Codmans (pendulums) are supposed to be so easy, yet is the most difficult exercise!  Not only is it hard to perform correctly, but to teach it to patient correctly is the ultimate task.  I’m sure you’ve all seen the funniest attempts by your patients. Their form is usually all over the board.  There are multiple ways to ‘stir the soup’.

Typically, I use it to be of a pain-relieving exercise for shoulder patients, but is used more precisely as a tool for appropriate ROM for post-op rehabilitation.  In order for this to be the most effective and place least stress on the healing repair, it needs to be performed correctly.

Newest addition of JOSPT had a great article measuring EMG on the supraspinatus, infraspinatus and deltoid during the pendulum exercise in various forms and other light ADLs.  I felt it had great clinical points to take back to the treatment room.

-Supraspinatus and infraspinatus EMG activity exceeded the 15% MVIC threshold for incorrect and large pendulums (51cm diameter).

-Statistical difference in percent MVIC was found between large (51cm diameter) and small pendulums (20 cm diameter) in correct and incorrect form.

Some things to be aware of:

-The study had all healthy (and young) subjects so may not correlate this directly to the older population with RTC pathology & repair.

-15% MVIC is a conservative percentile.  Levels of 20-25% MVIC show low to minimal EMG activity in prior studies.

-50N has been shown to be lowest force to cause failure after cyclical loading of RTC in prior studies. 15% MVIC in this study = only 30 N)

-Does this mean we can go larger than 20cm with circles without harm to the graft?

-MVIC of the infraspinatus was higher for all subgroup of pendulum exercises than supraspinatus.

-Present study allowed contralateral limb support but original description by Codman did not.  I like the support.

Bottom Line:

-Smaller (20cm diameter) pendulums performed correctly have less supraspinatus EMG and are subsequently safer for post-op RTC rehabilitation.

-Clinical decision making on diameter can be based on size of tear and number of tendons involved.

-What can represent 20cm diameter at home?

-I think the size of the patient’s shoe will work to allow comparision at home.  Usually bigger than 20cm but less than 51cm and will adjust for size of the person.  This will also go along with the thinking from above.

-What defines correct form?

-Codman’s description originally in 1984. My description on video below.

How do you describe pendulum exercises to your patients?  Do you perform them anterior/posterior and/or medial/lateral, rather than in circles?  Do you think larger circles are fine to perform s/p RTC repair?

Long JL, Ruberte Thiele RA, Skendzel JG, et al.  Activation of the Shoulder Musculature During Pendulum Exercises and Light Activities.  JOSPT. 2010; 40: 230-237.

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2 comments

  1. I read the same article but had different thoughts.

    How often do surgeries fail due to improper performance of Codman’s? How cyclic is cyclic? Patients don’t do the Codman’s at such a frequency that I’d view the exercise as something horribly repetitive.

    Shouldn’t common sense trump EMG readings?

    IF the person is doing the Codman’s in whatever fashion – truly passively or actually actively – and there is no pain or discomfort, do the EMG results really matter?

    My reality… I have patients actively perform small circles right from the get go. Generally, the person can relax and really let the arm hang (so gravity does a bit of joint distraction). In my opinion, if there is no pain, it is probably a good idea to have some actual contractions of the rotator cuff muscles. Just because EMG readings are statistically significant in comparing these two options does not necessarily equate to clinically significant difference. We have to remember that fact sometimes. The forces were much greater with drinking from a water bottle (which initially some people would describe as painful and difficult).

    My real thoughts on the article… might be nice for some trivia game, easily forgotten and continue to use common sense.

    1. Good to get your feedback Snippet (don’t know your name, so sorry for calling you snippet!). I do agree that pain is largely the guideline at this stage in the rehab.
      It is a good point to bring up the functional activity of drinking water as what people do at home is much worse typically (considering stress on the graft) than what we do in the clinic. I’m sure you get your patients who come in and say they can reach higher by themselves now even though we didn’t do this as an exercise and stressed to them not to!

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