Regional and Global Exercise: Motor Control, Stability, Speed and CBT

Regional treatment looks beyond the shoulder. Motor imagery and mirror training from graded motor imagery help prepare painful shoulders to move. Motor control work starts slowly with attention to substitution, such as a theraband over the upper trapezius for tactile feedback, multi-plane table slides and PNF patterns above 90 degrees. Stability exercises progress from weight bearing on the arms with body circles, to hands and knees, to an unstable surface, and then to a weighted ball moved on the wall facing toward and away from it. Eric argues that cardiorespiratory conditioning is often neglected, even though it reduces pro-inflammatory biomarkers in a population where metabolic syndrome and diabetes are common. Movement speed should also be trained to check whether motor control holds at faster speeds. At the global level, cognitive behavioral therapy and O'Sullivan's cognitive functional therapy help patients make sense of pain and change behavior, and activity-related progressions train valued tasks. The summary: frozen shoulder is unlikely to be just a glenohumeral problem.