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.
-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.