Shoulder flexion and shoulder extension are key gross movements of shoulder girdle. Shoulder girdle complex is a combination of three synovial joints and two functional articulations. Glenohumeral joint is the main joint of this complex. it can do the all shoulder movements into some range and then other joints involve to improve the range. Glenohumeral joint is a synovial type, ball and socket joint. This joint is formed by articulation of glenoid cavity of scapula(socket) and head of the humerus(ball).

Shoulder girdle has great mobility. That is why it can do many movements into high range. Shoulder flexion, Shoulder extension, Shoulder abduction, Shoulder adduction, Shoulder internal rotation and external rotation are the all gross movements of this complex.

During these movements, how to keep the stability? Ligaments, muscles surrounding the joint(rotator cuff muscles), coracoacromial arch and glenoid labrum are the answer for that. they maintain the ball in the socket in any movement.

Shoulder flexion

Basically, when you move your arm forward and medially towards the head is shoulder flexion. There are four muscles involve to do the movements.

Main muscles

Accessory muscles

Pectoralis major muscle (clavicular head)

Coracobrachialis muscle

Anterior fibers of Deltoid muscle

Short head of Biceps brachii muscle

The normal range of motion for shoulder flexion is 1800.

How to measure this range correctly.

We can’t do it by individually. We can measure other person’s movement range by using a equipment called goniometer. Before take the measurement, we have to position the person. This is very significant measurement those who can’t go to their maximum range due to someone fracture or pain. It is vital to take the daily improvements of joint motion. Normally, this is done by a physiotherapist in hospital

Step 1 – The person/patient is in a sitting on a chair position or head up lying position on a bed and his arm is at the side with palm facing medially

Step 2 – The therapist places one hand on the axillary border of the scapula to stabilize the scapula.

Step 3 – Then, therapist move the arm forward (if person can move arm without pain, he can do it actively, sometimes they measure it both actively and passively. During the passive movement therapist grasp the distal humerus.

Physical therapist gets this measurement 3 times and then he takes an average as final ROM of shoulder flexion.

Shoulder extension

If you want to do shoulder extension movement, you have to move your arm backwards and laterally towards the head. Shoulder extension takes place in a plane parallel to the surface of the glenoid cavity of scapula

There are four muscles contribute to perform the shoulder extension

Main muscles

Accessory muscles

Posterior fibers of the deltoid muscle

Teres major muscle

Latissimus Dorsi muscle

Long head of Triceps brachii muscle

If you are a healthy adult, The normal range of shoulder extension is 600.

How to measure this range correctly.

As I mention earlier, we are able to measure the shoulder extension

Step 1 – The person/patient is in a sitting on a chair position or head down(prone) lying position on a bed and his arm is at the side with palm facing medially

Step 2 – The therapist stabilizes the scapula.

Step 3 – Then, therapist move the arm backward (if person can move arm without pain, he can do it actively, sometimes they measure it both actively and passively. During the passive movement therapist grasp the distal humerus.

Like shoulder flexion movement, Physical therapist takes this measurement three times and get the average for a better result.

Exercises for shoulder flexion and extension

Warm up & Cool down

Before you start the exercises, it is significant to do some warm up exercises like jogging, walking or riding a bicycle to activate your muscles.

After the exercises, you should do some light cardio exercises like walking, jumping jacks in low intensity and do some stretching exercises for being normal after the strengthening exercises.

Stretching exercises

  1. Exercises for Improving shoulder flexion.
  • Cross chest stretches
    • Stand or Sit on a chair
    • hold your stretching arm above your elbow using your other hand
    • Pull the arm across your body toward your chest and when you feel a stretch hold 30 seconds at that position and release it
    • Do 3 times for one set
    • You can do it for other hand also
  • Table edge stretching
    • Sitting with the involved sidenext to the table, forearm resting along the table edge
    • elbow slightly flexed position
    • you should slide theforearm forward along the table while bending from the
    • After moving the head till the level of shoulder, you have to keep that position 30 seconds
    • Then release the pressure, come to starting position and once again do it.
    • Do three times for 1 set
    • Change your arm and stretch it as well
  1. Exercises for improving Shoulder Extension
  • Towel or Wand exercise
    • Sitting or standing
    • hold each end of a towel (or wand) with one armoverhead and the arm to be stretched behind the lowerback
    • then pull up on the towel with the overheadhand
    • It is good to do it 3 times for one set with 30 seconds hold.
  • Triceps stretching
    • Stand upright inside a doorway while facing a doorjamb, with the doorjamb in line with the right shoulder.
    • Place feet shoulder-width apart, with the toes pointing straightforward.
    • Bring the left arm across the body toward the right shoulder.
    • Pointing the thumb down, grab hold of the doorjamb at shoulder level.
    • Rotate the trunk in until you feel a stretch in the posterior left shoulder.
    • Repeat these steps for the opposite arm.

strengthening exercises

After you stretching the muscles, you can do some strengthening exercises for improving Shoulder movements. If you have pain in shoulders, it is good to do only against gravity movements. After you feel good and confident, you can use some resistance for your exercises. Physician normally advise healthy people to do exercise with Dumbbells and Thera bands.

If you want to strengthen your shoulder flexor muscles of both hands you can hold dumbbells with suitable weights and do the shoulder flexion. As well as you are able to strengthen your shoulder extensor by doing the shoulder extension with dumbbells. Those are called isotonic exercises since the muscle length is changed. But you also can-do isometric exercises using a wall. Go close to a wall and try to do the movement, when you try to do it by your maximum force, the muscles which involve to do shoulder flexion and extension is strengthened. But here we cannot see changing of muscle length.

But, if you are suffering from shoulder pain, first you should do the anti-gravity movement and after you confident about it, you can apply mild resistance by your other hand. However, you must need a physician’s advice to do so.

 

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