The SwimEx current can be used in many different ways. Most recently, I had a patient s/p Bankart Repair that I placed in the pool for shoulder stabilization strengthening. As we know, the Bankart repair is most commonly performed on patients that have chronic dislocations or shoulder instability. With these patients it is important to work on rotator cuff strength and shoulder stabilization to improve the overall function of the joint.
This particular patient was able to start pool stabilization drills 4.5 weeks post Anterior Bankart Repair. During his rehab, I was following the Mass General Hospital post surgical protocol for shoulder instability, which allows therapists to start stabilization drills between 2-5 weeks post surgery. It is very important to ensure that you do not stress external rotation until 8-12 weeks post surgery with these patients.
My thought process was to attack the shoulder muscles required in stabilization with an endurance based program using the SwimEx current. I started the first couple sessions by placing the patient perpendicular to the current (Figure 1) and they were told to make small circles with an outstretched arm. Once the patient and I got an idea of the patient’s baseline strength, we increased the size of the circle. The progression from this point was alternating clockwise and counter clockwise, figure 8’s, and alphabet. I had the patient perform each exercise for 5 sets of 30 seconds.
Once the patient was able to perform this exercise with minimal difficulty they were progressed to 45 degrees of horizontal abduction with approximately 90 degrees of shoulder flexion (Figure 2). Figure 3 shows an additional progression with the entire body turned to a 45 deg angle and the shoulder at 90 degrees of flexion. A further progression can incorporate a “pool toy,” such as a paddle, glove, or floating ball. Each pool toy has its benefits, depending on the therapist’s intentions. Figure 4 shows a pool toy with the entire body turned to a 45 deg angle and the shoulder at 90 degrees of flexion.
This exercise progression is one basic idea on how to incorporate additional shoulder stabilization exercises using the SwimEx pool. Feel free to use this exercise idea for all shoulder patients, such as: rotator cuff repairs, rotator cuff tendonitis, shoulder instability, etc. The exercise is recommended to be done at a depth and current level that is comfortable for the patient. Be creative with this exercise and change the shoulder angles, elbow angles, current speed, etc. Changing these parameters will allow the patient to continue to progress using the SwimEx pool. It was found that having their feet against the slant or back wall provided more support for the core allowing the shoulder to be the primary focus.
In summary, the SwimEx pool is a unique feature to use with your patients. It can provide a great environment to focus on the stabilization strengthening of the shoulder by fatiguing the musculature using the current. This is just one of the many benefits in using the SwimEx current to treat and progress your patients. Be sure to check the blog section in the future as there will be additional posts on how to incorporate shoulder strengthening with your SwimEx pool in the near future! - Jaeson Kawadler DPT, CSCS
Please make sure that the exercise is appropriate for the patient and within the surgical protocols before incorporating in the program.