WINNIPEG KYOKUSHIN KARATE - DOJO ENTHEOS

UPPER BODY STRENGTHENING PROGRAM EXERCISES

Additional Learning

Upper Body Strengthening Program

General instructions

  1. Equipment. Depending on which exercise(s) your therapist and doctor give you, you may need weights or a wooden bar. Use disc weights (donut weights-the kind with a hole in the center) or small dumbbell weights for these exercises. You will need 1/2 pound increments ranging from 1/2 pound to 6 pounds. This equipment can be purchased from many sporting goods stores. Dowel rods can be cut to your specifications at any lumber yard.
  2. Wear your brace or sleeve if your doctor has prescribed one while doing the exercises.
  3. Determine the maximum amount of weight your unaffected arm can lift in each exercise by performing each with the most weight you can handle. If the exercise seems easy, do it again with more weight. Record this maximum weight for each exercise that the unaffected arm can lift. This is the goal you work toward with the injured arm.
  4. Exercise the weaker arm once a day, every day. Perform the exercises slowly, at a rate of one repetition per second.
  5. Start exercising the weaker arm with a weight that will allow you to barely complete the prescribed number of repetitions because of fatigue. If the exercise seems easy, add more weight next time. If the exercise is too difficult, decrease the amount of weight next time. Over time, as the exercises become easier, increase the amount of weight by 1/2 pound. Do not add more repetitions, but continue to increase weights as you get stronger.
  6. These exercises are designed to be performed pain free. if you experience pain while doing them, decrease the height of the lift and/or the amount of weight you are lifting. The generalized muscle soreness you will feel is normal and should not be confused with joint pain. As you progress with the exercises, the soreness will diminish.
  7. When the weaker arm can lift the same weight as the stronger arm, continue the exercise with both arms to strengthen both of them to their maximal potential. When you have reached this level, perform the exercises every third day.

 

Exercise 1: Shoulder Extension

Lie on your stomach with your hands by your hips. Place a dumbbell or disc weight in the hand of the injured arm. Lower this arm down off the side of the table so that the hand is near the floor directly below the shoulder. Keeping your elbow straight, slowly lift that arm backward toward the ceiling with the palm facing up. Try to keep the front of your shoulder on the table as you raise your arm. Your hand should come up about 2 to 4 inches above the level of the table. Then, slowly lower your arm back to the starting position and repeat this exercise for 2 sets of 10 repetitions. You may rest for 30 seconds between sets. DO NOT CAUSE PAIN. Exercise 1 Image

 

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Exercise 2: Shoulder Flexion

Sit in a straight back chair and hold a weight in the hand of the arm to be exercised. Keeping the elbow straight, slowly lift that hand up in front of the body until it reaches a 90 degree angle directly in front of the shoulder. DO NOT CAUSE PAIN. Slowly lower the arm down to the starting position. This exercise should be performed a total of 20 times. A 30 second rest can be taken after the first 10 repetitions. DO NOT CAUSE PAIN. Exercise 2 Image

 

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Exercise 3: Shoulder Hyperflexion

Lie on your stomach with your arms out in front of you. Place a dumbbell or disc weight in the hand of your injured arm and slowly raise that arm toward the ceiling approximately 4 inches. Keeping your elbow straight, slowly lower your arm back to its starting position on the table. Repeat this exercise 10 times. Rest 30 seconds and repeat 10 more times for a total of 20 repetitions. DO NOT CAUSE PAIN. Exercise 3 Image

 

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Exercise 4: Shoulder Abduction

Stand in front of a mirror. Place a dumbbell or disc weight in each hand. Your arms should be by at your sides with your palms facing in toward your legs. Rotate your palms outward as you slowly raise your arms out to the side of your body 90 degrees. DO NOT CAUSE PAIN. At the top of the lift, rotate your hands back down toward the floor and slowly lower the arms down to your starting position. This exercise should be performed ten times followed by a 30 second rest and a second set of 10 repetitions for a total of 20 lifts. DO NOT CAUSE PAIN. Exercise 4 Image

 

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Exercise 5: Diagonal Shoulder Pattern

Stand in front of a mirror. Place a dumbbell in the hand of the arm to be exercised. Then place that hand in front of the hip of your opposite leg. The palm should be facing in toward the leg. Slowly lift the weight up and away from you diagonally across your body. As you are moving in this pattern, you should allow your hand to rotate so that the thumb is pointing out over your shoulder at the top of the lift. Lower the arm back slowly to the starting position, again rotating the hand to the starting position as you go. Do this exercise 10 times. DO NOT CAUSE PAIN. Exercise 5 Image

 

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Exercise 6: Rhomboid Strengthening

Lie on your Stomach with the hand of your injured arm in the small of your back at your belt level. Your palm should be facing the ceiling with the back of your hand on your spine. Place a small dumbbell or disc weight in that hand and lift it slowly up toward the ceiling. The elbow stays bent and the palm push up away from the belt approximately 2 to 4 inches. Slowly lower your hand back down to your belt and repeat this exercise 10 times. DO NOT CAUSE PAIN. Exercise 6 Image

 

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Exercise 7: Shoulder External Rotation

  1. Prone variation.
    Lie on your stomach close to the edge of a firm table. Your elbow should be at a 90 degree angle to your shoulder, the upper arm resting on the table, ...the forearm and hand hanging over the edge of the table. The hand is directly below the elbow. (it may be a good idea to place a pillow between the table and upper arm for comfort.) Holding a weight in that hand, keep the elbow bent and at the level of the shoulder. It acts as a pivot point to the hand. Lift your hand up toward your head by rotating the shoulder. Slowly reverse this rotation by lowering the hand back down to the starting position. This exercise should be done ten times in a row followed by a 30 second rest and another set of ten repetitions for a total of 20 repetitions. DO NOT CAUSE PAIN.
  2. Side Lying Variation.
    Lie on your side opposite the arm you will be exercising. Allow the elbow of the exercising arm to rest on your waist. The hand of that arm should be holding a weight and resting on the floor in front of your belly-button. Lift the weight up until it is parallel to the floor. The elbow stays bent and in contact with your waist, serving as the pivot point of the movement. Slowly lower the weight back down to the floor. DO NOT CAUSE PAIN.
Exercise 7a Image

Exercise 7b Image

 

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Exercise 8: Shoulder Internal Rotation

Lie on your stomach on a table or firm surface. Your shoulder should be at a 90 degree angle, the upper arm resting on the table, and the elbow and forearm hanging over the edge of the table at a 90 degree angle. (it is a good idea to place a pillow between the table and upper arm for comfort.) Holding a weight in the hand of the exercising arm and keeping that elbow bent to a 90 degree angle, slowly bring the hand up to the rear to the level of your hip. Then slowly bring the arm back to the starting position. This exercise should be done ten times in a row followed by a 30 second rest and another set of ten repetitions for a total of 20 repetitions. DO NOT CAUSE PAIN. Exercise 8 Image

 

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Exercise 9: Wall Push-ups

Stand facing a bare wall approximately 1 foot away from it. Reach both arms out in front of you to touch the wall. Let your palms rest firmly on the wall. Your elbows should be straight. Move forward or backward in order to feel comfortable with this reach. Slowly bend both of your elbows so your nose comes very close to the wall. Then slowly straighten your elbows back to the starting position. Do this exercise 10 times. When you find this easy, try the same thing but with one arm at a time. DO NOT CAUSE PAIN. Exercise 9 Image

 

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Exercise 10: Supraspinatus Strengthener

Sit in a straight back chair and place , small weight in the hand of the arm to be exercised . This hand should be rotated so that its thumb points to the floor. The elbow should be straight. Keeping this arm at an angle halfway between the front of your body and the side of your body, lift that weighted arm up to the height of your shoulder. Slowly lower the arm back to the starting position. DO NOT CAUSE PAIN. Exercise 10a Image
Exercise 10b Image

 

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Exercise 11: T-Exercise

Sit tall in a straight back chair. Place a disc weight in the hand of the arm to be exercised. Holding the weight with your fingertips directly in front of your shoulder, have the back of the hand face the shoulder. The elbow should be out to the side of the body at shoulder height. Slowly push the weight out in front of your chest, straightening the elbow. Keeping the hand at shoulder height all the time, move the arm to your right and then to your left as if you are "crossing the letter t". The hand should then return to center and in to the starting position of the exercise. This exercise should be performed 10 times each day. DO NOT CAUSE PAIN. Exercise 11a Image
Exercise 11b Image Exercise 11c Image

 

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Exercise 12: Bicep Strengthening

Sit on a chair and hold a dumbbell weight in the hand of the arm to be exercised. Rest the forearm of that arm on your thigh. Keeping the elbow steady as the pivot point of the exercise, slowly bend the elbow so that the weight comes up toward your face. Slowly lower the weight back down to the starting level. Repeat this exercise 20 times with a 30 second rest after ten repetitions. DO NOT CAUSE PAIN. Exercise 12 Image

 

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Exercise 13: Tricep Strengthening

Sit on a chair facing a mirror. Hold a dumbbell weight in the hand of your arm to be exercised. Raise that arm up to a position where the elbow is by your ear and your head is back by your shoulder bone. Keeping your elbow steady as the pivot point of the exercise, slowly straighten the elbow. Then, lower the weight back down to the shoulder by bending the elbow. Do this exercise 10 times. Rest 30 seconds and repeat again 10 more times for a total of 20 repetitions. DO NOT CAUSE PAIN. Exercise 13 Image

 

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Exercise 14: Pulley Exercise

Buy or construct a pulley system and hang off a door or wall mounted hook. Stand facing the pulley system grasping an end with each hand. Keep the shoulders level to each other at all times. With your strong arm, pull your hand down so that the weak arm is stretched up toward the top of the pulley. Slowly reverse the action so the weak arm pulls the strong arm up to the stretched position. Repeat this 10 times on each side. DO NOT CAUSE PAIN. Exercise 14 Image

 

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Exercise 15: Rubber Band Exercise

Place a wide office rubber band around the tips of all five fingers. Spread the fingers apart from each other as far as you can. Slowly release the tension of the rubber band, returning your hand to its starting position. You should do this at least 50 times a day. Very eventually, work up to 200 finger extensions per day. DO NOT CAUSE PAIN. Exercise 15 Image

 

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Exercise 16: Theraband Series

Using the large rubber strip given to you by your therapist, tie the ends of the strip in a knot to form a large circular band. Then try the following exercises:
  1. Stand in front of a secured door and place one end of the rubber band around the doorknob. Hold the other end of the rubber band in your hand. Keeping your elbow flexed at a 90 degree angle, pull your arm back away from the door against the resistance of the band. Release the tension of the band slowly as you return to the starting position. Repeat this exercise 20 times. DO NOT CAUSE PAIN. DO NOT HOLD YOUR BREATH.
  2. Stand with your side next to a secured door. Place one end of the rubberband around a doorknob. Hold the other end of the band in your hand. Push the band forward until you encounter resistance from the band. Slowly release the tension until your arm is in the starting position. This exercise should be repeated 20 times. DO NOT CAUSE PAIN. DO NOT HOLD BREATH.
  3. Keeping your elbows by your sides, bent to a 90 degree angle, place the rubber around your hands in front of your body. Try to pull your hands away from each other thereby placing resistance on the band. Slowly release the tension on the band, allowing your hands to resume their starting position. DO NOT CAUSE PAIN. DO NOT HOLD BREATH.
  4. Stand with your right side by a securely closed door. You should be approximately 18" away from the door. Place one end of the rubber band around the door knob and hold the other end in your hand. Keeping your elbow by your side, pull the band toward your stomach. Slowly release the band, allowing your arm to return to the starting position. The elbow must stay on the waist at all times. DO NOT CAUSE PAIN. DO NOT HOLD YOUR BREATH.
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Exercise 16b Image

Exercise 16c Image

Exercise 16d Image

 

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Exercise 17: Rhomboid/Posterior Deltoid Lift

  1. Lying on your stomach on a narrow table, drop both arms straight down off the table toward the floor. Grasp a dumbbell weight in each hand and lift them up directly to your sides without bending your elbows. Slowly lower the weights down to your starting position. Repeat for a total of 25 repetitions.
  2. Repeat the above exercise 25 more times, but this time bend your elbows as you raise your arms to your sides. DO NOT CAUSE PAIN.
Exercise 17a Image Exercise 17b Image

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Shoulder Range of Motion Exercises

The shoulder is the most flexible joint in the human body. The anatomical structure of this joint enables it to have an incredible amount of freedom or range of motion. The ability to move the shoulder joint in a wide variety of directions is vital for complete functionality in sporting activities.

Increased mobility of the shoulder joint comes at the potential expense of joint stability. Therefore anyone can experience shoulder problems. Active young people, especially children and athletes often develop shoulder injuries. After the age of 25, many individuals develop shoulder pain from the wear and tear of routine activities. Individuals who reach middle age, and use their shoulders frequently in their specific occupation are particularly susceptible to problems. Other groups especially prone to shoulder problems are weekend athletes and do it yourself painters.

Early treatment is imperative for a good prognosis. So, if you have shoulder pain, see your doctor without any hesitation. It is natural to react to shoulder pain by not moving your shoulder, which can lead to complete loss of shoulder mobility. Your doctor may refer you to a physical therapist. After evaluation, an exercise program will be designed to keep your shoulder in motion. One good exercise which can improve motion and decrease shoulder pain is Codman's Exercise or Pendulum Exercise. This exercise may be performed in a prone (face-down) lying position or standing while leaning on a chair with the opposite arm.

 

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[Codman Exercise Image 1] [Codman Exercise Image 2] [Codman Exercise Image 3]

 

PURPOSE:
To relax the muscles in your shoulder. To relieve pain and increase motion.
POSITION:
Lie on your stomach close to the edge of the bed. Let your weak arm hang over the edge of the bed. Relax your shoulder, arm and hand. Let your shoulder blade relax and drop down.
ACTION:
Slowly and gently swing your arm forward and back. Do not use your neck muscles. Relax them. It might be easier to have someone else gently start swinging your arm. As pain decreases, increase your swing. Initially arm swing should begin at 15 degree angles and eventually progress to 30-45 degree angles as pain subsides within time. The duration of the swing should initially be 15 seconds and eventually progress to 3-5 minutes.

 

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[Codman Exercise Image 4] [Codman Exercise Image 5] [Codman Exercise Image 6]

[Codman Exercise Animation]

PURPOSE:
To relax the muscles in your shoulder, in order to relieve pain and to increase motion.
POSITION:
Stand and hold onto a sturdy chair with your good arm. Bend forward at the waist and bend your knees to help protect your back. Relax your weak arm, let it hang limp. Relax your shoulder blade and let it drop.
ACTION:
Keep your shoulder relaxed and use body motion to swing your arm in small circles. Stand tall and relaxed. Repeat motion and change direction of circles. The duration of the circles should initially be 30 seconds and eventually progress to 3-5 minutes. To get a rough idea of the type of motion involved, the image to the side is an animation; if it is not moving, try reloading this page.

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Understanding more about your Shoulder
 

Anatomy

 
This model allows for the position of the bones of the shoulder to be observed in relation to the underlying rib cage. Due to its positioning on the rib cage, the scapula is offset 30 degrees from the frontal plane -- this is called the scapular plane. In the following models, the shoulder is isolated from the rib cage for emphasis -- and the purpose of this model is to show the actual spatial arrangement of those anatomical entities.

It is important to note that the scapula does protract, retract and rotate along the rib cage, and is responsible for much of the motion associated with the shoulder. Furthermore, much of the pathology associated with the shoulder joint may be caused by improper scapular movement.


 
This model displays the anterior view of the shoulder. It is especially good for observing the bones of the shoulder and the origins and/or insertion points of the subscapularis, supraspinatus, and biceps muscles.


 
This model displays the posterior view of the shoulder. In addition to the bony structures shown, this model clearly shows the deltoid, supraspinatus, and triceps muscles.


 
This model is another anterior view of the shoulder. It clearly displays the acromioclavicular, corocoacromial, coraco-humeral, and capsular ligaments, as well as the bones to which they attach. The superior, middle, and inferior glenohumeral ligaments are collectively referred to as the capsular ligaments.


 
This model is another posterior view of the shoulder. The acromioclavicular ligament is more clearly displayed, and the posterior aspects of the capsular ligments may be seen.


 
This picture shows a sagittal cut of the shoulder and displays the major entities of the rotator cuff. This view displays the capsule in which the head of the humerus sits, and the 4 major muscles (i.e. the rotator cuff) that are involved in stabilizing the humerus in its socket (function described in detail below).

 

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Functions of the Components of the Shoulder
 

Acromioclavicular joint
 

bulletCoracoacromial ligament: controls anterior and posterior translation of the lateral clavicle

 
bulletCoracoclavicular ligament: controls vertical stability; restrains superior and anterior displacement

 
bulletAcromioclavicular ligament: provides stability across the joint; restrains posterior translation and displacement of the clavicle
 

Glenohumeral joint
 

bulletCapsular ligaments: joins the glenohumeral joint capsule anteriorly, inferiorly, and posteriorly

 
bulletCoracohumeral ligament: provides stability superiorly, preventing superior translation
 

Muscles of the Rotator Cuff
 

bulletThe four major muscles of the rotator cuff rotate the humerus and properly orient the humoral head in the glenoid fossa (socket). The tendons of these four muscles merge, forming a cuff around the glenohumeral joint.

 
bulletSupraspinatus: abducts the humeral head and acts as a humeral head depressor

 
bulletInfraspinatus: externally rotates and horizontally extends the humerus

 
bulletTeres minor: externally rotates and extends the humerus

 
bulletSubscapularis: internally rotates the humerus
 

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Physical Evaluation of the Shoulder

Range of Motion (ROM) Tests

The following ROM tests should be conducted both actively (patient's own strength) and passively (performed by examiner), and the results should be considered separately. The reason for this is that if the patient is experiencing pain, he/she may restrict movement. Furthermore, the opposing limb should be examined in an identical fashion in order to evaluate bilateral symmetry. Note that all pictures shown here are performed passively, unless specifically noted as active.


 

External Rotation

The patient is positioned sitting and the elbow is flexed 90 degrees. While the elbow is held against the patient's side, the examiner externally rotates the arm as permitted.

Internal Rotation

The patient should be positioned sitting. Again with the elbows at the patient's side, the examiner should raise the thumb up the spine, and record the position in relation to the spine (reaching T7 is normal, unless bilateral symmetry is observed).

Internal Rotation at 90 degrees of Forward flexion

The patient is positioned sitting with the elbow and shoulder supported to prevent muscle contraction. The arm is at 90 degrees with the fingers pointing downward and palm facing posteriorly. The examiner attempts to rotate the forearm posteriorly as far as possible.

Forward flexion

The arm is kept straightened and brought upward through the frontal plane, and moved as far as the patient can go above his head. Note: for recording purposes, 0 degrees is defined as straight down at the patient's side, and 180 degrees is straight up.

Shoulder Abduction: Active Test

The arm is again kept straightened, while raised and abducted. Observe the twisting of hand -- facing outward, not forward, as in forward flexion. The ROM is measured in degrees as decribed for forward flexion. As pictured, this test is being done actively by the patient, but may be performed by the examiner as well.

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Acromioclavicular (AC) Joint Testing
 

Palpation of AC Joint

The patient's arm is kept at his side and the examiner palpates the AC joint for discomfort/pain and gapping.

Cross-Arm Horizontal Adduction Test


The patient places his hand on the opposite shoulder, while the examiner exerts force horizontally. Again, the presence of pain indicates possible pathology.

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Glenohumeral Laxity and Apprehension
 

Apprehension Test

Have the patient in the supine position, with the arm abducted 90 degrees. Rotate the shoulder externally by pushing the forearm posteriorly. If patient feels instability, they typically will balk when the test is performed.

Laxity Test

Have the patient in the supine position. Stabilize the scapula, and slide the humeral head anteriorly and posteriorly within the glenoid fossa to evaluate the stability of the joint. Note the axial load being applied to the elbow.

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Impingement Tests
 

Impingement Test

Position the patient sitting. Internally rotate the arm with the thumb facing downward, and abduct and forward flex the arm. If impingement is present, the patient will experience pain as the arm is abducted.

Hawkin's Test

Position the patient standing with the shoulder abducted 90 degrees, and internally rotate the forearm. The presence of pain with movement is indicative of possible pathology.

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Strength Tests
 

External Rotator Cuff (RC) Strength

Position the patient sitting, with his arms at his sides and elbows at 90 degrees. It is important to maintain the elbow positioning at the sides while the external rotation is attempted by the patient (the examiner applies internal resistance).

Internal RC Strength

Same as above, but the patient is attempting to rotate internally (and examiner resisting externally).

Supraspinatus Strength

The patient is positioned sitting with arms straight out, elbows locked, thumbs down, and arm at 30 degrees (in scapular plane). The patient should attempt to abduct his arms against the examiner's resistance.

Palpation of Bicipital Groove

Position the patient sitting, beginning with the arm straightened. The patient should then flex his arm to contract the biceps muscles. The examiner palpates the bicipital groove to attempt to illicit pain.