The main challenges facing physical therapists presently in outpatient physical therapy are designing efficient plans of care and ensuring that, once patients are discharged from skilled physical therapy care, they continue with an effective home exercise program.

In an outpatient orthopedic and sports physical therapy setting, shoulder patients have historically represented a high volume of our clientele. Some have suffered trauma, some are victims of time, but most are overhead athletes. Swimmers, tennis players, volleyball players and baseball players are the usual suspects who present to therapy with various shoulder diagnoses.

Restoring Stability

All of these overhead athletes typically present with some form of glenohumeral instability due to the repetitive overhead nature of their respective sport. Secondary to the instability, we usually assess subsequent rotator cuff tendonitis, proximal biceps tendonitis and/or sub-acromial bursitis. The repetitive overhead nature of the various sports and/or trauma contribute to inherent laxity of the inert shoulder structures (the glenohumeral joint capsule and the glenohumeral ligaments). When this occurs, the athlete must rely on the dynamic structures ("dynamic players") of the glenohumeral and scapulothoracic joints in order to effectively and safely stabilize the head of the humerous in the glenoid fossa. These "dynamic players," or muscles, include the supraspinatus, infraspinatus, teres minor, subscapularis, long head of the biceps, deltoid and mid trap/low trap/rhomboid for scapular stability.

In order to counter instability of the glenohumeral joint, a therapist must select specific shoulder stabilization exercises that require co-contraction of the "dynamic players." Traditional strengthening exercises alone do not provide this necessary reflexive muscular co-contraction for improving shoulder biomechanics and cannot ward off sub-acromial conditions.

We believe that we have found a tremendously effective tool for treating glenohumeral instability, and it is called "The Speed Bag" by Burn Machine, LLC. This innovative, multifaceted exercise device has many advantages. First, it possesses all of the necessary criteria for engaging the "dynamic players" of the glenohumeral joint to combat instability. With The Speed Bag held at 90 degrees of shoulder flexion, the 360-degree grips allow a multi-jointed upper-extremity movement engaging the full bilateral upper quarters in a weighted dynamic movement that mimics striking a boxing speed bag, while requiring co-contraction of the "dynamic players" for stabilization.

The Speed Bag units are available in 4-pound, 8-pound and 12-pound models, so they can accommodate the full spectrum of patients. The weight of the device and the 360-degree mobility of the units allow for a combination of isometric and concentric contractions in the bilateral upper quarters. This is a rare combination in terms of therapeutic exercise equipment choice. This is reflected by professional baseball second baseman Matt Hagen of the Somerset Patriots, who trained for the first time with The Speed Bag this past offseason. "Every baseball player is particular about shoulder exercises related to shoulder health," he said. "I couldn't believe how quickly The Speed Bag changed my body. My shoulders are stronger and my muscular endurance has improved quicker than it has with any other kind of training." Adler Volmar, a 1996 & 2008 US Olympian in judo added, "The Speed Bag is one of the most innovate pieces of fitness equipment on the market. I use it to achieve multiple goals like shoulder endurance, cardiovascular fitness, improved flexibility and strength training for judo and fighting."

Additional features of The Speed Bag include cardiovascular and muscular endurance, core strengthening and portability.

Added Benefits

From a cardiovascular and endurance perspective, just think-portable UBE at 3 percent of the cost. With the elbows positioned at the sides of the trunk, The Speed Bag mimics the function of the traditional UBE. Add in dynamic movements such as lunging, trunk rotation in stance and single leg balance in combination with The Speed Bag standard movement, and you get the added benefit of engaging the core. Combinations for engaging the core are endless.

We are most impressed with this final feature of The Speed Bag: portability. Our first client who we presented with The Speed Bag was Juan Pierre, outfielder for the Chicago White Sox. He was impressed with the function of the unit for the shoulder stabilization and health, but was most impressed with the ability to throw it in a bag, ready for travel.

We therapists have no problems creating home exercise programs of traditional design. Now we have an additional device called The Speed Bag by Burn Machine, LLC, that we can add to our therapist "tool box" for patients with glenohumeral instability and/or as a great suggestion for general patient fitness-especially those who travel.

Jack Zatorski is a USA Weightlifting Club Coach and the owner of XL Physical Therapy & Sports Rehab in Fort Lauderdale, FL (www.xlphysicaltherapy.com). He is a four-time Guinness World Record Holder for sit-ups and push-ups. Maria Pontillo is a recent graduate of Florida International University with a Doctorate in Physical Therapy and is the Fitness Program Coordinator at Nova Southeastern University in Fort Lauderdale, FL.