My company makes overdoor shoulder pulley exercise equipment for use
in physical therapy with people recovering from accidents or shoulder
surgery.  Often I am asked if there have been any studies verifying
that this exercise improves shoulder range of motion.  Can you help me
find several citations of clinical tests concerning shoulder pulley
exercise and its affect on range of motion?

---

Request for Question Clarification by rbnn-ga on 01 Nov 2002 14:12 PST

Is the comment sufficient answer?

---

Clarification of Question by robertleeallen-ga on 02 Nov 2002 07:21 PST

Good job with a quick and thorough response.  rob allen

Dear Rob Allen, 

I am very pleased that my research meets your needs and I am posting
it as the official answer.

The following studies and clinical trials address shoulder pulley
exercise and its affects on range of motion:

----------------------------------------------------------------------

Publication Type: Clinical Trial 
Orthopedics 1998 Nov; 21(11):1181-4 

Electromyography of the shoulder: an analysis of passive modes of
exercise by Dockery ML, Wright TW, LaStayo PC.
Department of Orthopedics, University of Florida, Gainesville 32610,
USA.

A short excerpt:

“(..) Ten healthy volunteers underwent EMG to investigate the relative
activity of the rotator cuff muscles during various exercises used
postoperatively following shoulder surgery.

The exercises tested were continuous passive motion machine (CPM),
pulley, pendulum, self-assisted bar raise using the contralateral arm
for power, self-assisted internal and external rotation,
therapist-assisted elevation in plane of the scapula, and
therapist-assisted internal and external rotation.”

The relative activity of the supraspinatus, infraspinatus, anterior
deltoid, and trapezius muscles were measured and expressed as a
percentage of maximal activity.”

For all muscle groups tested, the pulley exercise showed significantly
more activity than the CPM machine.

In the supraspinatus muscle, the pulley exercise averaged 17.6% of
maximal activity and 8.7% for the self-assisted bar raise using
contralateral arm power compared with 5.0% for the CPM machine.”

Source: National Center for Biotechnology Information - National
Library of Medicine
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9845449&dopt=Abstract

----------------------------------------------------------------------

Publication Type: Clinical Trial 
Changgeng Yi Xue Za Zhi 1999 Mar;22(1):37-43

Timing of shoulder exercise after modified radical mastectomy: a
prospective study by Chen SC, Chen MF.
Department of Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan,
R.O.C.

Although this study relates to radical mastectomy surgery, the results
show that the range of motion of the shoulder was slightly limited in
the patients that did not perform pulley and other exercises.

“(..)From 1994 through 1995, 344 consecutive patients were randomly
divided into three groups.

One hundred sixteen patients in the early group performed upper arm
exercises including pendulum, wall climbing and pulley exercises
beginning the third post-operative day.

One hundred fifteen patients in the later group patients did the same
exercises beginning the sixth post-operative day and 113 patients in
the delayed group did the same exercises after all the drains were
removed.(..)

Although the range of motion (ROM) of the shoulders in the delayed
group patients was slightly limited during the first month after
operation, ROM returned at 3 months and no difference was found 6
months after operation. (..)”

Source: National Center for Biotechnology Information - National
Library of Medicine
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10418208&dopt=Abstract


----------------------------------------------------------------------

Additional information that may interest you:

While searching I located this study which demonstrates that the
overhead pulley should be avoided during rehabilitation of stroke
patients.

Publication Type: Controlled Clinical Trial 
Am J Phys Med Rehabil 1990 Aug;69(4):205-8

Shoulder pain in hemiplegia. The role of exercise.
Kumar R, Metter EJ, Mehta AJ, Chew T.
Department of Rehabilitation Medicine Service, Veterans Administration
Medical Center, Sepulveda, California 91343

“The objective of this study was to analyze the occurrence of pain in
patients treated with one of the three exercise programs commonly used
in the rehabilitation of hemiplegia: 1) range of motion by the
therapist, 2) skate board and 3) overhead pulley.(..)Use of overhead
pulley has the highest risk of developing shoulder pain and should be
avoided during rehabilitation of stroke patients.”

Source: National Center for Biotechnology Information - National
Library of Medicine
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2383382&dopt=Abstract

----------------------------------------------------------------------

Scand J Rehabil Med 1985;17(3):129-40 

Shoulder externally rotating exercises with pulley apparatus. Joint
load and EMG by Harms-Ringdahl K, Arborelius UP, Ekholm J, Nemeth G,
Schuldt K.

The method described might be used to find optimal designs of shoulder
external rotation exercises with special regard to avoiding
unintentional overloading of joint structures weakened by disease or
trauma.

“The mechanical load on the gleno-humeral joint and the muscular
activity during shoulder external rotation resisted by a pulley
apparatus were analysed using normalized, low-pass-filtered EMG
recorded from the infraspinatus, deltoid, pectoralis major and
trapezius muscles. The load moment about the longitudinal axis of the
joint was compared with the distribution of maximum muscle moment over
different angles throughout the range of motion. The effect of subject
positioning on the joint load and the muscular activity was studied.

The best adaptation between the curves for load moment and maximum
muscle moment was obtained when the subject was positioned sitting
with the pulley located 20 degrees posterior to a frontal plane
through the shoulders at a distance of 1.3 m from the joint.”

Source: National Center for Biotechnology Information - National
Library of Medicine
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=4059885&dopt=Abstract

----------------------------------------------------------------------
Shoulder and Upper Extremity Impairments, Activity Limitation
And Physiotherapeutic Exercise in Women with Rheumatoid Arthritis
A biopsychosocial approach byCarina Boström
From the Division of Rehabilitation Medicine
Department of Public Health Sciences
Karolinska Institutet, Stockholm, Sweden 2000
http://diss.kib.ki.se/2000/91-628-4192-0/thesis.pdf

----------------------------------------------------------------------

Search Criteria:

pulley increase range of motion after shoulder surgery
shoulder pulley exercise and its affect on range of motion
National Library of Medicine
Pub Med
physiotherapeutic rehabilitation
Various Medical Journals 
The American Journal of Orthopedics


Best Regards,
Bobbie7-ga

Dear Robertleeallen-ga, 

The following studies and clinical trials address shoulder pulley
exercise and its affects on range of motion:

----------------------------------------------------------------------

Publication Type: Clinical Trial 
Orthopedics 1998 Nov; 21(11):1181-4 

Electromyography of the shoulder: an analysis of passive modes of
exercise by Dockery ML, Wright TW, LaStayo PC.
Department of Orthopedics, University of Florida, Gainesville 32610,
USA.

A short excerpt:

“(..) Ten healthy volunteers underwent EMG to investigate the relative
activity of the rotator cuff muscles during various exercises used
postoperatively following shoulder surgery.

The exercises tested were continuous passive motion machine (CPM),
pulley, pendulum, self-assisted bar raise using the contralateral arm
for power, self-assisted internal and external rotation,
therapist-assisted elevation in plane of the scapula, and
therapist-assisted internal and external rotation.”

The relative activity of the supraspinatus, infraspinatus, anterior
deltoid, and trapezius muscles were measured and expressed as a
percentage of maximal activity.”

For all muscle groups tested, the pulley exercise showed significantly
more activity than the CPM machine.

In the supraspinatus muscle, the pulley exercise averaged 17.6% of
maximal activity and 8.7% for the self-assisted bar raise using
contralateral arm power compared with 5.0% for the CPM machine.”

Source: National Center for Biotechnology Information - National
Library of Medicine
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9845449&dopt=Abstract

----------------------------------------------------------------------

Publication Type: Clinical Trial 
Changgeng Yi Xue Za Zhi 1999 Mar;22(1):37-43

Timing of shoulder exercise after modified radical mastectomy: a
prospective study by Chen SC, Chen MF.
Department of Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan,
R.O.C.

Although this study relates to radical mastectomy surgery, the results
show that the range of motion of the shoulder was slightly limited in
the patients that did not perform pulley and other exercises.

“(..)From 1994 through 1995, 344 consecutive patients were randomly
divided into three groups.

One hundred sixteen patients in the early group performed upper arm
exercises including pendulum, wall climbing and pulley exercises
beginning the third post-operative day.

One hundred fifteen patients in the later group patients did the same
exercises beginning the sixth post-operative day and 113 patients in
the delayed group did the same exercises after all the drains were
removed.(..)

Although the range of motion (ROM) of the shoulders in the delayed
group patients was slightly limited during the first month after
operation, ROM returned at 3 months and no difference was found 6
months after operation. (..)”

Source: National Center for Biotechnology Information - National
Library of Medicine
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10418208&dopt=Abstract


----------------------------------------------------------------------

Additional information that may interest you:

While searching I located this study which demonstrates that the
overhead pulley should be avoided during rehabilitation of stroke
patients.

Publication Type: Controlled Clinical Trial 
Am J Phys Med Rehabil 1990 Aug;69(4):205-8

Shoulder pain in hemiplegia. The role of exercise.
Kumar R, Metter EJ, Mehta AJ, Chew T.
Department of Rehabilitation Medicine Service, Veterans Administration
Medical Center, Sepulveda, California 91343

“The objective of this study was to analyze the occurrence of pain in
patients treated with one of the three exercise programs commonly used
in the rehabilitation of hemiplegia: 1) range of motion by the
therapist, 2) skate board and 3) overhead pulley.(..)Use of overhead
pulley has the highest risk of developing shoulder pain and should be
avoided during rehabilitation of stroke patients.”

Source: National Center for Biotechnology Information - National
Library of Medicine
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2383382&dopt=Abstract

----------------------------------------------------------------------

Scand J Rehabil Med 1985;17(3):129-40 

Shoulder externally rotating exercises with pulley apparatus. Joint
load and EMG by Harms-Ringdahl K, Arborelius UP, Ekholm J, Nemeth G,
Schuldt K.

The method described might be used to find optimal designs of shoulder
external rotation exercises with special regard to avoiding
unintentional overloading of joint structures weakened by disease or
trauma.

“The mechanical load on the gleno-humeral joint and the muscular
activity during shoulder external rotation resisted by a pulley
apparatus were analysed using normalized, low-pass-filtered EMG
recorded from the infraspinatus, deltoid, pectoralis major and
trapezius muscles. The load moment about the longitudinal axis of the
joint was compared with the distribution of maximum muscle moment over
different angles throughout the range of motion. The effect of subject
positioning on the joint load and the muscular activity was studied.

The best adaptation between the curves for load moment and maximum
muscle moment was obtained when the subject was positioned sitting
with the pulley located 20 degrees posterior to a frontal plane
through the shoulders at a distance of 1.3 m from the joint.”

Source: National Center for Biotechnology Information - National
Library of Medicine
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=4059885&dopt=Abstract

----------------------------------------------------------------------
Shoulder and Upper Extremity Impairments, Activity Limitation
And Physiotherapeutic Exercise in Women with Rheumatoid Arthritis
A biopsychosocial approach byCarina Boström
From the Division of Rehabilitation Medicine
Department of Public Health Sciences
Karolinska Institutet, Stockholm, Sweden 2000
http://diss.kib.ki.se/2000/91-628-4192-0/thesis.pdf

----------------------------------------------------------------------

Search Criteria:

pulley increase range of motion after shoulder surgery
shoulder pulley exercise and its affect on range of motion
National Library of Medicine
Pub Med
physiotherapeutic rehabilitation
Various Medical Journals 
The American Journal of Orthopedics

I hope the information I assembled for you meets your requirements and
I will post it as an official answer and  if you require additional
information just tell me and I will do additional research.

Sincerely,
Bobbie7-ga