Pendulum Exercise after Rotator Cuff Repair: To swing or not to swing


The pendulum exercise, also known as Codman’s Pendulums, are frequently used for patients with shoulder pathologies to provide gentle joint distraction and joint oscillation to reduce pain. This exercise is also frequently used post operatively after rotator cuff repairs for early joint mobilization, increased flow of nutrients to the joint space and pain reduction.

Correct Pendulum/Codman exercise:
The original Codman/pendulum exercise was described as a small movement of the upper extremity while bent over to patient comfort. The initiation of arm movement in this exercise is to be created by the body performing rocking or swaying motions, allowing the effected shoulder to hang and move passively. The key component of this description is passive. Generally speaking, patients who undergo rotator cuff repair surgery will be limited to passive range of motion only, and forbidden to perform active motion such as lifting or reaching for the first 6 wks. Therefore, the early initiation of the pendulum exercises after a rotator cuff repair must be performed in the appropriate passive manner.
Research has been performed to investigate the muscular activation of the rotator cuff muscles while performing pendulum exercises in both healthy and pathological shoulders. These studies recorded and compared the muscular activation of the rotator cuff muscles when performing pendulums in the passive correct manner, with both small and large circles. It subsequently observed the muscular activation when performed incorrectly, (with active range of motion) in small and large circles. This research has found that when performing pendulum exercises in circles no larger than a 20cm diameter (a little larger than a DVD), the rotator cuff muscles do not exceed an unsafe level of contraction; thus, avoiding undue stress on the new repair.  Subsequently, when the pendulums increase to 51cm (about the size of a tire), the rotator cuff muscles begin to approach an unfavorable amount of stress on the repair. The amount of supraspinatus muscle activation during incorrect pendulum exercises was also found to be higher in patients with shoulder pathologies when compared to healthy shoulders. This emphasizes the importance of technique when performing this exercise post-operatively.
Many variations of this exercise have evolved from its original description of passive arm hanging with small gentle swings. Frequently, patients post operatively perform large arm movements in an attempt to improve ROM, assuming “more is better.” We have learned, however, that this may be detrimental to healing.

Due to the frequent misinterpretation regarding the pendulum exercises, it is the opinion of this therapist that arm “hangs” are a safe alternative to the pendulum swings. I believe the same gentle traction effect can still be achieved while ensuring range of motion is strictly passive. Each patient is also educated on the importance of this hanging position to allow self-care while bathing and dressing.
Protection of the surgical repair is of the utmost importance after a rotator cuff surgery to allow appropriate healing. Care should be taken by all patients to understand their operation and the precautions set by their surgeon.

Activation of the shoulder musculature during pendulum exercises and light activities. Long JL, Ruberte Thiele RA, Skendzel JG, Jeon J, Hughes RE, Miller BS, Carpenter JE. J Orthop Sports Phys Ther. 2010 Apr;40(4):230-7. doi: 10.2519/jospt.2010.3095.

Electromyography of Selected Shoulder Musculature During Un-weighted and Weighted Pendulum Exercises. Abigail A. Ellsworth, DPT, Michael Mullaney, PT, Timothy F. Tyler, PT ATC, Malachy McHugh, PhD, and Stephen Nicholas, J MD. N Am J Sports Phys Ther. 2006 May; 1(2): 73–79.

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Author: Kyle Anderson

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