MS: RTC tear s/p stem cell treatment: Weekly Follow Ups: Week 3 (9-10-17

Phase 3: Progressive Loading of Scapular Stabilizers and Rotator Cuff
- This phase will begin to load the bicep, beginning in mid range and progressing to a more lengthened position
  - This should be done cautiously and without pain
- Improve activation of posterior rotator cuff
  - Be careful to maintain a light squeeze into the arm pit in an effort to maintain tension/activation of the back of the shoulder without pain or pressure in the top or back of the shoulder
- Progress active motion overhead with continued tricep, serratus, and latissimus activation
  - As overhead movement progresses, you may feel discomfort on the top of the shoulder at a certain point in the motion. Once you find a point where pain is reproduced, STOP BEFORE that pain on every subsequent rep. Your goal with all movements is to get a little tired with discomfort no greater then a 2-3/10 on the 0 to 10 pain scale
- It is once again imperative that you feel no pain or pressure in the top of the shoulder
  - `If you do feel any pain or pressure in the front or top of the shoulder, try to move very slowly to that point in the range and then quickly move out of that position
  - Emphasis on reps being slow and controlled to maintain control and tension in the correct areas with each rep taking 3-5 seconds IN EACH DIRECTION…that is really slow
  - If you do feel anything in the front or top of the shoulder, you may be able to decrease it by focusing on the shoulder blade position into a back and down pull
- This phase will start to organize the movements into circuits
  - Each should be completed 5-20 reps for one set, second time through the circuit complete 1/2 the reps as the first set
  - Once you complete the program you may want to continue utilizing these circuits to continue to progress shoulder strength and mobility
- Ice is recommended after each session 10-20 minutes
Goals:
- Minimize Irritation using ice as needed
- Begin loading of the bicep in a controlled range, ideally you will feel tension in the muscle belly of the bicep (in the middle of the arm) without feeling pain in the front of the shoulder
- Progress shoulder stabilization
- Progress to active overhead movement building on the movements you have completed thus far
Day 1:
- Mobility Warm Up Circuit: Go through the first time lightly
  - Goal: Get through it without provoking significant pain or soreness
  - Laying Down Humeral Depression with Progression to Pec Stretch VIDEO
    - Do both sides, try to do twice as many reps on the tighter side
  - Tall Kneel with Scapular Depression/Retraction VIDEO
    - Can be done kneeling or standing
    - Keep tension very light
  - Puppy Pose Progression VIDEO OR Downward Dog Progression From Higher Level to Floor VIDEO
    - Make sure you stay short of pain/pinch/pressure on the top of the shoulder
  - Foam Roll Pec Stretch and Thoracic Extension VIDEO
    - Begin with the roll between the shoulder blades, this can be done with a towel or yoga mat if you do not have a foam roll. You can also lay on a larger exercise ball
  - Shoulder Extension/Internal Rotation Bridge VIDEO
    - Gradual progression of the reach behind the back motion
Day 2:
- Mobility Warm Up Circuit: Go through the first time lightly
  - Goal: Get through it without provoking significant pain or soreness
  - Laying Down Humeral Depression with Progression to Pec Stretch VIDEO
    - Do both sides, try to do twice as many reps on the tighter side
  - Tall Kneel with Scapular Depression/Retraction VIDEO
    - Can be done kneeling or standing
    - Keep tension very light
  - Puppy Pose Progression VIDEO OR Downward Dog Progression From Higher Level to Floor VIDEO
    - Make sure you stay short of pain/pinch/pressure on the top of the shoulder
  - Foam Roll Pec Stretch and Thoracic Extension VIDEO
    - Begin with the roll between the shoulder blades, this can be done with a towel or yoga mat if you do not have a foam roll. You can also lay on a larger exercise ball
  - Shoulder Extension/Internal Rotation Bridge VIDEO
    - Gradual progression of the reach behind the back motion
- Strength Circuit #1
  - Standing Tricep Extension Band VIDEO
    - Be aware of shoulder blade position, especially as you straighten your elbows. When elbows straighten the shoulder blades will want to tip forward as you get tired
    - Band can be attached up high with a knot in the middle and closed in a door, or one arm at a time with end of band closed in the top of door
  - Bicep Loading Progression VIDEO
    - Band will work better then dumbbell
    - This is broken into 5 phases and I encourage you to move gradually through each
  - Table Top Progression VIDEO
    - Isometric tricep, carefully progress movement as tolerable
Day 3
- Mobility Warm Up Circuit: Go through the first time lightly
  - Goal: Get through it without provoking significant pain or soreness
  - Laying Down Humeral Depression with Progression to Pec Stretch VIDEO
    - Do both sides, try to do twice as many reps on the tighter side
  - Tall Kneel with Scapular Depression/Retraction VIDEO
    - Can be done kneeling or standing
    - Keep tension very light
  - Puppy Pose Progression VIDEO OR Downward Dog Progression From Higher Level to Floor VIDEO
    - Make sure you stay short of pain/pinch/pressure on the top of the shoulder
  - Foam Roll Pec Stretch and Thoracic Extension VIDEO
    - Begin with the roll between the shoulder blades, this can be done with a towel or yoga mat if you do not have a foam roll. You can also lay on a larger exercise ball
  - Shoulder Extension/Internal Rotation Bridge VIDEO
    - Gradual progression of the reach behind the back motion
Day 4
- Mobility Warm Up Circuit: Go through the first time lightly
  - Goal: Get through it without provoking significant pain or soreness
  - Laying Down Humeral Depression with Progression to Pec Stretch VIDEO
    - Do both sides, try to do twice as many reps on the tighter side
  - Tall Kneel with Scapular Depression/Retraction VIDEO
    - Can be done kneeling or standing
    - Keep tension very light
  - Puppy Pose Progression VIDEO OR Downward Dog Progression From Higher Level to Floor VIDEO
    - Make sure you stay short of pain/pinch/pressure on the top of the shoulder
  - Foam Roll Pec Stretch and Thoracic Extension VIDEO
    - Begin with the roll between the shoulder blades, this can be done with a towel or yoga mat if you do not have a foam roll. You can also lay on a larger exercise ball
- Strength Circuit #2
  - Scapular Control with Weight Shift Side Plank Progression VIDEO
    - Start with the weight shift onto each arm side to side progressing to a 5-10sec hold on each arm
    - Once again make sure you keep elbow tucked in and shoulder blade down
  - Wall Sit Active/Band Abduction VIDEO OR Prone I to T Progression VIDEO
    - Keep the tension in the back of the shoulder staying short of pain/pressure on the top or front of the shoulder
  - Shoulder Flexion & Forward Reach Towel Slide to Ball Roll Out VIDEO
    - Progresses from a basic forward reaching movement to a more challenging movement that coordinates abdominals to coordinate with shoulder blade stability
    - Remain in pain free range
Day 5
- Mobility Warm Up Circuit: Go through the first time lightly
  - Goal: Get through it without provoking significant pain or soreness
  - Laying Down Humeral Depression with Progression to Pec Stretch VIDEO
    - Do both sides, try to do twice as many reps on the tighter side
  - Tall Kneel with Scapular Depression/Retraction VIDEO
    - Can be done kneeling or standing
    - Keep tension very light
  - Puppy Pose Progression VIDEO OR Downward Dog Progression From Higher Level to Floor VIDEO
    - Make sure you stay short of pain/pinch/pressure on the top of the shoulder
  - Foam Roll Pec Stretch and Thoracic Extension VIDEO
    - Begin with the roll between the shoulder blades, this can be done with a towel or yoga mat if you do not have a foam roll. You can also lay on a larger exercise ball
  - Shoulder Extension/Internal Rotation Bridge VIDEO
    - Gradual progression of the reach behind the back motion
Day 6
- Mobility Warm Up Circuit: Go through the first time lightly
  - Goal: Get through it without provoking significant pain or soreness
  - Laying Down Humeral Depression with Progression to Pec Stretch VIDEO
    - Do both sides, try to do twice as many reps on the tighter side
  - Tall Kneel with Scapular Depression/Retraction VIDEO
    - Can be done kneeling or standing
    - Keep tension very light
  - Puppy Pose Progression VIDEO OR Downward Dog Progression From Higher Level to Floor VIDEO
    - Make sure you stay short of pain/pinch/pressure on the top of the shoulder
  - Foam Roll Pec Stretch and Thoracic Extension VIDEO
    - Begin with the roll between the shoulder blades, this can be done with a towel or yoga mat if you do not have a foam roll. You can also lay on a larger exercise ball
  - Shoulder Extension/Internal Rotation Bridge VIDEO
    - Gradual progression of the reach behind the back motion
- Strength Circuit #3
  - Laying on Back External Rotation Phase 1 VIDEO
    - Focus on feeling tension into the back of the shoulder/arm pit
  - Lying on Back Weight Pull Over OR Band Pull Over VIDEO
    - If painful do the movement below instead
      - Band Extension Deadlift VIDEO OR Off Edge of Bed VIDEO
  - Full Can/Scaption Supraspinatus VIDEO
    - Begin without weight, add weight as able maintaining slow controlled motion
    - If painful try the movement below
      - Full Can Regression Raise From Counter Height with Progression Laterally VIDEO
Day 7
- Rest
Complete for for the following week as well