Summary of correct exercises and points to note to improve range of motion through pendulum exercise rehabilitation | column | 日常で気軽に実践できる片麻痺のリハビリ方法や機能を低下させない生活習慣などを解説

Why it is effective in improving shoulder joint range of motion and relieving pain

Periarthritis of the shoulder and frozen shoulder are characterized by limited range of motion due to inflammation of the bursa and joint capsule in the shoulder joint, and severe pain during movement. Pendulum exercise is a safe and effective method for such conditions, promoting natural movement without placing excessive stress on the joint. It is often used as an introductory exercise to restore range of motion while reducing the patient's anxiety, especially in the initial stage of rehabilitation.

Pendulum exercises use your own weight to move the joints without using muscle strength, and have the advantage of being "less painful" and "easier to continue" compared to other rehabilitation methods. By incorporating it at times when the shoulder joint is likely to become stiff, such as in the morning or before going to bed, it is highly effective in improving blood flow and relieving fascial tension. In clinical settings, physical therapists often use it in combination with manual techniques, which contributes to preventing recurrence and early return to daily living activities.

What is its role in the functional recovery process after surgery or fracture?

In joint rehabilitation after fractures or orthopedic surgery, a major challenge is how quickly and safely to restore joint function. In particular, in cases where the range of motion of the shoulder is limited, such as humerus fractures or rotator cuff injuries, non-weight-bearing, highly repetitive exercises are required, as sudden movement increases the risk of re-injury. Among these, pendulum exercises are often introduced one week to ten days after surgery, and are extremely important as the first step in moving the joint after the peak of inflammation has passed.

The characteristic of pendulum exercise is that it puts very little strain on the affected area. By adjusting the swing range, it is possible to avoid excessive stress on the joint capsule and ligaments, while improving circulation of synovial fluid and suppressing muscle tension. In addition, it has the advantage of being easy for patients to perform at home, with a low psychological hurdle. By continuing the exercise properly under the guidance of a doctor or physical therapist, it can make a big difference in the speed of recovery.

Basic form and how to use your body should be practiced in the early stages

Pendulum exercise is a typical rehabilitation method for relieving shoulder joint contracture and muscle tension, and is widely recommended especially in the initial rehabilitation after proximal humerus fracture, shoulder periarthritis, and clavicle fracture. The greatest advantage of this exercise is that it does not put strain on the shoulder joint itself, and promotes circulation of the joint capsule and synovial fluid.

The specific form is to start in a forward-leaning position, with the healthy hand on the back of a table or chair, and with the affected arm completely relaxed. The key to posture is to relax the area around the shoulder blades, bend slightly at the waist, and let gravity take over. By simply adopting this position, you can avoid excessive stimulation of the affected area.

There are three basic types of exercise: front and back swaying, side to side swaying, and circular movements. Aim to do these movements 10 to 20 times per set, 2 to 3 sets per day, gradually increasing the number of times as long as the pain does not become too strong.

The effectiveness of such pendulum exercises is scientifically supported, and is considered a standard approach in the early stages among orthopedic surgeons and physical therapists. In addition, since poor posture increases the burden on the lower back, it is a good idea to use a non-slip mat and bend your knees slightly when bending forward.

The main purpose of rehabilitation is not only to restore function, but also to prevent recurrence and improve quality of life. In principle, pendulum exercises should be performed within the range of pain. If you feel any discomfort, stop immediately and consult with your doctor or physical therapist.

Differences in purpose and target between Codman exercises, pole exercises, and wall crawling

Pendulum exercises are very important rehabilitation exercises for restoring range of motion around the shoulder joint, and are often introduced mainly in the acute phase after surgery or fracture.
By using gravity to allow your shoulder to move naturally, you can regain range of motion without putting strain on the joint or surrounding tissue.

On the other hand, Codman exercises are a typical variation of this pendulum exercise, and are often prescribed in orthopedic and rehabilitation departments. The purpose is to prevent adhesion of the joint capsule and promote circulation of synovial fluid, and it can be started safely early after surgery.

Stick exercises are rehabilitation exercises used to increase the muscle output of the affected area, and are effective in the recovery stage when the range of motion of the shoulder joint has been restored to a certain extent. The patient operates the stick to adjust the left and right movement and height, aiming to re-educate the muscles and correct movement patterns.

Wall crawling exercises are exercises that increase the range of motion of the shoulder joint by raising the arm while running the hand up the wall. Compared to bar exercises, they are easier to bring out the mobility of the shoulder blade, and are often used for patients with shoulder periarthritis and frozen shoulder. The purpose and target of each rehabilitation exercise is clearly different, so it is important to use them together in stages.

It is very important to use rehabilitation exercises according to the stage of recovery. For example, if you perform stick exercises or wall crawling immediately after a proximal humerus fracture, there is a risk that the load on the affected area will be too strong and inflammation will worsen, so it is recommended to start with very light exercises such as pendulum exercises.

In this way, by accurately understanding the purpose and target of each exercise, it is possible to create an optimal rehabilitation program suited to each patient's recovery speed and the characteristics of their illness.

Recommended rehabilitation menus by disease and recovery phase

In rehabilitation, the optimal exercises vary depending on the type of disease and recovery phase. For example, after shoulder surgery or a fracture, it is important to divide the rehabilitation into three stages: the acute stage accompanied by inflammation, the recovery stage aimed at restoring function, and the maintenance stage to prevent recurrence.

Pendulum exercises are extremely effective in preventing joint contracture during the acute phase, allowing safe, pain-free movement. They can be started without difficulty even immediately after surgery, and are widely recommended by doctors and physical therapists. During the next recovery period, pole exercises and wall-crawling exercises are effective, and active exercises can further increase muscle output and range of motion.

The most efficient recovery comes from gradually introducing rehabilitation exercises according to the disease and phase. Pendulum exercises in particular are very effective as an early intervention in rehabilitation, as they maintain the range of motion without damaging the joints or surrounding tissues.

In addition, by combining wall crawling and stick exercises, you can strengthen the flexibility and strength of the shoulder joint in a well-balanced manner. In rehabilitation, the key to success is a "combination strategy" that combines multiple exercises, rather than relying on a single exercise.

At the facility, physical therapists and orthopedic surgeons create individual rehabilitation plans based on the patient's complaints of pain and data on joint range of motion. By using visual materials such as tables and graphs, patients can easily understand the purpose and effects of exercise, which helps maintain their motivation.

The misconception that "you should endure and continue even if the pain is strong"

Pendulum exercises are a typical form of exercise used in rehabilitation to improve shoulder joint contracture and increase range of motion, but the misconception that "continuing the exercises even if it hurts a little will help you heal faster" is a medically extremely dangerous misconception. For those recovering from a fracture or surgery, pain is not just discomfort, but an important signal that indicates the progression of tissue damage and inflammation. The longer you endure and continue the exercises, the more you hinder recovery and even run the risk of prolonging functional impairment.

In fact, orthopedic and rehabilitation doctors generally advise patients to "stop if pain increases." This is because forcing a joint to move when inflammation is present in the synovial fluid, fascia, and ligaments within the joint can cause the inflammation to spread, potentially worsening secondary symptoms such as heat and swelling in the affected area and nighttime pain. This is something that should be particularly noted in the early stages of rehabilitation for shoulder periarthritis and proximal humerus fractures, and there are many cases where patients mistakenly believe that "enduring pain = effective" based on their own judgment.

The following table provides a brief summary of the criteria for pain:

There have also been many clinical reports of cases where treatment was prolonged as a result of continuing to exercise while suffering from pain. In one orthopedic facility, an elderly patient who continued exercising despite the pain on his own accord developed myositis and required hospitalization for treatment. This is not an uncommon case, and it is a risk that lurks nearby, especially for the elderly and those who perform self-rehabilitation.

The appropriate time to start pendulum exercises and the appropriate intensity settings vary greatly depending on the disease, surgical history, age, etc. For example, in the case of a proximal humerus fracture, strenuous exercise is contraindicated until 3 to 4 weeks, which is the estimated time for bone union, and enduring pain while exercising before that time may cause re-fracture or false joint.

In conclusion, the idea that you should endure pain and continue with pendulum exercise is fundamentally wrong, and it is necessary to flexibly adjust the exercise to suit the patient's physical condition. In particular, for those who are unfamiliar with rehabilitation or the elderly, the shortest route to recovery is to proceed safely and effectively under the guidance of a physical therapist or orthopedic specialist.

The dangerous method of "If you want to recover quickly, swing quickly"

Many people mistakenly believe that "swinging faster will increase the range of motion" when performing pendulum exercises. However, such high-speed exercises are strictly prohibited in rehabilitation settings. The essence of pendulum exercise is to "improve the range of motion of joints through natural vibrations without exerting force," and intentional high-speed exercises deviate from the purpose of the exercise and cause unnecessary stress to the affected area.

Particular attention should be paid to patients and elderly people who perform pendulum exercises at home on their own. They have difficulty in understanding the sensation of relaxing and may mistakenly believe that "swinging harder is more effective," and may end up contracting the muscles around the scapula and biceps more than necessary. In this state, the effect of the original "non-weight-bearing exercise" is lost, and instead the shear force on the tendons and joints increases, which can lead to re-injury and inflammation.

Thus, the principle of pendulum movement is "slowly, effortlessly, and naturally." By increasing the speed, you may temporarily get a "sense of movement," but this is merely an illusion and does not lead to fundamental improvements such as recovery of range of motion or circulation of synovial fluid in the joints.

Furthermore, the act of shaking too quickly is often caused by psychological "impatience," and is a typical pattern in which the patient's desire to "recover as quickly as possible" ends up having the opposite effect. To counter this sense of impatience, medical professionals need to clearly explain that "the recovery process is different for each person," and that "the most reliable path is to build up strength little by little within the limits of what does not cause pain."

In addition, in rehabilitation after a proximal humerus or clavicle fracture, there are stages of exercise according to the progress of bone union, and sudden vibration exercise not only impedes that progress, but also carries the risk of re-fracture. One of the reasons why patients tend to repeat fast movements on their own is due to a lack of explanation of exercise guidelines by medical professionals.

Therefore, rather than pursuing speed, the key to maximizing the effectiveness of pendulum exercise is to focus on quality, such as "how to relax" and "how to regulate your breathing." Rehabilitation instruction that values precision and a sense of security, rather than speed, is what leads to the patient's early return to society.

Pendulum exercises are the basis of early rehabilitation for the shoulder joint and scapular area, and are particularly useful during the recovery period after surgery or proximal humerus fractures. They are widely recommended in orthopedic and rehabilitation settings because they can restore range of motion while reducing pain.

However, if you perform the exercises based on a misunderstanding such as "I should endure the pain and continue," or "I should move quickly because I want to heal quickly," you may put strain on the affected area, which may lead to re-injury or delayed recovery. Materials from the Japanese Orthopaedic Association also state that pendulum exercises should be started from the third week after surgery, which is safe and effective, and it is important to proceed in a way that suits each individual's condition.

In addition, by combining pendulum exercises with exercises such as stick exercises and wall crawling exercises depending on the recovery phase and symptoms, rather than relying solely on pendulum exercises, more efficient functional recovery can be expected. For example, a balanced program is recommended that focuses on pendulum exercises that move the joints comfortably during the acute phase, strength training to increase shoulder joint stability during the recovery phase, and whole-body exercises during the maintenance phase.

Although pendulum exercises may seem easy at first glance, they can be counterproductive if you get the form, number of repetitions, or the progression wrong. If the pain is severe, don't self-diagnose, but work with an orthopedic surgeon, physical therapist, or other specialist to ensure a safe and reliable recovery. With the right knowledge and proper guidance, you can regain shoulder range of motion without straining yourself. Take the first step today to eliminate your current worries and anxieties and start rehabilitation with peace of mind.

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LAP Co., Ltd.
address	2-1-40 Oikawa, Atsugi City, Kanagawa Prefecture, 243-0212
phone	046-204-9343

inquiry

Q. Is pendulum exercise really effective? What is the improvement rate according to the data?
A. Pendulum exercises have been shown to be extremely effective in the early stages of rehabilitation following shoulder periarthritis or proximal humerus fractures. In particular, they are highly regarded as a pain-free exercise that has been shown to be highly satisfactory for elderly people and post-operative patients, and is highly regarded for its safety and effectiveness.

Q. How much does it cost to go to the hospital for rehabilitation or to do it at home?
A. Orthopedic rehabilitation outpatient visits are covered by insurance and cost about 300 to 800 yen per visit. If you visit twice a week, the monthly cost will be about 2,400 to 6,400 yen. In addition, auxiliary equipment (such as anti-slip mats and gymnastic sticks) for safely performing pendulum exercises at home generally cost about 2,000 to 5,000 yen. If you wish to receive individual instruction from a physical therapist, the average cost is about 2,000 to 5,000 yen per session. To keep costs down while still being effective, it is recommended that you combine outpatient visits with home rehabilitation.

Q. Can elderly people safely do pendulum exercises at home?
A. Yes, if you take the necessary precautions to ensure safety, even the elderly can continue the exercise at home without difficulty. By laying a non-slip mat on the floor and supporting yourself firmly on the table, you can significantly reduce the risk of falling. In addition, since it is a "non-weight-bearing" exercise that avoids shoulder tension and moves like a pendulum using only the weight of the arms, it puts less strain on the joints and is safe. Furthermore, safety can be ensured by having family members supervise and getting permission from a doctor.

Q. What rehabilitation exercises can I use in addition to the pendulum exercise?
A. Pendulum exercises are particularly effective in the early stages of rehabilitation, but their effectiveness can be enhanced by combining them with other exercises depending on the recovery phase. For example, pole exercises are effective when you want to gradually strengthen your muscles, and wall crawling exercises are effective when you want to increase the range of motion of your shoulder joint. In orthopedics and rehabilitation departments, it is common to create menus according to the disease and recovery stage, and it is ideal to use pendulum exercises in the acute phase, wall crawling or pole exercises in the recovery phase, and transition to training that focuses on whole-body posture balance in the maintenance phase.

Company name: LAP Co., Ltd.
Location: 2-1-40 Oikawa, Atsugi City, Kanagawa Prefecture, 243-0212
Telephone number: 046-204-9343