulder exercises have shown the potential to improve shoulder function, particularly in patients with severe impairments.
The main drawbacks of this method are its accessibility and cost. Compared to pendulum exercises, HAL exercises utilize advanced technology and may not be accessible to all patients.
Proprioceptive Exercises
Proprioceptive exercises improve the body’s sense of joint position and movement, often impaired following shoulder injuries or surgery. These exercises can enhance stability and reduce the risk of future injuries. However, they require a high level of patient involvement and effort.
Unlike pendulum exercises, proprioceptive exercises are more strenuous and may not be suitable for patients in the early stages of recovery.
In conclusion, while pendulum exercises offer a practical and simple method for early-stage shoulder rehabilitation, other techniques like AROM exercises, battlefield acupuncture, scapulothoracic joint control exercises, HAL exercises, and proprioceptive exercises provide unique benefits and challenges.
The choice of rehabilitation technique should be individualized, considering the patient’s specific condition, recovery stage, and overall health status.
Dr. Brent Wells, Chiropractic and Physical Rehab Expert, Better Health Alaska
FAQ’s
How effective is pendulum exercise after the surgery of the shoulder?
Doing the pendulum exercises right after the day of surgery or during the first week of post-surgery assists the rotator cuff in increasing the blood flow at the affected shoulder.
As the muscles stimulate the inflamed shoulder muscles, they heal the joints and tissues around the shoulder bone. Therefore, pendulum exercises promote the shoulder’s healing process faster.
How does the shoulder get injured or dislocated?
Numerous athletes, sportsmen, and gym-goers are mainly prone to shoulder injuries. Making the shoulder flick in the wrong direction where it is not supposed to move can dislocate the rotator cuff from the collarbone.
Lifting heavy weights and objects without proper technique and direction can also result in shoulder dislocation. In some cases, shoulder injuries are occurred due to accidents as well.
How long does an injured or dislocated shoulder take to heal?
With the rehabilitation of physical therapy and a good nutritious diet, it may almost take 5 to 6 months for the shoulder to recover fully. To heal sooner than the actual healing time, the patient must take care constantly whenever moving while doing daily activities. Proper rest and maintaining solid mental health also speed up the recovery process.
What sort of food is beneficial for the shoulder recovery process?
A diet high in calcium, such as milk, curd, yogurt, and cheese, and high in protein, such as lean meats, is crucial to repairing damaged bone tissues and muscle fibers. Alongside carbohydrates, proteins, and fats, multivitamins and multimineral supplements are also beneficial during recovery.
Is it possible to dislocate the shoulder even after surgery?
Rarely the shoulder can be dislocated if proper precautions are not taken after the surgery. For instance, the joint may move out of alignment if we accidentally hit our affected shoulder with complex objects.
Start Gently and Follow Professional Guidance
Proper technique and caution are paramount when performing pendulum exercises after shoulder surgery to ensure a safe and effective recovery.
One common mistake is performing these exercises too aggressively, which can lead to increased pain or even re-injury. Pendulum exercises should be done gently, allowing the weight of the arm to create movement without forcing the range of motion.
To avoid this mistake, it’s crucial to start slowly, with small movements, gradually increasing as comfort allows, and always following the guidance of a healthcare professional. This cautious approach helps maintain mobility in the shoulder joint without compromising the healing process.
Ananvita Bhattacharya, Owner, WellnessZing
So, When to Start Pendulum Exercises After Shoulder Surgery?
Pendulum Exercises can be done a day or two after shoulder surgery. Most doctors and physical therapists often suggest these exercises. Doing these movements is crucial to avoid shoulder stiffness and prevent muscle loss.
Moving the shoulder in all possible directions stimulates the inflamed area and improves blood circulation. Moreover, it prevents dislocation whenever it hurts from an outside force. Only with the help of our shoulders can we carry out our basic movements throughout the day.
If pendulum or mobility exercises are not done after the deltoid muscle operation, there is a high chance of injury or dislocation. Therefore, physical therapy, shoulder rehabilitation, and a healthy diet are necessary after shoulder surgery.
Guest Author: Saket Kumar
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- Bullock, Garrett S., et al. “A systematic review of proposed rehabilitation guidelines following anatomic and reverse shoulder arthroplasty.” journal of orthopaedic & sports physical therapy 49.5 (2019): 337-346. ↩︎
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