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Table 2 Description of the therapeutic exercises

From: Dry needling in a manual physiotherapy and therapeutic exercise protocol for patients with chronic mechanical shoulder pain of unspecific origin: a protocol for a randomized control trial

Name and description Dose Weeks performed
Non-weight-bearing scapulohumeral stabilization exercise (CKC)
Standing; 90° shoulder flexion and hands resting on the wall. Slow scapular movements down towards the midline of the back. The physiotherapist will give tactile stimuli for activation of the lower trapezius and serratus anterior. In the 3rd and 4th weeks, more weight will be placed on the arms by tilting the trunk.
3 sets × 8 reps
4 sets × 5 reps
1st & 2nd
3rd & 4th
Scapulohumeral stabilization (OKC)
Standing; arms relaxed. Combined movements of lifting, retropulsion and lowering of both shoulders. During retropulsion and lowering should, shoulder blades should be stabilized in the dorsal midline.
3 sets × 10 reps 1st & 2nd
Anterior and posterior flexibilization of the joint capsule
Anterior flexibilization; standing with hand and forearm leaning on a doorframe, the ipsilateral leg forward and the trunk tilted forward until a feeling an anterior stretching sensation, without pain.
Posterior flexibilization, lateral decubitus of the affected side, shoulder and elbow at 90 degrees of flexion. From this position, the arm is brought towards the stretcher with the help of the other hand, until feeling posterolateral stretching without pain.
30 s × 3 times (each stretch) 1st & 2nd
Codman’s exercise
Standing; trunk tilted forward with the unaffected arm supported on a high surface. Affected arm should be relaxed and fall freely. With the help of the unaffected hand, perform passive swing movements, avoiding muscle activation of the affected arm.
3 sets × 25 reps 1st & 2nd
Proprioception with a fitball
Sitting, with the affected arm stretched and continuously supported on the fitball, perform side, anterior and diagonal movements, helping by tilting the trunk.
2nd set with closed eyes. 3rd set with destabilization thrusts on the fitball.
2 reps each movement. Until completion of 1 set. 1st & 2nd
Self-paced shoulder flexion and abduction
Standing; hands apart at shoulder level, holding a wooden stick. Flexion; arms extended to AROM without pain, in a controlled manner. Abduction (affected side); arms extended to end range without pain arms, in a controlled manner. If there is discomfort or lack of strength during the exercises, complete the ROM with the help of the other arm. On the descent of both movements, scapular control will be required.
3 sets × 8 reps (each movement) 3rd & 4th
Active shoulder flexion using a fitball
Standing; hands resting on a fitball against the wall and leaning forward. Active flexion movements alternating both arms, rolling the fitball along the wall to reach the maximum flexion of the affected shoulder without pain.
3 sets × 6 reps 3rd & 4th
Standing; arms stretched at 90° abduction and 30° horizontal flexion. External rotation movements of the shoulder and lowering of the scapula.
4 sets × 10 reps 3rd & 4th
Scapulohumeral stabilization using weights (OKC)
Standing; leaning against the wall. Horizontal bending movements (from 90° to 0°) holding a dumbbell of 0.5 or 1 kg according tolerance in each hand. During movement take both scapulae to the midline of the back in a controlled manner.
3 sets × 8 reps 5th & 6th
Strengthening of the rotator cuff and scapular muscles (Theraband)
Flexion, extension and abduction; in the standing position, with the arm extended and holding the band with the hand of the affected arm and holding the other end with the ipsilateral foot, will perform the exercises: [1] flexion, [2] extension and [3] abduction to end AROM without pain. During the abduction return movement, the patient will be instructed to control the internal rotation and scapular adduction movement. External and Internal rotation; in the standing position, with a towel between the body and the affected arm, shoulder at 0° flexion and elbow at 90° flexion, gripping the band with the hand of the affected arm and securing the other end to the doorknob, will perform the exercises: [4] external rotation and [5] internal rotation to AROM without pain.
Flex. & Abd.; 3 sets × 8 reps // Ext., Rot. Ext. & Int.; 3 sets × 10 reps 5th & 6th