Exercise therapy for a fracture of the humerus

A humerus fracture is a serious injury. The shoulder joint is the most mobile. His injuries significantly affect a person’s ability to work and activity. Shoulder fractures can be open or closed, with or without displacement. Depending on the location of the violation of the integrity of the bone tissue, the following types of humerus fractures are distinguished:

fracture of the head, surgical, anatomical neck, tubercles;
fracture of the body of the humerus;
fracture of the trochlea, external and internal epicondyles.

After a shoulder fracture, the patient abstains from any activity that causes pain for a long time. Doctors recommend avoiding pulling and pushing movements, lifting heavy objects, and activities that involve raising your arms. Physical therapy allows the healing process to proceed without complications. Rehabilitation specialists at the Yusupov Hospital individually select a set of exercises, taking into account the time and location of the fracture, the patient’s condition and the presence of concomitant diseases. To speed up the recovery of upper limb function, physiotherapists provide complex treatment, including massage and electrical procedures.

At the Yusupov Hospital, all conditions have been created for the rapid recovery of patients with a fracture of the humerus. Exercise therapy for a shoulder fracture begins as soon as possible. Patients perform exercises under the guidance of a senior exercise therapy instructor. During rehabilitation, patients are consulted by a neurologist and traumatologist. Rehabilitation specialists use innovative methods of physical rehabilitation.

Physical therapy for a humerus fracture

Exercise therapy after a shoulder fracture is carried out at the immobilization stage of treatment, in the first 3 weeks after the fracture. Rehabilitation specialists at the Yusupov Hospital individually select a set of physical exercises, which the patient performs for 30 minutes, 6-8 times a day. The arm must be in a sling at all times, except during activities. Active movements (rotation, flexion and extension, inward and outward rotation) in the hand, wrist and elbow joints stimulate blood circulation in the hand, reduce swelling and reduce the risk of blood clots.

Pendulum-like movements of the arms are excellent for relieving pain at any time. The patient can remove the affected limb from the bandage and, in a standing position, bending forward, make several pendulum-like swings with his hand. Rehabilitators include the following exercises in the exercise therapy complex after a fracture of the humerus:

abduction and adduction of the upper limb or elbow to the body;
crossing your arms in front of your chest;
clap first in front of the chest and then behind the back;
turns the body with hands clasped in front of the chest.

When discharged home, the patient receives a list of exercises that must be done daily.

The weak link in the chain

The critical region of the kinematic chain of the shoulder complex is often overloaded. Implementing effective corrective exercise programs will reverse shoulder dysfunction, help you stand out from your competitors, and help you redirect your traffic to build a client base and contacts with healthcare professionals. A good trainer helps a client recover from injury, while a great trainer will recognize dysfunction before it manifests as injury and know how to adjust the program when it does.

Physical therapy after a shoulder fracture

The functional stage of rehabilitation lasts 3-6 weeks. 3-4 weeks after a shoulder injury, the patient is recommended to undergo regular physical therapy exercises. Rehabilitation specialists at the Yusupov Hospital use modern devices from leading European manufacturers to restore limb function. The goal of rehabilitation at this stage is to restore the previous range of active and passive movements. The set of exercises is constantly expanding, but the starting position remains the same.

The patient should strive to gradually straighten the arm and perform exercises while standing without bending forward. He should perform the following physical exercises 4-6 times daily:

raising a straight arm in front of you;
swing your arms forward, backward and to the sides from the starting position “standing with a slight bend forward”;
abducting the arms behind the back with the shoulder blades together (the arms bent at the elbows should first be in front of the chest).

At this stage of recovery, rehabilitation therapists use block simulators. Patients use them to lift and lower the injured limb, and spread their arms to the sides. Therapeutic exercise is complemented by water procedures. The patient is recommended to perform various movements of the limbs in the pool, crossing his arms in front of the chest, and exercises simulating freestyle and breaststroke swimming. Staying in water increases the effectiveness of training, puts additional stress on the muscles, and improves blood circulation in them. Physiotherapists include 10-12 magnetic therapy and balneological treatment procedures in the rehabilitation complex.

Why pain occurs, main reasons

The appearance of pain in the shoulder area is not an independent disease, but a clinical manifestation of the influence of a significant number of different provoking factors, which include:

Aseptic inflammation affecting various structures of the shoulder (nerve fibers, capsule, cartilage tissue of the joint, tendons, muscles).
Joint infection (bacterial arthritis).
An autoimmune process that is the result of a violation of the functional state of the immune system, in which antibodies are produced to the body’s own tissues, in particular to the connective tissue structures of the musculoskeletal system with the development of an inflammatory reaction in them.
Degenerative-dystrophic processes with destruction of cartilaginous structures (arthrosis).
Systematic significant exposure to physical activity.
Previous injuries to the shoulder area affecting various structures (dislocation, subluxation, sprain of ligaments, capsules, fracture of the bone base, severe bruise).

Referred pain may also appear, which is the result of the development of a pathological process of another localization in the body (pain in the left shoulder with angina, referred pain with pathology of the cervical spine on the right or left).

Training stage of rehabilitation

7-8 weeks after a fracture of the humerus, the patient, under the supervision of rehabilitation specialists at the Yusupov Hospital, completely restores the functionality of the injured shoulder and upper limb. Further physical exercises are aimed at strengthening the muscles and fully restoring range of motion. Exercise therapy classes should take place 3-4 times a day. The patient is given a set of exercises, each of which he is recommended to repeat 10-12 times.

Physical therapy at this stage of recovery after a shoulder fracture consists of the following exercises:

raising your arms in front of you from a standing position;
abduction, adduction, rotation, pronation and supination of the upper limb;
hand rests and push-ups;
hanging on a crossbar or wall bars;
manipulations with dumbbells weighing no more than 5 kg and with medicine balls.

Stretching exercises are effective: placing a gymnastic stick or towel behind your back, “walking” your fingers along the wall to the sides and up. These manipulations allow for complete restoration of arm mobility in all directions.

With a rationally selected rehabilitation scheme, complete recovery of a patient with a shoulder fracture occurs in 2-3 months. Only after this do rehabilitation specialists prescribe exercises designed to develop stretching, physical strength, and endurance.

Fabrics and movement

Before looking at the shoulder, let's take a look at the human movement system as a whole. Remember, this is just an overview; trainers need to go deeper into the topic before creating corrective exercise programs for clients with shoulder dysfunction.

Connective tissues have different elastic-viscous properties, greater or lesser density and are designed to withstand everyday stress. Under normal conditions, they respond to load differently depending on the speed, magnitude and duration of the force applied (Magee et al. 2007).

Each type of fabric has its own purpose and unique abilities. Dense connective tissues of bones, ligaments, and tendons are rigid and can only elongate 10% before breaking. Because of their relative inflexibility, dense tissues protect the extremes of the range of motion, but their injuries are widespread. Loose connective tissue is much more pliable. Loose tissues of the joint capsule, muscles, nerves and other sites can elongate up to 80% of their resting state without structural strain (Magee et al. 2007). This is very important for fitness professionals to know, because from the moment the load shifts primarily to the damaged, denser connective tissues, any errors in technique or movement control will significantly increase the risks.

Tissue is damaged when it can no longer withstand the stress and deformation caused by rapid force development, angle, duration and frequency of application. The manifestation of such common consequences of repeated overuse as tendonitis and bursitis of the shoulder is usually preceded by a movement disorder. A good personal trainer can identify these types of problems before they become injury. In this case, exercise therapy can be used to help correct the impaired movement pattern (Sahrmann, 2001).

Physical therapy after a shoulder fracture

Physical therapy for a fracture of the shoulder joint begins 10-14 days after applying the bandage. First, patients perform passive exercises, and then active ones with a further increase in load. The objectives of exercise therapy after a fracture of the shoulder joint are as follows:

restore the range of motion of the injured limb;
restore tissue elasticity;
strengthen the muscular system.

The rehabilitologist creates a set of exercises individually for each patient. First, the patient performs the following exercises:

rocking the upper limb back and forth in the shoulder joint with relaxed muscles, tilting the torso towards the injured arm;
clenching and unclenching fingers;
flexion and extension of the limb at the elbow joints, grasping the lower third of the forearm of the sore limb with the healthy hand.

At the end of the second week, the rehabilitator recommends performing small-amplitude pendulum-like swinging movements to the side, small circles with a straight arm. From the fifteenth day, exercises begin to be used that prepare the arm for lifting to a horizontal level: the amplitude of pendulum-like movements with a straight arm increases, swinging movements of the limb are performed to the side, pushing the sore arm with the healthy arm with short pushes. There are many different exercises for physical therapy for a fractured shoulder joint. The video is on the Internet. Rehabilitation specialists at the Yusupov Hospital do not recommend performing them without consulting a specialist.

The patient can make a slight tilt of the body towards the sore arm, throw the arm behind the back with a slight swinging movement, bending it at the elbow, gradually increasing the amplitude. It is recommended to slowly raise your elbows, reducing the load on the deltoid muscle by resting your palms on your torso. Rotational movements in the shoulder joint are effective when the torso is tilted towards the affected limb (the arm hangs freely with the elbow extended). You can move the elbow to a horizontal position with the support of the healthy limb on the lower third of the forearm of the injured arm. When performing this exercise, the sore arm should be bent at the elbow joint at an acute angle.

Rehabilitation specialists at the Yusupov Hospital will draw up an individual plan for physical therapy after a fracture of the humerus. To effectively restore limb function, rehabilitation clinic specialists use modern simulators and proprietary techniques. Call the Yusupov Hospital and the coordinating doctor will make an appointment for you with a doctor.

Grade

The assessment will provide us with information to develop a personalized program. Apply individual clauses correctly; Invest in good education to understand assessment protocols. Correlate results from multiple assessments (cluster testing) to provide an accurate picture of the position, structure and function of the shoulder complex. The following types of assessment are recommended (Clark & Lucett, 2010):

Static posture assessment
Assessment in transitional provisions
Assessment of dynamic movements.

When performing a static assessment, look at the five main load-bearing joints at the front, side and back. Look at the ankles, knees, pelvis, shoulders and head - the five control points of the kinetic chain. A simple assessment of transitional positions: the Appley touch test or the shoulder rotation test can help determine movement asymmetries and also to some extent assess thoracic mobility (Clark & Lucett 2010; Cook et al. 2010).

Other options for assessing transitional positions include the overhead squat test, the push-up or press test, and the pull-up or deadlift test, which shows how the shoulder complex is integrated into the movement of the rest of the kinematic chain (Clark & Lucett, 2012). When assessing overhead stick squats, have the client start in a neutral position and observe 5 to 10 repetitions performed from the front, side, and back. Also note the asymmetries and compensations in motion in other regions of the kinetic chain.

Each assessment is an exercise and each exercise is an assessment. Watch the client perform presses and rows, such as a standing crossover press or a lunge resistance band row. Change your observation point every few reps and keep an eye on all 5 control points. Watch for lifting of the shoulder girdle, flexion of the thoracic region, extension of the neck, or hyperextension of the lower back. If the client performs the movement well, demonstrating sufficient stability and mobility, increase the difficulty of the exercise. Additional information can be found in the Clinic Assessment and Corrective Exercises appendix.

Contraindications

It is not always possible to carry out physical therapy exercises during rehabilitation in full. At some points during training, the process of accelerating recovery itself can lead to aggravation of the existing problem.

You should resort to exercise therapy only if the following contraindications have not been identified:

A feeling of severe pain in the shoulder girdle, which only intensifies with any movement;
The presence of infectious diseases present during an exacerbation;
A sharp increase in temperature caused by hyperthermia;
Detection of a disease such as diabetes in a person;
If the anamnesis shows the presence of a cardiac disease, because all the loads force the heart to work at a faster pace.

Rehabilitation for injuries to the shoulder part of the body is an indispensable condition for more quickly restoring the functionality and performance of the injured limb, allowing you to return to your normal lifestyle as soon as possible.