Motion Restore Upper MRD USER MANUAL

“THE UPPER MRD PROGRAM”

Just like the LOWER MRD, the UPPER MRD is an “open
kinetic” chain device. But unlike the LOWER MRD, the
exercises are done in a “closed kinetic” chain stance with
the feet on the ground. Alignment of the skeletal structure
from the feet to head are important when performing the
shoulder motions described below. Good static posture and
alignment while doing the motions on either MRD is an
important key to a successful outcome.

A common issue in rehabilitation of the shoulder is the
imbalance of tension between the mobility function of the
deltoid muscle especially during functional activities that
are above shoulder level and the rotator cuff muscles whose
main function is stability of the glenohumeral joint. The goal
of the following program for the UPPER MRD is restoring that
balance. Let’s get started.

KEY POINTS TO REMEMBER FOR ALL SHOULDER MOTIONS:

•STATIC POSTURE AND ALIGNMENT ARE IMPORTANT WITH
ALL SHOULDER MOTIONS. TO START EACH MOTION, HEAD
AND FACE IS STRAIGHT AHEAD AND CHIN IS PARALLEL
WITH THE FLOOR SO NECK IS IN A “NEUTRAL POSITION.”
PELVIC AND SHOULDER GIRDLES ARE STRAIGHT AHEAD.
FEET ARE STRAIGHT AHEAD WITH EQUAL WEIGHT
BETWEEN BALL OF LITTLE AND BIG TOES AND INSIDE AND
OUTSIDE OF HEELS. LOOK FOR SYMMETRY OF STRUCTURE.

•ALIGN AXIS OF MOTION FOR THE GLENOHUMERAL JOINT
OF THE SHOULDER WITH THE AXIS OF MOTION FOR THE
UPPER MRD FOR ALL MOTIONS.

•WORK WITHIN THE “DYSFUNCTIONAL PAIN” RANGE OF
MOTION (ROM) ARC. THAT IS, THE MOTION OF THE
SHOULDER THAT OCCURS UNTIL FIRST EXPERIENCING
PAIN AND/OR STRETCH AND HOLD. THIS IS NOT A
SITUATION OF “NO PAIN, NO GAIN” TRYING TO MOVE
THROUGH THE PAIN.

•HOLD THE END POSITION OF THE “DYSFUNCTIONAL PAIN”
ARC INITIALLY FOR 5 SECONDS AND GRADUALLY
INCREASE THE HOLDING TIME TO 30 SECONDS.

•BEGIN DOING REPETITIONS OF 3-6 AND GRADUALLY
INCREASE TO 6-12 TIMES FOR EACH SESSION. BREAK
SESSIONS UP DURING THE DAY USING THE UPPER MRD
RATHER THAN DOING ONE LONG, SESSION.

•KEEP RESISTANCE OF UPPER MRD AT “ZERO” UNTIL
TREATING SURGEON GIVES THE OKAY TO PUT AN
EXTERNAL LOAD ON THE TISSUES SURGICALLY INVOLVED.
ONCE IT IS OKAY, GRADUALLY INCREASE THE
RESISTANCE. IF CLIENT CAN DO 12 REPETITIONS WITH
RELATIVE EASE AT A RESISTANCE SETTING, INCREASE
THE RESISTANCE. HAVE THE CLIENT WORK UP TO 12
REPETITIONS AGAIN BEFORE CHANGING RESISTANCE.

Before getting into the shoulder motions, have the client
familiarize themselves with the UPPER MRD by first flexing
and extending the elbow in the sagittal plane. Remember,
the UPPER MRD is active movement with no active-assist
arm as with the LOWER MRD. However, the client is still in
control of their motion working within the “dysfunctional
pain” arc. Begin with elbow flexion and extension in order to
build confidence before getting to the more complex
shoulder motions.

Position the handle with the arm at side of body and the
elbow is extended. This is the starting position for elbow
flexion and extension.

Keep upper arm close to side with palm facing side of body.
Flex elbow up to 90º or more until first experiencing
dysfunctional pain and back into elbow extension 0º, the
starting position.

Get client familiarized with changing the sensory input as
done with each shoulder motion. With elbow flexion and
extension, eyes stay closed as with all shoulder motions to
eliminate the influence of vestibular-ocular reflexes. Move
eyes out to the L and down as flex the R elbow until first
experiencing a stretch or pull. Move eyes out to the L and up
and slowly extend elbow back with control to starting
position. Relax eyes and repeat. Can do this sequence as
many times as necessary until client feels confident and
safe using the UPPER MRD.

1) SAGITTAL PLANE SHOULDER MOTION FOR ANTERIOR/
POSTERIOR DELTOID:
Begin working the shoulder in the sagittal plane (flexion
and extension) with eye movements being out and down
on opposite side as shoulder flexion and out and up on
opposite side as shoulder extension.

Starting position will be with R arm at side of body,
elbow extended (0º), and palm of hand facing side of
body. Adjust the handle of the UPPER MRD arm
accordingly to the starting position.

Have client close eyes and move eyes out to the L and
down as moving arm up into shoulder flexion
until first experiencing pain and/or stretch and hold.
Initially, hold the shoulder flexion position for 5 seconds
and gradually increase to a maximum of 30 seconds.

Keeping eyes closed, have client move eyes out to the

L and up while slowly moving arm back in shoulder
extension with control to the starting position and past
the hip if possible where first experiencing pain and/or
stretch and hold. Hold initially for a count of 5 seconds
and gradually increase to a maximum of 30 seconds.
Relax R shoulder and arm, eyes L and up, and return to
starting position. Repeat this cycle of shoulder flexion
and extension 3-12 times.

You can have the client do this with both shoulders as
with all the shoulder motions. If there is a significant
fear of moving the involved extremity, start with the
uninvolved limb and then do the involved limb. It has
been my own personal experience and also in working
with post-surgical shoulders, that there is a real fear to
overcome when beginning shoulder motion after
surgery or an injury.

With shoulder extension, initially this motion has very
little resistance because of working with gravity’s
assistance. As a result, there is not much resistance
being experienced by the client. Once it is okay with
the treating surgeon, resistance can be applied by
using the UPPER MRD resistance mode with shoulder
flexion and extension. Keep this in mind when doing
other shoulder motions with the assistant of gravity.

KEY POINTS TO REMEMBER FOR SHOULDER FLEXION/
EXTENSION MOTION AFFECTING POSTERIOR/
ANTERIOR DELTOID:

•ALIGNMENT AND POSTURE ARE IMPORTANT TO A
SUCCESSFUL OUTCOME.

•STARTING POSITION OF ARM IS AT SIDE WITH PALM
OF HAND FACING SIDE OF BODY.

•EYES ARE CLOSED AND OUT AND UP ON OPPOSITE
SIDE OF SHOULDER FLEXION MOTION AND EYES ARE

CLOSED AND LOOK OUT AND DOWN ON OPPOSITE

SIDE OF SHOULDER EXTENSION MOTION.

2) FRONTAL PLANE SHOULDER MOTION FOR MIDDLE
DELTOID AND ROTATOR CUFF:
As the client gains confidence and has less fear of
moving the surgically repaired or traumatized shoulder,
begin frontal plane motion (abduction/adduction) that
involves tilting or side bending of the head and
neck as well as eye movements on the same side as
shoulder abduction/adduction motion.

Starting position is with arm at side, elbow slightly
flexed and palm facing front of body so adjust the
UPPER MRD handle accordingly.

Have the client close their eyes and keeping their head
and face straight ahead, position the head and neck
so it is tilted or side bent 15-30º toward R shoulder and
hold.

Keeping the eyes closed, have client move eyes out to
the R and up as raising R arm out from side into
shoulder abduction until first experiencing pain and/or
stretch and hold. Initially, hold for 5 seconds and
gradually increase to a maximum of 30 seconds.

Keeping eyes closed with head and neck tilted toward

R shoulder and eyes out to the R and up, have client

slowly bring R arm in shoulder adduction with control to

side of body and the starting position. Relax head and

neck tilt R, eyes R and up, and R shoulder and arm.

Repeat cycle of shoulder abduction/adduction motion 3-

12 times.

Alter the position of client’s R hand so palm is now
toward side of body and elbow extended. Adjust UPPER
MRD handle accordingly. This is the starting position.

Head and face is vertical with no side bend or tilt and

straight ahead with chin parallel with the floor. Have

client close their eyes and move eyes out to the R and

down. Keeping elbow extended, raise R arm out from

side in abduction until first experiencing pain and/or

stretch or shoulder level and hold. Hold initially for 5

seconds and gradually increase to a maximum of 30

seconds. Keeping eyes out to R and down, slowly

adduct R arm with control to starting position at side of

body. Relax eyes R and down, R shoulder, and R arm.

Repeat 3-12 times.

L shoulder abduction/adduction with starting position of

arm at side having palm facing forward and elbow

slightly flexed is done in the same manner.
Eyes are closed and head and neck side bent or tilted
15-30º toward L shoulder. Move eyes out to the L and up
as raise L arm up in shoulder abduction and down in
shoulder adduction.

With L shoulder abduction/adduction and the starting
position of arm at side and palm facing side of body,
close eyes. Head and neck is vertical with no
side bend or tilt and straight ahead having chin parallel
with the floor. Move eyes out to the L and down as raise
L arm up in shoulder abduction to shoulder level or
below and back down in shoulder adduction.

KEY POINTS TO REMEMBER FOR SHOULDER
ABDUCTION/ADDUCTION MOTION:

•ALIGNMENT AND POSTURE IS IMPORTANT TO A
SUCCESSFUL OUTCOME.

•EYES ARE CLOSED.

•HEAD AND NECK IS TILTED OR SIDE BENT 15-30º

WITH EYES OUT AND UP TO SAME SIDE AS SHOULDER
ABDUCTION/ADDUCTION MOTION WHILE HAVING
STARTING POSITION OF ARM WITH PALM FACING
FORWARD.

•HEAD AND NECK IS VERTICAL AND STRAIGHT AHEAD
WITH EYES OUT AND DOWN TO SAME SIDE AS
SHOULDER ABDUCTION/ADDUCTION MOTION WHILE
HAVING STARTING POSITION OF ARM WITH PALM OF
HAND TOWARD BODY.

3) FRONTAL/TRANSVERSE PLANE SHOULDER MOTION
AFFECTING ROTATOR CUFF:
As client gains more confidence, the more
complex shoulder movements involving rotation can
start. With these rotational shoulder movements, eyes
are closed and eye motion is utilized while head and
neck is straight ahead and chin parallel with floor.

SHOULDER EXTERNAL/INTERNAL ROTATION AT SIDE:
Start first with the internal/external rotation of the
shoulder with the starting position at side of body.
Have R arm at side of body with elbow flexed to 90º and
palm of hand facing toward midline of body. Adjust
handle of UPPER MRD accordingly. The starting
position of this exercise in review is with the R arm at
side of body, elbow flexed to 90º, and palm of hand is
facing midline of body.

Have client close eyes and move eyes out to the R and
up as bringing R arm out into external rotation to the R
until first experiencing pain and/or stretch and hold.
Hold initially for 5 seconds and gradually increase to 30
seconds. Move eyes out to the R and down and slowly
bring R arm back across in internal rotation with
control until first experiencing pain and/or stretch and
hold. Relax eyes R and down and R arm and shoulder.
Repeat cycle of R shoulder external/internal rotation
3-12 times.

L shoulder external/internal rotation with arm at side is
done in the same manner. With L arm in starting
position, have client close eyes and move eyes out to
the L and up as bring L arm out in external rotation
to the L and keeping eyes closed, move eyes out to to
the L and down as bring L arm back in internal
rotation across to the L.

SHOULDER EXTERNAL/INTERNAL ROTATION WITH 90º
SHOULDER ABDUCTION AND 90º ELBOW FLEXION
AFFECTING ROTATOR CUFF:
Next is shoulder internal and external rotation with
the arm at 90º of abduction and 90º elbow flexion, a
more complex motion. Adjust UPPER MRD arm so R
upper arm is positioned directly out to the side with
shoulder abduction to 90º and upper arm is parallel with
the floor with elbow flexed 90º. Adjust handle on UPPER
MRD arm accordingly with palm facing toward floor in
the starting position.

Position head and neck straight ahead and chin
parallel to the floor. Have R arm and shoulder in starting
position so palm is down toward floor. Close eyes and
move eyes out to the R and up as bringing R shoulder
and arm back in external rotation where first
experiencing pain and/or stretch and hold. Initially hold
for 5 seconds and gradually increase to a maximum of
30 seconds.

Keeping eyes closed, move eyes out to the R and down
as bring R shoulder forward in internal rotation to
where first experiencing pain and/or stretch and hold.
Initially hold for 5 seconds and gradually increase to a
maximum of 30 seconds.
Relax eyes R and down, R shoulder and arm, and return
to starting position. Repeat cycle of R shoulder
external/internal rotation 3-12 times.

L shoulder external/internal rotation with arm at 90º

shoulder abduction and 90º elbow flexion is done in the

same manner. With L arm in starting position and L

palm toward floor, have client close eyes and move

eyes out to the L and up as bring L arm up in external

rotation. Keeping eyes closed, move eyes out to the L

and down as bring L arm down in internal rotation.

KEY POINTS TO REMEMBER FOR SHOULDER

INTERNAL/EXTERNAL ROTATION MOTION WITH ARM

AT SIDE AND AT 90º SHOULDER FLEXION AND 90º

ELBOW FLEXION AFFECTING ROTATOR CUFF:

• HERE ARE TWO STARTING POSITIONS ONE WITH ARM
AT SIDE AND ELBOW FLEXED TO 90º AND PALM OF
HAND TOWARD MIDLINE OF BODY WHILE

THE OTHER
POSITION IS WITH THE ARM DIRECTLY OUT FROM THE
SIDE WITH 90º SHOULDER ABDUCTION AND 90º ELBOW
FLEXION.

•WITH BOTH STARTING POSITIONS, EYES ARE CLOSED
AND EYES MOVE OUT AND UP ON SAME SIDE OF ARM
MOVING IN EXTERNAL ROTATION AND EYES MOVE
OUT AND DOWN ON SAME SIDE OF ARM MOVING IN

INTERNAL ROTATION.

4) SAGITTAL/TRANSVERSE PLANE SHOULDER MOTION
FOR ANTERIOR/POSTERIOR DELTOID.
With these three shoulder rotational movement
sequences, the eyes are closed and eyes move out
and up/down opposite of shoulder and arm movement.

SHOULDER EXTERNAL/INTERNAL ROTATION AT SIDE
AFFECTING POSTERIOR/ANTERIOR DELTOID:
Position head and neck straight ahead and chin parallel
with the floor. Have R arm resting with palm facing
midline of body. Flex R elbow to 90º and adjust handle
of UPPER MRD accordingly. Starting position of this
exercise is with the R arm at side of body, elbow
flexed to 90º, and palm of hand facing midline of body.

Have client close eyes and move eyes out to the L and
up as bring R arm out in external rotation to the R until
first experiencing pain and/or stretch and hold. Hold
initially for 5 seconds and gradually increase to a
maximum of 30 seconds. Keeping eyes closed, move
eyes out to the L and down and slowly bring R arm back
across in internal rotation with control to the L until
first experiencing pain and/or stretch and hold. Relax
eyes L and down and R arm and shoulder. Repeat cycle
of R shoulder external/internal rotation 3-12 times.

L shoulder external/internal rotation with arm at side is
done in the same manner. With the L arm in starting
position, have client close eyes and move eyes out to
the R and up as bring L arm out to the L in external
rotation. Keeping eyes closed, move eyes out to to the
R and down as bring L arm back in internal
rotation across to the R.

SHOULDER EXTERNAL/INTERNAL ROTATION WITH 90º
SHOULDER ABDUCTION AND 90º ELBOW FLEXION
AFFECTING POSTERIOR/ANTERIOR DELTOID:
Next is shoulder internal and external rotation with
the arm at 90º of shoulder abduction and 90º elbow
flexion, a more complex motion.

Adjust UPPER MRD arm so R upper arm is positioned
directly out to the side from shoulder to 90º abduction
and upper arm is parallel with the floor having 90º
elbow flexion and palm is toward the floor in starting
position.

Position head and neck straight ahead and chin
parallel to the floor. Have R arm and shoulder in starting
position with palm toward floor. Close eyes and look out
to the L and up as bringing R shoulder back into
external rotation where first experiencing pain and/or
stretch and hold. Initially hold for 5 seconds and
gradually increase to a maximum of 30 seconds.

Keeping eyes closed, move eyes out to the L and down
as bring R shoulder forward in internal rotation to
where first experiencing pain and/or stretch and hold.
Initially hold for 5 seconds and gradually increase to a
maximum of 30 seconds. Relax eyes L and down, R
shoulder and arm, and return to starting position.
Repeat cycle of R shoulder external/internal rotation
3-12 times.

L shoulder external/internal rotation in 90º shoulder
abduction and 90º elbow flexion is done in the same
manner and same starting position having palm facing
toward the floor.

Close eyes and move eyes out to the R and up as bring
L shoulder and arm up in external rotation until first
experiencing pain and/or stretch and hold. Initially hold
for 5 seconds and gradually increase to 30 seconds.

Keeping eyes closed, move eyes out to the R and down
as bring L shoulder and arm down in internal rotation
until first experiencing pain and/or stretch and hold.
Initially hold for 5 seconds and gradually increase to 30
seconds.

KEY POINTS TO REMEMBER FOR SHOULDER
INTERNAL/EXTERNAL ROTATION MOTION WITH ARM
AT SIDE AND AT 90º SHOULDER FLEXION AND ELBOW
FLEXION AFFECTING POSTERIOR/ANTERIOR DELTOID:

• THERE ARE TWO STARTING POSITIONS ONE WITH THE
ELBOW FLEXED TO 90º AND ARM AT SIDE AND PALM
OF HAND TOWARD MIDLINE OF BODY. THE OTHER
POSITION IS WITH THE ARM DIRECTLY OUT FROM THE
SIDE AT 90º SHOULDER ABDUCTION AND 90º ELBOW
FLEXION SO PALM OF HAND FACES FLOOR.

•EYES ARE CLOSED AND EYES MOVE OUT TO
THE OPPOSITE SIDE AND UP AS DO SHOULDER
EXTERNAL ROTATION MOVEMENT AND MOVE OUT TO
THE OPPOSITE SIDE AND DOWN AS DO SHOULDER
INTERNAL ROTATION MOVEMENT.

SHOULDER HORIZONTAL ABDUCTION/ADDUCTION
AFFECTING POSTERIOR/ANTERIOR DELTOID:
Have R arm and shoulder positioned directly
out in front of body to 90º shoulder flexion with the
elbow extended and palm facing midline of body. Adjust
the upper MRD handle accordingly. This is the starting
position.

With eyes closed and out to the L and up, keep R elbow
extended and swing R arm out to the R in horizontal
abduction where first experiencing pain and/or stretch
and hold. Initially hold for 5 seconds and gradually
increase to a maximum of 30 seconds. Keeping eyes
closed, move eyes out to the L and down and slowly
swing R shoulder and arm with control back in
horizontal adduction toward the starting position and
eventually crossing the midline of the body until first
experiencing pain and/or stretch. Initially hold for 5
seconds gradually increasing to a maximum of 30
seconds. Relax R shoulder and arm and eyes L and
down. Repeat cycle of R shoulder horizontal abduction
and horizontal adduction 3-12 times.

L shoulder horizontal abduction/adduction is done in the
same manner with arm starting in 90º shoulder flexion,
elbow extension, and palm of hand facing toward
midline of body. Close eyes and move eyes out to the R
and up as bring L shoulder and arm out in
horizontal abduction to the L. Keeping eyes closed,
move eyes out to the R and down as bring L arm
across in horizontal adduction to the R toward starting
position and eventually across midline of body.

KEY POINTS TO REMEMBER FOR SHOULDER
HORIZONTAL ABDUCTION/HORIZONTAL ADDUCTION
MOTION:

•GOOD POSTURE AND ALIGNMENT ARE THE KEY TO A
SUCCESSFUL OUTCOME.

•STARTING POSITION IS WITH ARM OUT IN FRONT OF
BODY TO 90º SHOULDER FLEXION AND ELBOW
EXTENDED SO PALM IS TOWARD MIDLINE OF BODY.

•EYES ARE CLOSED AND MOVE OUT OPPOSITE AND UP
AS DOING SHOULDER HORIZONTAL ABDUCTION AND
MOVE OUT OPPOSITE AND DOWN AS DOING SHOULDER
HORIZONTAL ADDUCTION.