среда, 27 апреля 2016 г.

Shoulder Exercises for Arthritis

Any type of arthritis in the shoulder can cause severe shoulder pain and limit mobility, making physical activity challenging. However, not exercising the shoulder can result in muscle atrophy, joint instability, further joint degeneration, and possibly a frozen shoulder (adhesive capsulitis).
Under the guidance of a health professional, many people with shoulder arthritis can benefit from a comprehensive program of shoulder exercises that includes:
  • Shoulder stretches to encourage flexibility in the shoulder joint and surrounding muscles;
  • Shoulder strengthening exercises designed to build muscle around the shoulder, including the scapular stabilizing muscles, and
  • Low impact aerobic workouts, which promote a healthy blood flow throughout the body, including the shoulder joints.

This article provides specific sets of exercises for shoulder stretches, strengthening, and low impact aerobic activities for those with arthritic shoulders.

Benefits of Shoulder Exercises

 
Stretching and strengthening exercising together with aerobic workouts can provide multiple benefits, including:
    Reduces pain. Exercise strengthens muscles, and stronger muscles provide better support to joints. One danger of shoulder arthritis is that the individual avoids activities that cause pain or discomfort, causing shoulder muscles to atrophy. By strengthening the muscles surrounding the shoulder, including the rotator cuff and scapular stabilizing muscles, the shoulder’s glenohumeral joint becomes more stable. This stability can help prevent bone dislocation as well as protect bones from impact and friction, thereby reducing pain. Exercise also releases endorphins, the body’s natural painkillers.
    Increases range of motion and function. Shoulder pain can discourage a person from being active, thus compounding the problem of joint pain with stiffness, which leads to increased pain. Regular exercise will help keep the shoulder joint and surrounding muscles limber, thereby increasing shoulder function.
    Supports healthy cartilage. Joint cartilage needs motion and a certain amount of stress to stay healthy. Synovial fluid is stored in cartilage like water in a sponge. When the joint is used, the synovial fluid excretes from the cartilage and delivers nutrients and lubrication to the joint. Synovial fluid is also thought to encourage a healing environment for the joint, thereby reducing inflammation and supporting healthy joint function.
    Helps with weight loss. Exercise combined with a nutritious, low fat diet can help shed pounds. While weight loss is not as crucial for people with shoulder arthritis as it is for people with arthritis in weight-bearing joints (e.g. knee), weight loss can improve overall health and mobility, making shoulder arthritis easier to bear.
    Helps maintain function. Chronic shoulder pain can prevent a person from doing day-to-day tasks or participating in sports and recreational activities. The limitations in everyday activities can be frustrating and sometimes depressing. Exercise - along with perhaps physical modifications - can help those with shoulder arthritis return to many of the activities they love, and engage in everyday routines.

Preparing for Shoulder Exercises

An individual should always work with a health care provider to design an exercise plan that meets his or her specific needs and physical challenges. A well-tailored warm-up and post-workout routine will help maximize the benefits of stretching, strengthening and exercise while minimizing the possibility for pain or injury.
    Warm up: Any exercise routine should typically be preceded by a 10-minute warm-up activity, which increases blood flow and literally warms up the body, making muscles more flexible. A walk or other slow-paced aerobic activity will help warm the body up. For those with more severe arthritis, gentle range-of-motion activities and a warm compress might also be sufficient.
    Post workout: After a workout, some people may need to ice the shoulders (a bag of frozen peas will do) and/or take an over-the counter NSAID medication (e.g. Advil, Aleve) to reduce swelling and relieve discomfort.
If any pain is felt during shoulder exercises, stop and seek advice from a healthcare professional or an appropriately qualified athletic trainer before continuing.

Gentle shoulder stretches are a core part of most shoulder arthritis treatment programs.
The stretches described below can be done once or twice a day. To avoid straining joints is important to maintain the right form and use modifications when necessary. Stretches to maintain the shoulder’s range of movement are important, but stretches to increase range of motion should be undertaken with caution, as they can result in injury.1

Overhead Shoulder Stretch

  • Stand with legs shoulder-width apart.
  • Let arms hang down at each side.
  • Interlock fingers with palms facing down.
  • Keeping fingers interlocked, raise arms up and stretch them over the head with the palms facing toward the ceiling.
Hold the stretch for 20 seconds.
    Modification: Those who are unable to interlock fingers and do this stretch may hold a long pole (such as a broomstick) in both hands and raise the pole overhead, keeping the pole parallel to the floor.

Crossover Shoulder Stretch

  • Stand with legs shoulder-width apart.
  • Raise the right arm parallel to the floor and move it across the front of the body, with the upper arm coming in towards the chest.
  • Placing the left hand on the right elbow, pull the right arm further across the body.
  • The right elbow should be slightly bent, not be locked.
Hold the stretch for 20 seconds and repeat 3 times for each arm.

Towel Shoulder Stretch

  • Stand with feet shoulder-width apart. 
  • Hold a medium-size towel, or a stretchy exercise band, in the right hand.
  • Raise the right arm straight up and slightly behind the head, so that the towel extends down the back. (The right elbow may bend slightly.)
  • Reaching back with the left arm, grab the bottom of the towel.
  • Gently pull the towel upward with the right hand so that the left shoulder is stretched.
  • Hold for 20 seconds.
  • Next, pull the towel down with the left arm so that the right shoulder is stretched.
Repeat using opposite arms, holding the left arm above the head.

References:

  1. Burbank K.M., Stevenson J.H., Czarnecki G.R., Dorfmon J., “Chronic Shoulder Pain: Part II. Treatment” American Family Physician. 2008 Feb 15; 77(4):493-497. Accessed September 2011 via www.aafp.org
Strengthening and conditioning the shoulder muscles increases the muscles’ ability to stabilize the ball-and-socket construction of the main shoulder joint, the glenohumeral joint. Joint stability minimizes the effects and progression of arthritis in the shoulder.

Lateral Raises

Lateral Raises Part 2
Figure 1b:
Lateral Raises Part 2
Lateral Raises Part 1
Figure 1a:
Lateral Raises
Part 1
  • Sit in a straight back chair with a 3-lb weight in each hand and arms hanging down at each side.
  • Rotate arms so that thumbs face outward, away from the body (this position will help ensure tendons do not become irritated).
  • In a slow, controlled manner, gently exhale and raise arms out to the sides. Thumbs should be facing up; elbows should be only slightly bent.
  • When arms are raised parallel to the ground, pause, and then inhale while slowly bringing arms down.
A reasonable goal is three sets of 12. Adjust the amount of weight to add or lessen the level of difficulty. Lateral raises may also be done while standing, with knees only slightly bent (3-5 degrees) and back straight.
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Shoulder Press

Shoulder Press Part 1
Figure 2a:
Shoulder Press
Part 1
  • Sit in a straight-back chair holding a 3 lb. weight in each hand and arms hanging down at each side.
  • Raise upper arms out and parallel to the ground, with elbows bent at 90 degree angles and hand weights up - as if striking a pose to show off bicep muscles.
  • Holding the weights, palms and fingers should face inward toward the body. This is the starting position.
  • From this position, gently exhale while slowly raising the arms and straightening elbows, bringing the weights together overhead.
  • Pause briefly, and then inhale while returning back to the starting position.
  • A straight (not arched) back and contracted abdomen should be maintained throughout this exercise.
Shoulder Press Part 2
Figure 2b:
Shoulder Press
Part 2
A reasonable goal is three sets of 12. Adjust the amount of weight to add or lessen the level of difficulty.
Shoulder presses may also be done while standing, with knees only slightly bent (3-5 degrees). Whether standing or sitting, always maintain back straight and contracted abdomen.





In addition to specific stretching and strengthening exercises, most people with shoulder arthritis will benefit from a regular routine of low-impact aerobic exercise.
Most medical experts recommend an aerobic conditioning program that is tailored to the individual’s situation, including his or her level of arthritis pain and fitness level.

Aerobic Exercise for Shoulder Arthritis

Since the shoulder does not bear weight like the knees and hips, those suffering from shoulder arthritis can walk, jog, and use aerobic gym equipment such as treadmills.
Patients with moderate to advanced shoulder pain and stiffness may find it best to avoid aerobic exercise that involves use of the shoulder, such as using an elliptical trainer or swimming.
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Patients with more advanced symptoms may find swimming too challenging but may try a water aerobics or other water exercise classes. For most, water therapy (pool therapy) is tolerable, affording aerobic health benefits without stressing the shoulder too much.
Exercising while in the water provides advantages, including:
  • Buoyancy, with the support of the water reducing pressure on joints
  • Resistance, requiring muscles to work harder to move (e.g. walking in waist-deep water is more difficult than walking on land).
Many local YMCAs and health clubs have pools and offer water exercise classes designed for people looking for a low-impact workout.
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It is best to gradually increase the intensity of the aerobic workout, ideally in concert with recommendations from a physician or other qualified health professional.
The goal is to incorporate low impact aerobic exercise into one’s daily routine. The US Department of Health and Human Services recommends a minimum of 150 minutes of moderately intense aerobic activity each week, or 30 minutes five days per week. Individuals who can easily meet this goal can then increase the level of intensity of their workout.

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