Abstract:
A human shoulder stretcher and method of use for gradual, progressive posterior capsular stretching to rehabilitate the shoulder, in particular to address tightness of the posterior capsule of the glenohumeral joint through use of a lever arm and ratcheting mechanism that permits a patient to stretch his or her shoulder without the need for a therapist present.

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation-in-part application of and claims the benefit of International application PCT/US2008/066509, filed Jun. 11, 2008, and U.S. provisional application 60/949,480, filed Jul. 12, 2007, both of which are incorporated by reference herein. 
    
    
     FIELD OF INVENTION 
     The invention relates generally to a device for use in rehabilitation of the shoulder of a human, in particular to address tightness of the posterior capsule of the glenohumeral joint, i.e., the human shoulder. 
     BACKGROUND OF INVENTION 
     Tightness of the posterior capsule of the glenohumeral joint is a common problem that occurs secondary to a minor shoulder problem. It is a significant problem to athletes who throw, to post-operative patients having had shoulder surgery and to people who suffer from impingement syndrome of the shoulder, the most common source of shoulder pain. 
     Devices and methods for shoulder stretching are known. For example, U.S. Pat. No. 5,520,615 (“the &#39;615 patent”) describes a pulley system included in a self-assertive shoulder stretching and rotation machine wherein a supine person&#39;s forearm is secured to a forearm support that is attached to a horizontal support movable by the supine person&#39;s pulling on a rope. U.S. Pat. No. 6,007,500 (“the &#39;500 patent”) describes a belt and pulley system included in a rotator cuff stretching machine with pivoting members that provide for simultaneously stretching of the rotator cuff, shoulder and elbow in selective upper arm positions of yaw and pitch angles and selective elbow positions of flexion or extension. The &#39;500 patent machine includes upper and forearm assemblies that are pivotably joined through a bearing assembly and requires the patient to sit upright. The assembly has a rotational capacity of 360 degrees and is attached to a vertical support that rotates in horizontal yaw on a vertical yaw pivot pin. U.S. Pat. No. 6,569,067 (“the &#39;067 patent”) describes a device that elevates the elbow off of the torso and abducts the arm for rehabilitating the shoulder. It includes a first C-shaped member for supporting the extremity of the patient and a second C-shaped member for engaging the torso of the patient. 
     SUMMARY OF INVENTION 
     Embodiments of a shoulder stretcher and methods of use described herein provide the first known devices that function to permit, without a physical therapist or other assistant, posterior capsular stretching of the human shoulder through use of a mechanical ratcheting device. In one preferred embodiment the device includes a base or rigid support, an arm strap, and a lever arm that is rotatably fastened to the base, and preferably includes a ratcheting mechanism that prevents reverse rotation except upon operation of a ratchet release. In another preferred embodiment the device includes a backboard, should strap, elbow cup with a pad, a hand grip and wrist stabilizer and a ratcheting mechanism. 
     The mechanical stretching device functions to stretch human shoulders and is preferably for use in shoulder rehabilitation and prevention of posterior capsular tightness and capsulitis. It can be used for self-stretching by a patient, and preferably incorporates a dial type ratcheting mechanism for staged stretching of the shoulder. It can be used for posterior capsule stretching and in its reverse position or orientation can be used for external rotation stretching. The shoulder stretching apparatuses and methods described herein function to provide for progressive stretching of the shoulder joint in both internal and external rotation. The apparatus provides a person with the capability to maximally stretch the shoulder without an assistant or therapist while slowly advancing range of motion in a desired plane. It allows the person to gradually advance the rotation of his or her shoulder capsule through a home therapy program. These functions and capabilities are accomplished by preferred strap systems that stabilize the arm and elbow to a firm platform while the forearm is progressively advanced in the desired direction of shoulder rotation by means of a lever arm. The ratcheting mechanism allows for forward stretching of the forearm without the ability to reverse or go backwards unless a release mechanism is activated. This provides the user with the ability to stretch his or her shoulder joint over an extended period and at his or her own pace. The device has the capability to rotate 180° and thus can be used for stretching either upper extremity, i.e., either the left or right shoulder. In addition to stretching the posterior capsule and internal rotation deficit, this device allows for dynamic sustained stretching in the external rotation plane. By simply releasing the ratcheting mechanism, the arm support can be rotated in either direction, thus allowing for a full 180° stretch. 
     During use of one embodiment in stretching, the injured shoulder&#39;s forearm is positioned adjacent to, or rested against the lever arm, and the user&#39;s/patient&#39;s forearm is strapped to or otherwise stabilized to the lever arm. The user&#39;s upper arm is strapped or otherwise stabilized to the base. In another preferred embodiment the user&#39;s shoulder is stabilized to the backboard and the user&#39;s wrist is stabilized to the ratchet mechanism lever arm. In both preferred embodiments the device&#39;s lever arm and the user&#39;s forearm are preferably advanced or rotated preferably by the patient&#39;s other arm. As the forearm of the injured shoulder is advanced, the ratchet mechanism clicks and holds its place with each advancing increment of rotation to prevent backward or reverse motion of the forearm. The patient can stop the rotation at any increment or increments of rotation to rest the shoulder at a desired degree or increment of rotation and stretching. After each rest period, the patient can then continue the sequence of rotation, rest; rotation, rest, etc., until a desired degree of stretching is reached for a given exercise or therapy session. During this sequential series of motions and rests the arm strap holds or stabilizes the patient&#39;s upper arm to the base or backboard, so that that shoulder does not lift off of the base or backboard. Thus, during use the arm strap or shoulder strap secures the patient&#39;s arm to the base or backboard in order to prevent the upper arm from lifting off of the base or backboard, as the forearm is advanced toward the base. Once the shoulder has been stretched adequately, or at any other time during the therapy session, a ratchet release actuator can be pressed or otherwise activated to release the ratchet. Releasing the ratchet mechanism permits reverse rotation, or backwards movement of the lever arm. The ratchet mechanism and lever arm preferably permit 180° of rotation of the lever arm/forearm rest. Thus, the device may be used for right and left shoulder rehabilitation, and for progressive, staged stretching of the shoulder at a pace and to the extent desired by the patient. 
     These and other embodiments, features, aspects, and advantages of the invention will become better understood with regard to the following description, appended claims and accompanying drawings. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The foregoing aspects and the attendant advantages of the present invention will become more readily appreciated by reference to the following detailed description, when taken in conjunction with the accompanying drawings, wherein: 
         FIG. 1  is a perspective view of a preferred embodiment shoulder stretcher; 
         FIG. 2  is a perspective view of the  FIG. 1  embodiment in reverse orientation; 
         FIG. 3  is a top view of the stretcher as shown in  FIG. 2 ; 
         FIG. 4  is a front view of the stretcher as shown in  FIG. 2 ; 
         FIG. 5  is a side view of the stretcher as shown in  FIG. 2 ; 
         FIG. 6  is a view of the ratchet mechanism of the  FIG. 1  embodiment with the housing shown in dashed lines to expose the interior ratchet mechanism; 
         FIG. 7  is a view of the  FIG. 1  embodiment including a drawing of a user as would be orientated during a shoulder stretching operation; and, 
         FIG. 8  is a view of an alternate embodiment showing a lever arm that includes a forearm rest. 
         FIG. 9  is a perspective view of a preferred alternate embodiment showing a shoulder strap and a wrist stabilizer. 
         FIG. 10  is a perspective view of the  FIG. 9  embodiment shown from a different angle. 
         FIG. 11  is an exploded perspective view of the  FIG. 9  embodiment. 
         FIG. 12  is a top view of the  FIG. 9  embodiment. 
         FIG. 13  is a front view of the  FIG. 9  embodiment. 
         FIG. 14  is a side view of the  FIG. 9  embodiment. 
         FIG. 15  is an exploded perspective view of the arm assembly and handle assembly of the  FIG. 9  embodiment. 
         FIG. 16  is a close-up perspective view of arm assembly and ratchet assembly of the  FIG. 9  embodiment. 
         FIG. 17  is a close-up side view of arm and ratchet assemblies of the  FIG. 9  embodiment shown in a first position. 
         FIG. 18  is a close-up front view of arm and ratchet assemblies of the  FIG. 9  embodiment taken through line B-B of  FIG. 17 . 
         FIG. 19  is a close-up side view of arm and ratchet assemblies of the  FIG. 9  embodiment shown in a second position. 
         FIG. 20  is a close-up front view of arm and ratchet assemblies of the  FIG. 9  embodiment taken through line B-B of  FIG. 19 . 
         FIG. 21  is a close-up side view of arm and ratchet assemblies of the  FIG. 9  embodiment shown in a third position. 
         FIG. 22  is a close-up front view of arm and ratchet assemblies of the  FIG. 9  embodiment taken through line B-B of  FIG. 21 . 
         FIG. 23  is a close-up side view of arm and ratchet assemblies of the  FIG. 9  embodiment shown in a fourth position. 
         FIG. 24  is a close-up front view of arm and ratchet assemblies of the  FIG. 9  embodiment taken through line B-B of  FIG. 23 . 
         FIG. 25  is a close-up side view of arm and ratchet assemblies of the  FIG. 9  embodiment shown in a fifth position. 
         FIG. 26  is a close-up front view of arm and ratchet assemblies of the  FIG. 9  embodiment taken through line B-B of  FIG. 25 . 
     
    
    
     Reference symbols or names are used in the Figures to indicate certain components, aspects or features shown therein. Reference symbols common to more than one Figure indicate like components, aspects or features shown therein. 
     DETAILED DESCRIPTION 
     With reference to  FIGS. 1-26  preferred embodiments of the mechanical shoulder stretcher device and methods of their use will be described. Referring to  FIGS. 1-8 , a first preferred embodiment shoulder stretcher  20  includes a base or rigid support  22 , arm strap  24 , elbow strap  26 , lever arm  30 , ratchet mechanism  32  and ratchet release actuator  34 . Shoulder stretcher  20  functions to stretch the posterior capsule without need for a physical therapist or other assistant. The device has the capability to rotate 180° and thus can be used for stretching either upper extremity, i.e., either the left or right shoulder. In addition to stretching the posterior capsule and internal rotation deficit, this embodiment allows for dynamic sustained stretching in the external rotation plane. By simply releasing the ratcheting mechanism, the arm support can be rotated in either direction, thus allowing for a full 180° stretch. In other words, the person with the injured shoulder, i.e., the patient, can operate the device by himself or herself. The attendant advantages to such a self-use device include more flexibility in scheduling therapy sessions, reduced costs, and increased number of therapy sessions because no appointment with a physical therapist is needed. The shoulder stretcher  20  is intended to be used for shoulder rehabilitation and prevention of posterior capsular tightness or capsulitis, i.e., inflammation of the shoulder capsule. 
     Base  22  is preferably a padded board and functions to provide a stable platform for the user&#39;s torso. The board need not be padded. While the board shown in the  FIG. 1  embodiment is generally rectangular, having a longitudinal centerline  21 , it may be of virtually any shape, and be made of virtually any material so long as it provides a platform sufficiently stable to facilitate stretching of the shoulder in accordance with the methods of stretching described herein. Also, the size of the board may vary, in accordance with the size of the user, i.e., a relatively small board for a small user such as a child, and a relatively large board for a larger user, such as a professional basketball, football or baseball player. 
     The arm strap or belt  24  is preferably a conventional strap that may be made of leather, natural fibers or synthetic material. The arm strap  24  preferably extends from two slots in the base that are preferably equidistant from the centerline  21  and functions to provide a firm, stable securing of the patient&#39;s upper arm to the base  22  with sufficient restraining force to prevent the upper arm from lifting off of the patient&#39;s proximal shoulder during use of the device. By the term upper arm is meant that part of the arm surrounding the humerus bone. Preferably a single strap is used, and the strap is of a sufficient width and placed in a position on the base so that during use it functions to hold the upper arm, from the distal end of the humerus bone to the proximal end of the humerus bone in a fixed position on or near to the base. Preferably the arm strap and the slots are constructed and adapted to be capable of movement long the centerline  21  to accommodate arms of different lengths. This allows for variations in size of the patients&#39; arm length between the elbow and the shoulder. During use it is important that this strap be tightened enough to hold down the shoulder/upper arm so that the shoulder touches the base during use of the device, or alternatively, holds the shoulder/upper arm close to the base during use of the device. When the patient&#39;s arm is stretched in this device, it has a tendency to rise superiorly, and thus the arm strap functions to prevent this rise. As will be apparent to those skilled in this art, one or more arm straps may be used. Also, various materials of construction may be used, such as for example, leather, natural fiber cloth, and synthetic materials. 
     The arm strap preferably has Velcro® brand or some other brand of loop and hook type fastener to maintain the strap in a tightened position. Alternatively, other conventional belt-fastening devices may be used. The arm strap  24  may be made of virtually any material and may be fastened in a tight position with virtually any type of fastener, including a conventional knot, so long as the strap is capable of functioning for its intended purpose. Optionally, the device may be made to have the arm strap positionable at various locations along centerline  21 , as shown in  FIG. 3 . Such a construction is believed to be within the skill of a person of ordinary skill in this field, and could include, optionally, for example relatively long slots  44 ,  46  that would extend in the same direction as line  21 , but of course be longer than the slots  44 ,  46  illustrated in  FIG. 3 . Use of such a positionable arm strap would of course enable a single device to be used by patients of a wide range of sizes. 
     As shown in  FIGS. 1-5  and  7 - 8 , a second strap  26  also provides for holding the upper arm down on or near to the base during operation. As shown here the second strap  26  operates primarily on the distal end of the upper arm for the injured shoulder. Second arm strap  26  is preferably a conventional strap, much like the first arm strap  24 , and is used to secure the elbow and lower part of the upper arm to the base during use. In one embodiment the second arm strap  26  is preferably provided with a reinforcing frame  28  having opposed sides that are equidistant from the centerline  21 , and that function to provide additional structure to secure the patient&#39;s elbow to the base so that the elbow does not lift off the base during use. As described above, use of two arm straps is optional. In one embodiment, a single arm strap may be used so long as it functions to restrain movement of the shoulder away from the base during operation of the device. 
     Telescoping lever arm  30  includes at one end a handle and at its other end a connection to the axle of ratchet mechanism  32 . The axle extends along the centerline  21 , at a relatively short distance above the centerline  21 , and provides an axis of rotation for the ratchet mechanism  32  and lever arm through planes that are perpendicular to the axis of rotation. In  FIGS. 1 ,  3  and  4  a plane through which the lever arm rotates is shown as plane A, and the plane through which the ratchet wheel or gear rotates is shown as plane B. Planes A and B are generally perpendicular to the plane in which the base  22  lies and they are also generally perpendicular to the axis of rotation of the ratchet mechanism. As may be appreciated, the plane in which the ratchet mechanism rotates, plane B, is parallel to the plane in which the lever arm rotates, i.e., plane A. The conventional telescoping arm provides for and accommodates a range of arm lengths. The handle extends back toward the patient and during use of the device may be gripped by the patient&#39;s hand or used as a support for the patient&#39;s hand, either front side or back side. With reference to  FIGS. 6 and 8 , the ratchet mechanism includes a gear or toothed wheel positioned inside of a housing and fastened about the axle for rotation in either the clockwise direction or counterclockwise direction. A U-shaped brake  44  is rotatingly attached to one side of the housing, and extends exterior to the housing in the form of a release and reverse lever  34 . As shown in  FIG. 6 , the lever  34  operates as a brake against rotation in a clockwise direction. By rotating the lever  34  in a clockwise direction the brake  44  is also rotated clockwise to a position against the wheel  42  at which it operates as a brake against counterclockwise direction. The housing is fastened to the base via conventional fasteners  36 , such as screws, rivets, staples, nails, glue or any other means so long as they function to keep the housing fastened to the base.  FIG. 7  illustrates the positioning of a user&#39;s body, particularly the shoulder, upper arm, forearm and hand in relation to the various parts of the shoulder stretcher mechanism. 
     As shown in  FIG. 8 , the device may be provided with an optional forearm rest  48  positioned on the lever arm  30 . The forearm rest functions to provide a stable support for the forearm. The end of the lever arm  30  distal from the ratchet mechanism  32  is formed into a “U” shape, with the closed end of the “U” forming a handgrip  50 . The handgrip may be made of any of a variety of materials, such as cloth, a rubber or elastomeric material, or an absorbent material. A sling  52  is positioned on the legs of the “U” and extends between the “U” to form and function as a forearm rest. A strap  54  is preferably fastened to one of the legs of the “U” and extends across, and is attachable at the opposite let of the “U”. The strap  54  functions to provide a restraint for the forearm in one direction of rotation, and as the forearm rest in the opposite direction of rotation. The strap  54  is preferably fastened to one leg with a hook and loop type fastener. Various types of materials may be used for, and various techniques may be used to fasten the forearm sling and forearm strap to the lever arm  30 . In yet another alternate embodiment, the lever arm may be in the form of a horseshoe with elongated legs of the same length, the distal ends of which are fastened to the axle of the ratchet mechanism. In this alternate embodiment webbing, a solid surface or some other material extends between the elongated legs and then along the length of the lever arm to function as a forearm rest or support. The elongated horseshoe lever arm may also be of a telescoping design capable of adjustment to accommodate arms of different length. 
     Referring to  FIGS. 9-26 , a second preferred embodiment shoulder stretcher  100  includes a backboard  102 , shoulder strap  104 , elbow cup with pad  106 , lever arm  108 , ratchet mechanism  110  and ratchet direction lever  192 . Shoulder strap  104  is shown as a generally triangular shaped strap, and can be of various shapes and sizes so long as it functions to restrain the patient&#39;s shoulder during use. Shoulder strap  104  is attached to backboard  102  at three locations, one of which is adjustable, shown as a Velcro brand fastener and adjustable strap at  114 . The adjustment capability may be accomplished through various types, sizes and locations of components, so long as they cooperate to provide for adjustment to accommodate variously sized shoulders. Positioned at one end of the lever arm  108  are a handgrip  116  and a wrist stabilizer  118 . The lever arm  108  also includes a handle adjustment knob  166 . The backboard may also have additional slots, such as at  122  and  124  to provide locations for additional/alternate straps with which to stabilize the shoulder to the backboard and/or the backboard to some other structure. As shown in  FIG. 11 , an exploded view of  FIGS. 9-1 , the arm assembly  126  is shown with attachment knobs, one of which is shown at  128 , positioned to removably attach the arm to the backboard  102  with their pins extending through attachment holes  130 ,  132  on the backboard  102 . Also shown in  FIG. 11  are shoulder strap holes  124 ,  134 ,  136  and  138 . 
     Referring to  FIGS. 12-14 , the shoulder strap  104  includes removable strap anchors  140  and the Velcro brand fastener for the adjustable strap  114 . A side view of the hand grip assembly  142  and ratchet arm assembly  126  is provided in  FIG. 13 . The opposite side view shown in  FIG. 14  illustrates the location of numeric indicator  144 . 
     Referring to  FIG. 15 , an exploded view of the ratchet assembly  126  and hand grip assembly  142 , the components of those assemblies will be described. Ratchet assembly  126  is fastened to mounting plate  146  via screws not shown and the mounting plate is attached to the backboard with two attachment knobs  128 . Ratchet assembly  126  includes a first chassis member  148  and a second chassis member  150  fastened together with a plurality of screws shown at  152 , but not specifically numbered. The ratchet mechanism is preferably conventional and includes ratchet gear  154 , over center spring  156 , balance spring  158 , ratchet pawl  160  and fasteners also shown generally at  152 , but not specifically numbered. Hand grip assembly  142  includes lever arm  108 , handle back plate  162 , handle clamp plate  164 , handle adjustment knob  166 , a plurality of screw fasteners shown at  168 , handle bar  170  and hand grip  172  forming handgrip  116 , wrist bars  174  and wrist pads  176  forming wrist stabilizer  118 . Attached to the arm  108  is angle indicator  178  to display the angle of rotation of the arm during use. Also attached to the arm  108  are elbow cup  180 , Velcro brand attachment strip  182  and elbow pad  184 , which when assembled provide padding and support for the patient&#39;s elbow. Handle clamp plate  164  is slideably, adjustably fastened to back plate  162  via the adjustment knob  166 . The hand grip and wrist stabilizer are fastened to the handle back plate  162  on the side opposite the handle adjustment knob. The ratchet assembly is enclosed in an enclosure, one side of which is shown at  186 . 
     Referring to  FIGS. 16-18  further description and options for construction of the lever arm assembly and ratchet assembly are provided. The lever arm assembly includes handle assembly  188 , handle adjustment knob  166  so that it is slidably positioned along the length of the arm  108  by loosening knob  166 , moving the handle assembly along the slot  190  and tightening the knob  166  at a position depending on the length of the arm of the user. Hand grip  172  and wrist stop  118  are shown positioned on the arm  108  on the side opposite that of the knob  166 . Handgrip  172  may be positioned so that it extends at 90° from the arm  108 , or, preferably at some other angle, such as shown in  FIGS. 16-17 , for comfort and effectiveness during use by a patient. Elbow cup  180  and elbow pad  184  are also shown at the bottom of arm  108 . The ratchet assemble is attached to the arm  108  on the other side of the elbow cup  180  and elbow pad  184 . The ratchet assembly is shown assembled, and includes ratchet gear  154  as it is positioned in the enclosure, but in  FIG. 16  the enclosure is not shown. One of the set screws for the enclosure is shown at  196  for ease in viewing the relative positioning of the ratchet mechanism components. Positioned above the gear  154  is direction lever  192  and ratchet pawl  160 . Over center tension spring  156  is shown anchored to the pawl at its top and anchored to the mounting plate  146  by stationary spring anchor  194 . 
       FIGS. 17 and 18  provide additional details regarding the orientation of various components, each to the other, so as to facilitate understanding of operation. Handle assembly preferably also includes wrist stop adjustments, including screw  196  and a slot, or series of overlapping holes through which the screw may be positioned and then tightened to adjust the position of each wrist stop.  FIG. 18  also illustrates details of the ratchet pawl  160  and direction lever  192 , by showing its engagement with the ratchet gear  154 . Balance spring  158  is also shown in position to act as a force to balance the gear and return it to a neutral position when the pawl is not engaged. In these views the interior components are shown as positioned within chassis  148  and enclosure  186 . 
       FIGS. 19 and 20  show the arm  108  in a vertical position and first detent  198  engaged and second detent  200  disengaged from the gear  154 . In  FIGS. 21 and 22  the arm  108  is shown at position  202  to indicate that is a point during movement in a counterclockwise direction. Detent  198  remains engaged with the gear  154  to illustrate that as the arm rotates the ratchet clicks over detent  198 , and the balance spring  158  is compressing as shown at  204 .  FIGS. 23-24  show the positions of the arm and ratchet components as the arm has been rotated further in a counterclockwise direction. Detent  198  remains engaged with the gear  154 , but in a radial position that is different than that shown in  FIGS. 19-22 . Balance spring  158  has been compressed further as shown at  206 . 
     In  FIGS. 25-26  the arm and ratchet mechanism are shown when the arm  108  has moved in a clockwise direction from the position shown in  FIGS. 23-24  to a new, different position shown at  208 . The ratchet handle or direction lever  192  has been reversed, as shown at  210 . In this position the second detent  200  is engaged and clicking whereas the first detent  198  is disengaged from the gear. Also, the balance spring  158  has been unloading as the arm moves in a clockwise direction from the position shown in  FIGS. 23-24 , and is shown in a relatively unloaded condition at  212 . The above description of motion of the arm from a vertical position counterclockwise to the extended position shown in  FIGS. 23-24  also applies to motion of the arm from vertical in a clockwise direction, with corresponding engagement and disengagement of the opposite detents, and compression and unloading of the springs taking place on opposite sides of the ratchet mechanism. 
     The shoulder stretcher embodiments described herein function to stretch the posterior capsule without need for a physical therapist or other assistant. The devices have the capability to rotate 180° and thus can be used for stretching either upper extremity, i.e., either the left or right shoulder. In addition to stretching the posterior capsule and internal rotation deficit, these embodiments allow for dynamic sustained stretching in the external rotation plane. By simply releasing the ratcheting mechanism, the arm support can be rotated in either direction, thus allowing for a full 180° stretch. In other words, the person with the injured shoulder, i.e., the patient, can operate the device by himself or herself. The attendant advantages to such self-use devices include more flexibility in scheduling therapy sessions, reduced costs, and increased number of therapy sessions because no appointment with a physical therapist is needed. The shoulder stretchers described herein are intended to be used for shoulder rehabilitation and prevention of posterior capsular tightness or capsulitis, i.e., inflammation of the shoulder capsule. 
     The base or backboard is preferably a padded board and functions to provide a stable platform for the user&#39;s torso. The board need not be padded. While the preferred board or base is generally rectangular, having a longitudinal centerline, it may be of virtually any shape, and be made of virtually any material so long as it provides a platform sufficiently stable to facilitate stretching of the shoulder in accordance with the methods of stretching described herein. Also, the size of the board may vary, in accordance with the size of the user, i.e., a relatively small board for a small user such as a child, and a relatively large board for a larger user, such as a professional basketball, football or baseball player. 
     The straps or belts are preferably made of conventional materials such as leather, natural fibers or synthetic material. The first embodiment arm strap  24  preferably extends from two slots in the base that are preferably equidistant from the centerline  21  and functions to provide a firm, stable securing of the patient&#39;s upper arm to the base  22  with sufficient restraining force to prevent the upper arm from lifting off of the patient&#39;s proximal shoulder during use of the device. By the term upper arm is meant that part of the arm surrounding the humerus bone. In this embodiment preferably a single strap is used, and the strap is of a sufficient width and placed in a position on the base so that during use it functions to hold the upper arm, from the distal end of the humerus bone to the proximal end of the humerus bone in a fixed position on or near to the base. Preferably the arm strap and the slots are constructed and adapted to be capable of movement long the centerline  21  to accommodate arms of different lengths. This allows for variations in size of the patients&#39; arm length between the elbow and the shoulder. During use it is important that this strap be tightened enough to hold down the shoulder/upper arm so that the shoulder touches the base during use of the device, or alternatively, holds the shoulder/upper arm close to the base during use of the device. When patient&#39;s the arm is stretched in this device, it has a tendency to rise superiorly, and thus the arm strap functions to prevent this rise. As will be apparent to those skilled in this art, one or more arm straps may be used. Also, as shown in the alternated preferred embodiment, the shape and size and position may be varies such that it functions and may be referred to as a shoulder strap. Here, as with other embodiments, various materials of construction may be used, such as for example, leather, natural fiber cloth, and synthetic materials. 
     The straps preferably have Velcro® brand or some other brand of loop and hook type fastener to maintain the strap(s) in a tightened position. Alternatively, other conventional belt-fastening devices may be used. The straps may be made of virtually any material and may be fastened in a tight position with virtually any type of fastener, including a conventional knot, so long as the straps are capable of functioning for their intended purpose. Optionally, the devices may be made to have the straps positionable at various locations on the base or backboard. Such alternate constructions are believed to be within the skill of a person of ordinary skill in this field, and could include, optionally, for example relatively long slots and differently shaped slots. Use of such positionable straps would of course enable a single device to be used by patients of a wide range of sizes. 
     Also in regard to the first embodiment, as shown in  FIGS. 1-5  and  7 - 8 , a second strap  26  also provides for holding the upper arm down on or near to the base during operation. As shown here the second strap  26  operates primarily on the distal end of the upper arm for the injured shoulder. Second arm strap  26  is preferably a conventional strap, much like the first arm strap  24 , and is used to secure the elbow and lower part of the upper arm to the base during use. In one embodiment the second arm strap  26  is preferably provided with a reinforcing frame  28  having opposed sides that are equidistant from the centerline  21 , and that function to provide additional structure to secure the patient&#39;s elbow to the base so that the elbow does not lift off the base during use. As described above, use of two arm straps is optional. In one embodiment, a single arm strap may be used so long as it functions to restrain movement of the shoulder away from the base during operation of the device. 
     Telescoping lever arm  30  includes at one end a handle and at its other end a connection to the axle of ratchet mechanism  32 . The axle extends along the centerline  21 , at a relatively short distance above the centerline  21 , and provides an axis of rotation for the ratchet mechanism  32  and lever arm through planes that are perpendicular to the axis of rotation. In  FIGS. 1 ,  3  and  4  a plane through which the lever arm rotates is shown as plane A, and the plane through which the ratchet wheel or gear rotates is shown as plane B. Planes A and B are generally perpendicular to the plane in which the base  22  lies and they are also generally perpendicular to the axis of rotation of the ratchet mechanism. As may be appreciated, the plane in which the ratchet mechanism rotates, plane B, is parallel to the plane in which the lever arm rotates, i.e., plane A. The conventional telescoping arm provides for and accommodates a range of arm lengths. The handle extends back toward the patient and during use of the device may be gripped by the patient&#39;s hand or used as a support for the patient&#39;s hand, either front side or back side. With reference to  FIGS. 6 and 8 , the ratchet mechanism includes a gear or toothed wheel positioned inside of a housing and fastened about the axle for rotation in either the clockwise direction or counterclockwise direction. A U-shaped brake  44  is rotatingly attached to one side of the housing, and extends exterior to the housing in the form of a release and reverse lever  34 . As shown in  FIG. 6 , the lever  34  operates as a brake against rotation in a clockwise direction. By rotating the lever  34  in a clockwise direction the brake  44  is also rotated clockwise to a position against the wheel  42  at which it operates as a brake against counterclockwise direction. The housing is fastened to the base via conventional fasteners  36 , such as screws, rivets, staples, nails, glue or any other means so long as they function to keep the housing fastened to the base.  FIG. 7  illustrates the positioning of a user&#39;s body, particularly the shoulder, upper arm, forearm and hand in relation to the various parts of the shoulder stretcher mechanism. Alternate embodiments operate in a similar fashion, although in the preferred alternate embodiment a unitary arm having a slidably adjustable handle assembly is used rather than a telescoping arm. 
     As shown in  FIG. 8  for the first preferred embodiment, an optional forearm rest  48  may be provided, as shown, for example, positioned on the lever arm  30 . The forearm rest functions to provide a stable support for the forearm. The end of the lever arm  30  distal from the ratchet mechanism  32  is formed into a “U” shape, with the closed end of the “U” forming a handgrip  50 . The handgrip may be made of any of a variety of materials, such as cloth, a rubber or elastomeric material, or an absorbent material. A sling  52  is positioned on the legs of the “U” and extends between the “U” to form and function as a forearm rest. A strap  54  is preferably fastened to one of the legs of the “U” and extends across, and is attachable at the opposite let of the “U”. The strap  54  functions to provide a restraint for the forearm in one direction of rotation, and as the forearm rest in the opposite direction of rotation. The strap  54  is preferably fastened to one leg with a hook and loop type fastener. Various types of materials may be used for, and various techniques may be used to fasten the forearm sling and forearm strap to the lever arm  30 . In yet another alternate embodiment, the lever arm may be in the form of a horseshoe with elongated legs of the same length, the distal ends of which are fastened to the axle of the ratchet mechanism. In this alternate embodiment webbing, a solid surface or some other material extends between the elongated legs and then along the length of the lever arm to function as a forearm rest or support. The elongated horseshoe lever arm may also be of a telescoping design capable of adjustment to accommodate arms of different length. 
     The various embodiments of the shoulder stretcher are designed to address tightness of the posterior capsule of the glenohumeral joint (shoulder) that is an extremely common problem that occurs secondary to a minor shoulder problem. It is a real problem in throwing athletes, post-operative patients, and patients with a diagnosis of impingement syndrome of the shoulder, the most common source of shoulder pain. These shoulder stretchers are designed primarily for posterior capsule stretching, although they also could be used for internal stretching simply by reversing the orientation of the user with respect to the device during use. During use the patient lies on the side of the pathology, and then straps the arm into the device. Next, using the ratchet mechanism, the arm is bent towards the floor in the vicinity of the hip on the same side of the shoulder problem. This bending is in general a rotation with the upper arm as the axis of rotation, and with the upper arm extending in general along the base centerline. Thus, in general the axis of rotation of the upper arm and the axis of rotation of the ratchet mechanism are parallel, and for example, as shown in  FIG. 1  preferably would also be parallel to the centerline  21 . The device is designed primarily for rotation in one direction that stretches the posterior capsule. The reason for 180° of motion is to allow for right or left use with the same unit. Thus, for each arm the device can be rotated in the clockwise direction as well as in the counterclockwise direction. For example, as shown in  FIG. 7  the user&#39;s right arm is positioned for rotation in the counter-clockwise direction, so that posterior capsule stretching takes place during the rotation. When the device is used on the left arm, the direction of rotation is clockwise for posterior capsule stretching. When during use the right arm is rotated in the clockwise direction the interior stretching takes place. 
     When stretching the shoulder with this device, the patient lies on the platform or base, preferably padded and made of a plastic material, then turns on the side of the injured shoulder. The strap (or straps if more than one strap is used) is placed across the arm between the elbow and the shoulder is tightened sufficiently to prevent the upper arm from lifting up or rising during rotation of the arm of the user and lever arm of the device. The optional forearm rest, if used, provides a surface on which the forearm rests while the hand grips the handgrip of the lever arm for support. The patient then uses the other arm to pull or rotate the lever arm and arm towards the floor adjacent to the hip. As the forearm rest advances or rotates incrementally toward the floor, as each increment of rotation is accomplished, the ratchet mechanism prevents reverse rotation of the forearm rest back toward its starting position. With this ratcheting capability, the patient can sequentially rotate the arm to a first desired rotational position, then stop and rest the shoulder with the lever arm locked in that position. After resting a desired period, the patient can resume rotation until a second desired rotational position is achieved, and again stop rotation to rest the shoulder. The patent can then continue the sequence of rotation, rest, rotation, rest, rotation, etc., until a final desired position of stretching is achieved for a given therapy session. Then the patent can release the ratchet, so that the lever arm and patient&#39;s arm can be reverse rotated back to the starting position. 
     By this sequential action and motion, the patient sequentially stretches the posterior capsule and holds it in a stretched position. The user rotates the lever arm to a position that can be tolerated, and then waits for the shoulder to stretch. After a while, the shoulder is stretched and the user can advance, or further rotate the level arm, and the attached forearm of the user to further stretch the shoulder. This cycle or sequence of rotation, rest; further rotation, rest; further rotation, etc., takes place for a desired number of times at the choice of the user during each session. The user also chooses the number of sessions, preferably under the direction of his or her treating physician. The sessions and stretching operations are continued until the shoulder capsule has been stretched sufficient to return the shoulder to normal ranges of motion, or otherwise to a position of acceptable stretching for that particular patient. During each stretching session, once the shoulder has been stretched adequately, or to some desired position of rotation for that session, the release button is pressed to release the ratchet brake, and to permit reverse rotation of the forearm rest and the ratchet mechanism to their original, starting positions. Thus, the patient may gradually and progressively stretch his or her shoulder joint in both internal and external rotation. 
     Although specific embodiments of the invention have been described, various modifications, alterations, alternative constructions, and equivalents are also encompassed within the scope of the invention. 
     The specification and drawings are, accordingly, to be regarded in an illustrative rather than a restrictive sense. It will, however, be evident that additions, subtractions, deletions, and other modifications and changes may be made thereunto without departing from the broader spirit and scope of the invention as set forth in the claims.