Still Doing Those Pendulum Exercises For Shoulder Pain?

Quite a few patients who came to our clinic this week had frozen shoulder. Almost all of these patients had been prescribed pendulum exercises (also know as Codman pendulum exercises) by their previous healthcare provider. The intention is to move/ rehabilitate the glenohumeral (or shoulder) joint while not worsening recently injured or operated tissue.

This is done with the patient standing with a slightly bent torso with the affected arm hanging downwards, using the momentum of the torso/ trunk to move the arm without activating the muscles in the shoulder girdle. The arm can be moved side to side, forwards and backwards, or in a circular motion. Codman pendulum exercises are also always  prescribed after shoulder surgery . In fact, they are the mainstay of many shoulder rehabilitation protocols.

However, Cunningham et al (2020) demonstrated that Codman pendulum exercises involved minmial glenohumeral and scapular-thoracic movement. Movement is mainly from the trunk. They may be a safe way to start early movement/ stretching of the upper limb but may be of limited further use in restoring passive shoulder range of motion.

In fact Gurney et al (2016) found that Codman pendulum exercises induced the least muscle contraction in rotator cuff activity when they investigated several tasks, common rehabilitation exercises and ambulation. Wearing and taking off a shirt induced the highest. Even walking produced substantially higher muscle activity than the Codman exercises. 

Of course if the movement is directly generated from the shoulder rather than the trunk as well as performing larger pendulum circles, there will be increased rotator cuff muscles activity.

Personally, in our clinic, I find that teaching patients 3 basic exercises with elastic resistance bands work much better for the shoulder. Intensity, dosage and exercise position will have to be modified dependent on the surgery and condition the patient has. 

I show them the one arm shoulder frontal raise (pictured above), the lateral raise and a simple basic rowing exercise where the shoulder blade is retracted (or pulled back). In fact, the same few exercises and the single arm reverse fly (pictured below) were found to be effective for office workers to perform daily for 10 minutes to reduce neck and shoulder pain (Saterbakken et al, 2020). 

From Saterbakken et al (2020)

You can definitely stop doing those Codman pendulum exercises.

References

Cunningham G, Charbonnier C, Ladermann A et al (2020). Shoulder Motion Analysis During Codman Pendulum Exercises. Arthrosc Sp Med Rehab. 2(4): e339. DOI: 10.1016/j.asmr.2020.04.013

Gurney AB, Mermier C, LaPlante M et al (2016). Shoulder Electromyography Measurements During Activities Of Daily Living And Routine Rehabilitation. Ex J Orthop Sp Phy Ther. 46(5): 375-383. DOI: 10.2519/jospt.2016.6090.

Saterbakken AH, Makrygiannia P, Stien N et al (2020). Dose-response Of Resistance Training For Neck-and Shoulder Pain Relief: A Workplace Intervention Study. BMC Sp Sci Med Rehab. 12:8. DOI: 10.1186/s13102-020-0158-0