eappendix 1. Cervical Rotation Hold stretch 15 seconds. Do 3 times on each side.

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This supplementary digital content is from:

Top Spinal Cord Inj Rehabil 2013;19(4):311-323

www.scijournal.com doi: 10.1310/sci1904-311

• This exercise stretches tight muscles in the neck.

• Slowly turn your head to the right as if you are going to look over your shoulder.

• When you have gone as far as you can easily go without forcing, hold this position for 15 seconds, relaxing your shoulders as you hold.

• Return to the start position, looking straight ahead.

• Now slowly turn your head to the left, hold for 15 seconds, relaxing your shoulders as you hold.

• Repeat 3 times on each side.

In order to diminish pain in the shoulder region, we are asking you to perform 5 stretching exercises and 4 strengthening exercises daily (5-7 days a week).

Start with the stretches and then complete the strength exercises.

We will give you a log to keep a daily record of the exercises. Please keep accurate records.

If you have any question regarding any of these exercises or recording data in the logbook, please call: _____________________

Stretching Exercises

You should feel some tension in the muscle with a firm prolonged stretch, but never a sharp pain. STOP if you feel a sharp pain!

1. Cervical Rotation Hold stretch 15 seconds.

Do 3 times on each side.

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• This exercise stretches tight muscles at the side and back of the neck.

• Start by looking straight ahead, with your shoulders relaxed.

• Keep looking straight ahead (nose pointing forward), leave both shoulders relaxed, and tilt your right ear toward your right shoulder. Do not force your head to the right, just relax and let the weight of your head do the work. Hold for 10 seconds.

• Leave your head tilted to the right, and slowly roll your chin down toward your right shoulder and hold for 10 seconds.

• Return to the start position and relax.

• Repeat to the other side, tilting your left ear toward your left shoulder.

• Repeat on 3 times on each side.

The following stretching exercises are done with the wheelchair positioned in the doorway so that the arm to be stretched will just fit behind the door jamb without having to lean forward or backward in the wheelchair.

3. Biceps Stretch

Hold stretch for 20-30 seconds.

Do stretch 3 times with each arm.

• Position arm at a 45-degree angle down, elbow straight and thumb up.

2. Lateral Head Tilt

Hold stretch 10 seconds in first position (A) and 10 seconds in second position (B).

Do 3 times on each side.

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• Place lower forearm against doorjamb. You may hold onto the doorjamb if this helps.

• Rotate wheelchair away from arm until you feel a stretch in the biceps muscle.

• Repeat for 3 repetitions, hold the stretch for 20 to 30 seconds each time.

• Repeat with the other arm.

4. Pectoral Stretch A

Hold stretch 20-30 seconds.

• With elbow at shoulder height and bent to 90 degrees, place forearm on doorjamb, making contact from elbow to wrist.

• Lean slightly forward until a firm stretch is felt in the chest region and hold.

• Repeat for 3 repetitions, and hold the stretch for 20 to 30 seconds each time.

• Repeat with the other arm (or you may stretch both arms at the same time).

5. Pectoral Stretch B

Hold stretch for 20-30 seconds.

• Position arm at a 45-degree angle up in the air, elbow straight, thumb up.

• Place forearm against doorjamb. You may hold onto the doorjamb if this helps you.

• Rotate chair away from arm until you feel a stretch in the chest muscles.

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• Repeat for 3 repetitions, and hold the stretch for 20 to 30 seconds each time.

• Repeat with other arm.

• If this arm position is painful, use a lower arm position.

Strength Exercises

All strengthening exercises are done one arm at a time with an elastic band tied on a doorknob or with a knot in the end and shut in a door. Hold onto the other end of the elastic band. If it is easier for you, you can tie a loop in this end and slip the loop around your wrist. Position wheelchair far enough away from the door to take up any slack in the elastic band. It is important to go slow as you perform each movement and return slowly to the starting position.

STOP if you feel a sharp pain. While performing these exercises you may feel fatigue, but never a sharp pain.

1. Scapular Retraction – Rows Reps: ________

Sets: ________

• Hold elastic band out in front of you with arms straight.

• Pull one arm back in a rowing motion, squeeze shoulder blades together.

• Keep the other arm still to secure the band.

• Hold for a count of 3, then return slowly to the starting position.

• Perform 1 set of 5 repetitions and then repeat with other arm.

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2. External Rotation Reps: ________

Sets: ________

• Turn wheelchair so that you are at a 90-degree angle to the door.

• Hold elastic band in hand that is farthest from the door.

• Place yourself far enough away so that the band’s tension allows your hand to rest on your abdomen with your elbow bent to a 90 degree angle, with your elbow at your side.

• Keeping your elbow at your side and bent at 90 degrees. Pull your wrist away from the door and bring your wrist as far as you can toward the opposite side.

• Your elbow should stay bent at 90 degrees and at your side throughout the motion.

Perform 1 set of 5 repetitions and then repeat with other arm.

3. Shoulder Adduction Reps: ________

Sets: ________

• Position your wheelchair so that you are at a 90-degree angle to the door.

• Secure elastic band in doorway as high up in the door as you can reach.

• Hold the elastic band in the hand that is closest to the door with your arm out straight.

• Pull your wrist down toward your side while keeping your elbow straight.

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4. Shoulder Extension Reps: ________

Sets: ________

• Keep the elastic band in the same position as in previous exercise.

• Hold elastic band in one hand, starting at shoulder height.

• Pull your wrist down toward your side while keeping your elbow straight.