BACKGROUND: Postoperative shoulder stiffness after arthroscopic rotator cuff repair (ARCR) is a frequent complication limiting recovery. Flossing therapy, applying circumferential compression with an elastic band, has shown promise in sports medicine but has not been reported in postoperative shoulder rehabilitation. CASE PRESENTATION: Two patients in their 50s developed stiffness after ARCR despite standard rehabilitation. Flossing was applied by wrapping an elastic band from the upper arm to the shoulder, followed by passive and active movements under compression, and then active motion after decompression. Flossing therapy was performed as an adjunct to routine postoperative rehabilitation. OUTCOME AND FOLLOW-UP: Case 1 improved flexion from 160° to 180°, abduction from 150° to 180°, and internal rotation from T12 to T7. Case 2 improved flexion from 110° to 170°, abduction from 80° to 170°, and internal rotation from L2 to T10. Both patients experienced reductions in pain and improvements in strength and satisfaction. DISCUSSION: These cases suggest that flossing therapy may help improve shoulder mobility when progress plateaus with standard rehabilitation. Possible mechanisms include enhanced fascial gliding and proprioceptive modulation; however, no causal conclusions can be drawn from two cases. Further controlled studies are needed to evaluate safety, efficacy, and optimal treatment parameters.

Periarthritic Shoulder conditions, including adhesive capsulitis, rotator cuff–related shoulder pain, and periarticular inflammatory disorders, represent a significant cause of pain, functional limitation, and disability worldwide. Conventional rehabilitation approaches such as therapeutic exercise, manual therapy, electrotherapy, and pharmacological interventions demonstrate variable outcomes, particularly in chronic and refractory cases. Cupping therapy, an ancient therapeutic modality rooted in traditional medicine systems, has gained renewed interest as a complementary intervention in musculoskeletal rehabilitation. Emerging evidence suggests that cupping therapy may modulate pain, enhance local circulation, reduce inflammation, and improve tissue extensibility, thereby supporting functional recovery. This paper provides a comprehensive review of periarthritic shoulder cupping therapy, examining its physiological mechanisms, clinical rationale, integration within contemporary shoulder rehabilitation programs, and therapeutic outcomes in musculoskeletal shoulder disorders. Mechanistic pathways including neurophysiological pain modulation, microcirculatory enhancement, fascial decompression, and immunological responses are explored. Clinical protocols for dry cupping and moving cupping in periarthritic shoulder conditions are discussed, alongside safety considerations and contraindications. Outcome measures such as pain intensity, shoulder range of motion, muscle activation, and functional performance are critically analysed. The synthesis of current evidence supports cupping therapy as a valuable adjunct to physiotherapy-based rehabilitation, particularly when integrated into multimodal treatment strategies. Further high-quality randomized controlled trials are recommended to establish standardized protocols and long-term efficacy.

Evaluating the Role of Shoulder Rehabilitation in Preventing Falls among Rural Elderly Populations

ABSTRACT Context: Previous studies have shown that scapular retraction exercises produce greater trapezius activation in the prone position than in standing, likely due to increased gravitational load. However, the prone position requires less lumbopelvic control, potentially increasing anterior pelvic tilt and reducing scapular muscle stability. Objective: To investigate scapulothoracic muscle activation during scapular retraction exercises (SRE) in the prone position while maintaining lumbopelvic stability with voluntary abdominal contraction (VAC). Design: Descriptive laboratory study Settings: A climate-controlled laboratory Patients or Other Participants: A total of 30 physically active participants with healthy shoulders (15 males, 15 females; Tegner activity level ≥5; mean age = 23.9 ± 2.7 years; height = 173 ± 8.9 cm; weight = 67.3 ± 9.3 kg; BMI = 22.2 ± 1.8 kg/m²) were included. Interventions: Participants performed SRE in four arm positions: 0° (SRE-0), 45° (SRE-45), 90° (SRE-90), and 120° (SRE-120) of abduction, in randomizer order, with and without VAC. Main Outcome Measures: Surface electromyographic activity was recorded from the dominant extremity upper trapezius (UT), lower trapezius (LT), and serratus anterior (SA) muscles. Results: Scapular retraction exercises elicited variable muscle activation depending on arm position and VAC condition. UT activity generally remained low to moderate across all variations, while SA activation was consistently low. LT activity showed the most sensitivity to VAC: it increased during the eccentric phase at 0° abduction but decreased during concentric and isometric phases at 45°. At higher abduction angles (90° and 120°), VAC had minimal impact on UT, LT, and SA activity. Overall, VAC had no meaningful effect on scapular stabilizing muscle activation. Conclusions: VAC had minimal influence on scapulothoracic muscle activation during prone SRE, suggesting it may not be necessary for optimizing neuromuscular control in shoulder rehabilitation.

The latissimus dorsi (LD) comprises 2 neuromuscular regions-the thoracic and lumbar-pelvic-costal (LPC)-that may exhibit distinct activation patterns during shoulder and trunk exercises. A detailed understanding of these regional differences is crucial for optimizing therapeutic interventions due to their potential impact on muscle imbalances and rehabilitation outcomes in people with musculoskeletal conditions. Increasing contraction levels are expected to amplify differences between the thoracic and LPC regions, with the thoracic region demonstrating greater activation, particularly during shoulder extension and internal rotation tasks. Descriptive laboratory study. Level 5. A total of 20 healthy participants (15 men and 5 women) were recruited. High-density surface electromyography (HD-sEMG) electrode grids were positioned over the LD. Participants performed isometric contractions for shoulder extension, adduction, internal rotation, and lateral trunk bending at 10%, 30%, 50%, 70%, and 100% of their maximum voluntary contraction (MVC). The variables assessed included sEMG amplitude for each region and the spatial distribution of muscle activation (x- and y-axis barycenter). During shoulder extension, the thoracic region showed greater sEMG amplitudes than the LPC region at 50% (P = 0.02), 70% (P = 0.01), and 100% MVC (P < 0.01). Furthermore, shoulder extension generated greater amplitudes than all other exercises across both regions (P < 0.05). Barycenter analysis revealed a significant cephalomedial shift in the x-axis during both shoulder extension and internal rotation. The thoracic region is preferentially recruited during isometric shoulder extension and internal rotation. This spatial redistribution of muscle activity suggests a functional specialization within the LD, which has important implications for the development of targeted shoulder rehabilitation strategies. Exercises emphasizing shoulder extension may preferentially activate the thoracic region of the LD, thereby enhancing scapular stability while reducing strain on the rotator cuff tendons.

This study aims to evaluate the kinematic performance of two shoulder rehabilitation exoskeleton configurations to address the critical challenge of human–robot compatibility. Utilizing Hunt’s mobility formula and task-specific Jacobian analysis, we developed a closed-chain kinematic model integrating transient glenohumeral joint dynamics, validated through force/torque measurements and ANOVA statistical comparisons. The PPRRRP configuration, featuring orthogonally distributed passive prismatic joints, demonstrated superior performance: 40–60% lower interaction forces (), near-isotropic manipulability (ellipsoid axis ratio < 1.5), and 60% reduced operational torque () compared to RRRUP’s universal joint design. These results establish passive DOF optimization as a viable alternative to actuator-dense systems, diverging from conventional approaches like ARMin-III that prioritize active control. The originality lies in bridging theoretical configuration synthesis with empirical validation, offering a replicable framework for compatibility assessment. This work advances rehabilitation robotics by demonstrating that mechanical transparency—achieved through strategic passive joint allocation—enhances natural movement synergy without compromising stability, proposing hypotheses on energy efficiency and isotropy–fatigue correlations for future exploration. Clinical translation and adaptive impedance control integration are identified as critical next steps to optimize patient-specific rehabilitation outcomes.

IntroductionThe main clinical symptoms of patients with chronic rotator cuff injuries (CRCI) include pain and/or limitation of movement, which severely reduce the function of the shoulder joint. Local injection of corticosteroid with local anaesthetics can control the inflammatory response and effectively relieve patients’ pain in the short term. In addition, rehabilitation exercises are considered an important tool for improving shoulder function. However, due to the presence of pain or substandard execution of movements, it is often difficult for patients to achieve the desired therapeutic effect. Although there are many options for digital rehabilitation, relatively few purely conservative treatments have been used for patients with CRCI. And even fewer studies have addressed how to improve exercise accuracy in such patients.Methods and analysisThis protocol comprises three phases. First, shoulder active motion data will be collected from patients with CRCI and analysed using K-means clustering to define distinct clinical rehabilitation stages based on movement patterns and biomechanical principles. The clinical stages will be validated using one-way analysis of variance (ANOVA) and cross-tabulation to evaluate interstage functional differences and clinical consistency. Second, a shoulder rehabilitation system with real-time feedback will be developed, and its usability evaluated through a pilot study incorporating the System Usability Scale, Simulator Sickness Questionnaire and semistructured interviews. Finally, a randomised controlled trial will be conducted. 60 participants will be randomly allocated to either G1 (corticosteroid injection+digital rehabilitation) or G2 (corticosteroid injection+traditional home rehabilitation). The primary outcome is the Constant-Murley Score. Secondary outcomes include range of motion, Numerical Rating Scales, University of California at Los Angeles Shoulder Score, movement accuracy and exercise attitude questionnaire. Between-group comparisons will use independent t-tests or Mann-Whitney U tests, and within-group changes will be analysed with repeated measures ANOVA or Friedman test, with post hoc Bonferroni-adjusted comparisons.Ethics and disseminationThe protocol was approved by the Medical Ethics Committee of Gongli Hospital, Pudong New Area, Shanghai (number: GLYY1s2024-031). All participants will provide informed consent prior to enrolment. The study findings will be disseminated through publication in a peer-reviewed journal or presentations at relevant national and international academic conferences.Trial registration numberChiCTR2500097903.

Trapezius muscle activity during wall slide exercise: Natural vs corrected head posture.

The aim of this systematic review was to evaluate the effectiveness of thoracic manual therapy with or without exercise for improving clinical outcomes (pain, disability, range of motion (ROM), quality of life (QoL) and satisfaction) in patients with subacromial pain syndrome (SPS). A systematic review was conducted following PRISMA guidelines. Randomized controlled trials (RCTs) involving thoracic manual therapy with or without thoracic exercise for patients with SPS were included. Databases searched included PubMed, PEDro, Cochrane Library, and Web of Science up to April 2025. The methodological quality was evaluated with the PEDro scale. Seven RCTs involving 393 patients were included. Interventions ranged from thoracic manipulation alone to combinations with exercises. Better outcomes were reported for every clinical outcome evaluated: pain, disability, ROM, QoL and satisfaction. However, methodological heterogeneity and variability in follow-up durations limited result generalizability. Thoracic manual therapy applied in isolation or with exercise was reported to have positive effects in reducing pain and disability in patients with SPS, especially in the short term. These findings support the inclusion of thoracic interventions as complementary strategies in shoulder rehabilitation programs. Future high-quality trials with long-term follow-up are needed to confirm and standardize these approaches.

Rotator cuff injuries are a leading cause of shoulder disability, directly impacting joint mobility and overall quality of life. Effective recovery in these patients depends not only on surgical intervention, when necessary, but also on accurate and continuous monitoring of joint movements during rehabilitation, especially across multiple anatomical planes. Traditional tools, such as clinical assessments or motion capture systems, are often subjective or expensive and impractical for routine use. In this context, wearable devices are emerging as a viable alternative, offering the ability to collect real-time, non-invasive, and repeatable data, both in clinical and home settings. This study presents innovative wearable sensors, developed through 3D printing and integrated with fiber Bragg grating technology, designed to detect the shoulder’s planes of motion (sagittal, scapular, and frontal) during flexion–extension movements. Two wearable sensors made of thermoplastic polyurethane (TPU 85A and 95A) were fabricated and subjected to metrological characterization, including strain and temperature sensitivity, hysteresis error, and tear resistance, and tested on eight healthy volunteers. The results demonstrated high discriminative ability, with sensitivity values up to 0.76 nm/mε and low hysteresis errors. The proposed system represents a promising, cost-effective, and customizable solution for motion monitoring during shoulder rehabilitation.

Background: The use of intra-articular corticosteroid injections remains standard practice in adhesive capsulitis, but professionals disagree about the best supplementary treatment to enhance both pain relief and functional outcomes after shoulder rehabilitation. Spencer technique is used as a manual therapy along with corticosteroid injections to replace the traditional physical therapy. Objective: To compare Spencer technique and conventional treatment in adjuncts to corticosteroids injection in frozen shoulder. Methodology: A randomised controlled trial was conducted to evaluate the comparative effects of these two treatment approaches. The study included 18 participants of Stage 2 and 3 frozen shoulder who received either intra-articular corticosteroids together with Spencer technique as Group A or intra-articular corticosteroid injection with conventional therapy as Group B. The interventions were delivered twice per week throughout four weeks of treatment. The researchers assessed three outcome measures through the visual analogue scale for pain measurement, the Goniometer for range of motion assessment, and the Functional Shoulder Scale for functional improvement monitoring. The data was analysed through independent t-tests in addition to repeated measures ANOVA. Results: The participants from both groups achieved significant improvements in pain reduction together with shoulder range of motion and functional recovery, however the Spencer technique group showed better results. Subjects in the Spencer technique group exceeded the conventional therapy group in achieving better internal rotation results (76.33° vs. 66.67°; p&lt;0.05) together with superior total functional scoring (89.89 vs. 77.44; p&lt;0.001). The subjects in both groups experienced pain reduction, but the subjects receiving the Spencer technique demonstrated marginally better VAS scores during Week 4 (visual analogue scale score: 0.78 vs. 1.22; p&lt;0.001). Conclusion: Shoulder function, along with mobility, improved to a greater degree with the combination of the Spencer technique and intra-articular corticosteroid injection than with corticosteroids alone.

Introduction: Shoulder injuries are common in cricket. Such injuries can result from an ineffective training routine, traumatic injury, and micro-trauma-induced muscle strains. Scapular stabilising exercises should be prescribed during the early part of a shoulder rehabilitation programme to increase the strength of the upper limb musculature and prevent re-injury. Need of the study: Upper and lower limb plyometrics involve explosive, high-intensity exercises that can improve power, speed, and agility, which are crucial for bowlers to deliver fast and accurate deliveries. Therefore, studying the effect of a twoweek training programme consisting of scapular stabilisation exercises and upper and lower limb plyometrics as part of a warm-up routine on medium-paced bowlers can provide valuable insights into enhancing their performance and reducing the risk of injury. The effectiveness of various training programmes on medium-paced bowlers’ performance is an area of ongoing research, and there is a need to investigate the potential benefits of incorporating scapular stabilisation exercises and upper and lower limb plyometrics into their warm-up routine. Aim: To evaluate the effect of two weeks of scapular stabilisation exercises with upper limb plyometrics versus scapular stabilisation exercises with upper and lower limb plyometrics as part of a warm-up on bowling speed in medium-paced cricket bowlers. Materials and Methods: This research protocol is planned to conduct a randomised clinical trial in Belagavi, Hubli, and Dharwad in Karnataka, India, and will employ a randomised, parallel-armed clinical experimental design. The duration of the study will be approximately four years, from January 2023 to February 2027. A total of 66 male cricketers from various KSCAregistered cricket clubs in Belagavi, Hubli, and Dharwad, with medium-paced bowling speed, aged between 18 and 35 years, will be randomly allocated to either a scapular stabilisation and upper limb plyometric group (N=33) or a scapular stabilisation upper limb and lower body plyometric group (N=33) for a period of two weeks (6 times per week). Bowling speed will be used to determine the speed of the ball, the one-minute pull-up test will be used to determine the strength of the upper limb, the vertical jump test will be used to determine the power of the lower limb, a goniometer will be used to determine shoulder range of motion and Glenohumeral Internal Rotation Deficit (GIRD), and target-based bowling accuracy will be used to determine bowling accuracy for one over. Inferential as well as statistical methods will be used to analyse the gathered data. A test for normal distribution will be conducted to determine whether non-parametric tests (Wilcoxon signed rank test, Mann-Whitney U test) will be performed. A probability value of &lt;0.05 will be considered statistically significant.

Shoulder injuries frequently appear in various upper limb-dominated sports, and there will be physical discomfort, pain and stretching during competitions and daily sports training, which brings great distress to athletes in such sports. Therefore, it is necessary to provide relevant guidance for professional athletes and others who are enthusiastic about shoulder injury rehabilitation. This paper mainly discusses the various rehabilitation treatment methods and methods of shoulder joint injury and analyzes the advantages and treatment effects of each method. The results show that exercise training, physical factor therapy, acupuncture and massage therapy have good curative effects on shoulder joint injury, and each has its specialization. For example, exercise training can better restore the patient's shoulder joint mobility, improve the patient's overall physical quality and improve the level of metabolism to a certain extent, and is not subject to a single rehabilitation place in the hospital. Physical factor therapy is effective in relieving shoulder pain and helping the outflow of inflammatory factors, while acupuncture and massage therapy focus on the comprehensive recovery of patients, so that the total clinical effective rate of patients is greatly improved. This paper fills the gap that there is no systematic induction of shoulder rehabilitation in the professional community and can provide guidance for the comprehensive rehabilitation of shoulder joints to a certain extent.

Background: Frozen shoulder (Waja-i-Mafṣal-i-Katif) is a painful condition that leads to stiffness and restricted movement of the shoulder joint. While conventional treatments often rely on medications, Unani regimenal therapy provides a non-invasive alternative for management. Objective: This study aims to assess the effectiveness of Hijāma Dalkiyya (Gliding Cupping) combined with targeted shoulder exercises in improving pain, mobility, and functional ability in individuals with frozen shoulder. Methods: A 67-year-old male diagnosed with right shoulder adhesive capsulitis underwent 21 gliding cupping sessions and structured exercises. Pain levels and shoulder mobility were evaluated using the Shoulder Pain and Disability Index (SPADI) and clinical diagnostic tests before and after treatment. Results: The intervention resulted in a notable improvement in range of motion (ROM), a reduction in SPADI scores, and the negation of previously positive diagnostic tests. The combined effects of cupping therapy and exercise enhanced blood circulation, reduced inflammation, and restored flexibility, improving shoulder function. Conclusion: Unani regimenal therapy, particularly gliding cupping with targeted exercises, shows promise as an effective, non-pharmacological approach for treating frozen shoulder. Further clinical studies are recommended to validate these findings and integrate this method into modern rehabilitation practices. Keywords: Frozen shoulder, Unani therapy, Hijāma Dalkiyya, Gliding cupping, Shoulder rehabilitation

Range of motion (ROM) measurements are essential for evaluating and diagnosing musculoskeletal disorder (MSDs) in the shoulder, such as rotator cuff tendinitis, impingement, rotator cuff tears, and tendinopathy. This study proposes a computer vision (CV)-based system for shoulder rehabilitation ROM measurement as a cost-effective, noninvasive, and accessible alternative to traditional goniometric methods. The system uses the MediapPipe Pose model to predict shoulder joint angles for remote rehabilitation assessment. The predicted joint angles were in agreement (LoA within ± 2.5° and RMSE < 1) with standard ROM measurement systems. Real-Time visual feedback with dynamically drawn trajectories on the screen around the subject are color-coded as red, orange, and green to indicate achieved ROM angles of <80°, between 80° and 100°, and >100°, respectively. These feedback mechanisms enhance patient engagement by motivating them to improve their rehabilitation outcomes. Thus, a novel system has been designed exclusively for shoulder rehabilitation by quantifying their performance using ROM metrics. The results have been compared against commercially available motion tracking sensors towards validating its real-time clinical applicability.Clinical Relevance- The CV-based joint movement analysis has significant implications, particularly for MSD care and rehabilitation, by providing real-time feedback to physiotherapists and patients.

PurposeThis systematic review evaluates the efficacy and feasibility of portable exoskeletons for upper limb rehabilitation in patients post‐stroke and with postoperative neurological complications. It focuses on motor function, range of motion (ROM), spasticity reduction and improvements in daily living activities.MethodsFollowing PRISMA guidelines [12], PubMed, Cochrane, and Scopus databases were searched up to October 2024 using combinations of keywords and MeSH terms such as “exoskeleton devices” and “shoulder rehabilitation.” Included studies (January 2008–October 2023) assessed portable exoskeletons for upper limb function in patients with chronic stroke or postoperative neurological complications. Excluded were studies on non‐portable robots, animal studies, protocols, those without quantitative outcomes, and those not involving human patients. The Joanna Briggs Institute (JBI) Critical Appraisal tool, and the Risk Of Bias 2 (ROB2) tool assessed study bias.ResultsFive selected studies included 70 patients. Evaluated exoskeletons included the Tenodesis‐Induced‐Grip Exoskeleton Robot (TIGER), Wilmington Robotic Exoskeleton (WREX), Hybrid Exoskeleton Upper Limb 30A (HEXO‐UR30A), and Hybrid Assistive Limb (HAL). These devices demonstrated significant improvements in motor function, ROM, spasticity reduction, and kinematic parameters. High adherence and absence of severe adverse events supported feasibility.ConclusionPortable exoskeletons are promising tools for upper limb rehabilitation post‐stroke and after neurological surgery. They enhance motor recovery and functional outcomes. However, moderate risk of bias, small sample sizes, and limited data in orthopedic contexts—especially comparisons with conventional rehabilitation—underscore the need for further high‐quality RCTs.Level of EvidenceLevel IV.

Background. Adhesive capsulitis is an inflammatory condition characterized by shoulder stiffness, pain, and significant loss of passive range of motion, with a prevalence of 2% to 5% in the general population. Low-level laser therapy is an adjunct treatment for shoulder rehabilitation. Deep friction massage reduces pain and inflammation. Aim of the study. This study aims to evaluate the effects of combining low-level laser therapy and deep friction massage on pain, range of motion, functional activities, and inferior gleno-humeral capsule thickness using ultrasonography. Materials and methods. A randomized controlled trial involving patients aged 40 to 60 with adhesive capsulitis was conducted. Participants were divided into experimental and control groups. The experimental group received low-level laser therapy and deep friction massage, while the control group received therapeutic ultrasound and exercise therapy. Results. The study included 40 participants, with 20 in the experimental group and 20 in the control group. Between-group analysis of post-intervention values showed statistically significant differences for pain (p = 0.0086), abduction range of motion (p = 0.0001), external rotation range of motion (p = 0.0001), functional activities (p = 0.0001), and inferior gleno-humeral capsule thickness (p = 0.0069). Within-group analysis of each outcome in the control group was statistically significant, with a p-value of &lt; 0.0001. Conclusion. The study suggests that low-level laser therapy with deep friction massage can significantly reduce pain, improve range of motion, enhance quality of life, and decrease inferior gleno-humeral capsule thickness in patients with adhesive capsulitis.

This study explores the growing role of immersive virtual reality (VR) applications for the rehabilitation of patients with rotator cuff (RC) tears. VR is increasingly integrated into shoulder musculoskeletal rehabilitation, offering a personalized and interactive approach to restoring joint function. VR can enhance patient motivation, engagement, and adherence to therapy by providing feedback and customizable exercises tailored to individual recovery needs. However, challenges such as needing specialized equipment, potential discomfort from prolonged use, and issues like “cybersickness” must be considered. Despite these limitations, the ability of VR to track movement and adapt exercises to the patient’s recovery stage makes it a promising tool in shoulder rehabilitation. Future research is essential to assess the long-term clinical efficacy of immersive VR applications in traditional rehabilitation protocols. The potential for home-based VR therapy, under remote supervision, could enhance accessibility, particularly for patients who face challenges attending in-person sessions. As VR technology continues to evolve, its ability to improve rehabilitation outcomes for RC injury patients is expected to expand, offering both supervised and unsupervised treatment options. KEY WORDS: Rotator cuff tear, shoulder, virtual reality, rehabilitation, orthopedics.

To evaluate the effectiveness of extracorporeal shock wave therapy (ESWT) in improving pain, range of movement, and functional outcomes in patients with shoulder stiffness following rotator-cuff repair. Descriptive study. Place and Duration of the Study: Department of Orthopaedic Surgery, The Fifth Affiliated Hospital, Southern Medical University, Guangzhou, China, from January 2021 to December 2023. Patients with postoperative shoulder stiffness after rotator-cuff repair who underwent ESWT (two sessions per week for four weeks) were enrolled. Outcomes assessed included shoulder range of movement, pain levels (numerical rating scale), Constant- Murley scores (C-M), and American Shoulder and Elbow Surgeon scores (ASES). Data were collected at baseline and at 1, 2, 4, and 6 weeks, and repeated-measures ANOVA was performed to assess changes over time. Sixty patients participated in the study. Significant improvements were observed across all parameters (p <0.001). Shoulder range of movement increased at all follow-up intervals (p <0.001). Pain scores decreased from a mean baseline of 7.81 ± 1.64 to 2.05 ± 1.61 at six weeks. Functional outcomes improved significantly, with C-M scores rising from 48.45 ± 9.78 to 78.50 ± 4.20 and ASES scores increasing from 46.08 ± 13.53 to 79.14 ± 4.29 by the end of the study. No adverse effects or complications related to ESWT were reported. ESWT significantly enhances shoulder mobility, reduces pain, and improves function in postoperative rotator-cuff repair patients. It offers a safe and effective alternative for inclusion in rehabilitation protocols. Rotator-cuff repair, Extracorporeal shock wave therapy, Stiffness, Functional rehabilitation, Analgesia.

With a paradigm shift towards objectivity, measurements and treatments that prioritize numerical values have become more important to the rehabilitative process for medical practitioners. This objectivity is important for assessing musculoskeletal status as well as informing exercise prescription, the shoulder being the focus of this paper. Previously many physiotherapeutic tests and training interventions have been performed with little thought given to load quantification. For example, elastic band resistance is a commonly employed method of applying load to injured tissue, however, the overload provided by this type of resistance difficult to quantify. The implementation of a novel strain gauge device in-line with elastic-based resistance allows for the ability to measure and determine musculoskeletal loads, enabling better monitoring and measurement of loading parameters for the optimization of treatment and client outcomes. In this Masterclass, we discuss the clinical applications of strain gauge implementation in elastic based resistance training for the physical therapist with a focus on practical exercises for shoulder strengthening.