Scapular Mobilization

Question: Hi there! I am an occupational therapist (recently graduated) currently working in an inpatient hospital. I have a stroke patient who is experiencing severe shoulder pain with motion over 90 degrees (she has voluntary movement). I believe she lacks the scapular control and I think I am just adding to the problem by having her perform activities over this range, which is just crushing and pinching soft tissue and muscle. What are some good scapular mobilization exercises I could perform or assist her in strengthening these muscles?

Answer: An activity that I like to do with stroke patients (as long as they don't have back problems) is as follows:

1. Have the patient lie on their back with knees bent and both arms out to the side at approximately 45 degrees of abduction. Instruct the patient to to roll his or her knees side to side.

2. As the patient becomes comfortable with the above movement, move their arms further into abduction to approximately 90 degrees (arms straight out to sides) if tolerated without pain.

3. After rocking the knees side to side, ask the patient to roll onto their affected side with the affected arm out in front of them. Have them gently rock back and forth mobilizing the affected scapula. Return to supine and repeat three to five times.

4. Next, ask the patient to lie on their back and perform serratus anterior strengthening by doing scapula (or straight arm) punches. This is done by keeping the shoulder flexed to 90 degrees and lifting the shoulder blade off the mat and back down 10 times while keeping the elbow straight.

5. Finally, have the patient do self passive range of motion into shoulder flexion up to 90 degrees, then into full range of motion as able, and then into external rotation by placing both hands behind the head and relaxing in that position for 15-20 seconds. Have patient do range of motion in pain free range only.

If the above activity hasn't alleviated the pain, then I roll the patient onto their non-affected side (or have them sit up) and mobilize the scapula myself via NDT techniques. Youtube is actually a useful source for finding videos regarding mobilization techniques. Some of the therapy schools have videos of their instructors demonstrating techniques to students. Hope that helps.