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Prehab vs. Rehab
May 17, 2017


In the most recent issue of the Spinal Cord Injury Saskatchewan's Parascope Magazine, Lee Stevens, one of our Physiotherapists and the Director of Sport Physiotherapy, talks about the benefits of preventative exercise for those wiht spinal cord injuries that experience shoulder pain due to an increased use of their arms.

Here is the article:

Prehab vs. Rehab

Want to maintain good shoulder health? Consider the benefits of a thorough preventative exercise maintenance program. –Lee Stevens, Physiotherapist, Craven SPORT services

For individuals with a spinal cord injury, an increased reliance on one’s arms to transfer, get around, and perform daily activities is inevitable. Shoulder pain and injuries are common in people with SCI due to this increased demand, which can have a devastating impact on quality of life. Shoulder injury prevention, therefore, is critical to maintain function and independence across a lifetime. Don’t wait until you have pain to do something about it. It’s far better to take a proactive or preventative approach and focus on maintaining shoulder health. Rather than trying to regain it once it’s been lost.

Based on its anatomy, the shoulder is a joint with a great deal of flexibility and mobility. Most people know that the shoulder is a ball and socket joint, but what they may not know is how shallow that socket really is. Like a golf ball on a tee, the inherent stability of the shoulder is considerably lower than many other joints. To make up for this, the shoulder relies on surrounding muscles like the rotator cuff to provide dynamic strength and stability of the joint. When this is lacking, the shoulder is left vulnerable to overuse injuries like impingement, tendinitis, and bursitis, which can be particularly debilitating for wheelchair users.

Fortunately, there is plenty that you can do to prevent issues like this. Working on a preventative strengthening program can significantly reduce your risk of developing pain and injury when performed properly. Check out the photos and descriptions for some exercises that you may want to include in your home exercise program. Starting with two or three sets of eight to ten repetitions per side is a good way to start.

Our thanks to Nikita Ens for agreeing to be our model. Nikita is 28 years old and has a C6-7 incomplete injury. Take note of her posture in every picture: her chest is up and her shoulders are back. Maintaining good posture throughout each exercise is critical in order for them to be safe and effective.

Keep in mind that these exercises are not a one-size-fits-all package. The types of exercises that are going to be right for you, as well as the equipment and modifications required, will depend on a number of factors, including level of injury, hand function, postural control, spasticity, and others. I encourage you to seek out the care of a physiotherapist to help you develop an individualized plan that’s tailored to your needs. If you’re having any shoulder pain with the exercises outlined here, stop and consult your doctor or physiotherapist before continuing.

  1. Shoulder External Rotation: Anchor band to doorknob. Wrap band around hand. Elbow bent to 90 degrees. Rotate hand outwards, keeping elbow by your side.
  2. Shoulder Internal Rotation: Anchor band to doorknob. Wrap band around hand. Elbow bent to 90 degrees. Rotate hand inwards, keeping elbow by your side.
  3. Shoulder Diagonal Raise: Wrap band around one hand. Hold the other end by your opposite hip. Raise hand up and out to the side, as if drawing a sword from your belt.
  4. Shoulder Abduction: Anchor band under one wheel of your wheelchair. Arm straight down by your side. Raise arm to shoulder height, leading with the thumb.
  5. Tricep Press: Anchor band under one wheel of your wheelchair. Arm is up with elbow bent. Straighten your elbow towards the ceiling.
  6. Bicep Curl: Anchor band under one wheel of your wheelchair. Arm down by your side. Bend elbow, bringing hand towards your shoulder.
  7. ‘W’ Exercise: Wrap band around each hand and hold it close to your chest. Squeeze shoulder blades down and back as your arms form a ‘W’.
  8. Chest Press: Wrap band around each hand and loop band around back of your wheelchair. Press hands straight forward.

Motivation is what gets you started, habit is what keeps you going.

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