Pilates for Anterior Humeral Glide Syndrome. Om Paramapoonya September 26, 2017 Comprehensive Program March 2017 May 2017 Davis, California

Transcription

1 Pilates for Anterior Humeral Glide Syndrome Om Paramapoonya September 26, 2017 Comprehensive Program March 2017 May 2017 Davis, California

2 Abstract Anterior Humeral Glide (AHG) syndrome is usually a result of muscle imbalances in the glenohumeral and/or scapulothoracic joints. This problem becomes most evident when the arms move into extension. For example, in the rowing movement when the arms are pulled back behind the shoulder blades, over one-third of the humeral heads will noticeably tilt forward over the acromia rather than remaining stable in the sockets (glenoid fossae). Over time this poor movement pattern can lead to several issues from shoulder instability and minor shoulder pain, to more serious problems, such as labral tears, shoulder impingement and biceps tendonitis. A well-selected Pilates conditioning program can help combat AHG by improving scapular stabilization, correcting muscle imbalances, as well as increasing movement awareness of the overall shoulder region. 2

3 Table of Contents Abstract.2 Table of Contents...3 Anatomical Description...4 Case Study 7 Conditioning Program..9 Conclusion...12 Bibliography.13 3

4 Anatomical Description Here are the main muscle imbalances that lead to Anterior Humeral Glide (AHG) syndrome: 1. Overactive Pectoralis Minor The pectoralis minor a small, triangular muscle in the upper part of the chest is mainly responsible for anterior tilting of the scapula. When this muscle becomes tight and overactive, it will inhibit the posterior rotators of the humerus, including the infraspinatus and teres minor, which consequently causes an anterior shift in the humeral resting position. 4

5 2. Weakness in Serratus Anterior and Lower Trapezius Serratus Anterior Trapezius The serratus anterior (the fan-shaped muscle at the lateral wall of the thorax) and the lower trapezius (the triangle-shaped, lowermost section of the trapezius muscle near the lowest six thoracic vertebrae) function as the main scapular 5

6 stabilizers. Weakness in these muscles combined with over activity of the pectoralis minor results in inadequate scapular stabilization, which further worsens the anterior tilted position of the humeral heads. 3. Weak Subscapularis and Dominant Latissimus Dorsi Subscapularis Latissimus Dorsi The subscapularis is the largest rotator cuff muscle, attached to the anterior surface of the scapula and the front of the upper arm. It is another important shoulder stabilizer whose main functions are to rotate the humerus internally, and at the same time, posteriorly draw the humeral head into the socket and keep it 6

7 snug in there. When the subscapularis is weak, it is not internally rotating the humerus as it should. Therefore, the latissimus dorsi, a much larger and stronger internal rotator (oftentimes along with other internal rotators, such as pectoralis major and teres major), picks up the slack and becomes overactive. However, this compensatory muscle action does not provide the posterior pull of the humeral head as the subscapularis does. As a result, the humeral head glides forward rather than remaining centrated in the glenoid fossa. Case Study I am a 37-year-old female, recovering couch potato, who exhibits all of the anatomical symptoms of AHG, as discussed above. My anterior-tilted humeral heads are noticeable in the humeral resting position and become even more pronounced when my arms move into extension. This problem is not accompanied by kyphosis or excessive rounding of the upper back. In the anatomical position, my spine looks perfectly normal. My shoulders are the only parts that tip forward out of ideal alignment. I have no knowledge of when the problem first started. However, I am certain that my tight, overactive pectoralis minor and other muscle imbalances are the direct result of having worked a desk job for over ten years and slouching over the computer all day. I became aware of my AHG when I started to learn Pilates about two years ago. During some Pilates exercises, such as Chest Expansion and Stomach Massage Flat Back, I found it almost impossible to open the chest or pull the shoulder heads back as my instructor cued me. In addition, due to my scapular instability, I would often feel the clunking sensation as if my shoulders were slipping out of their sockets during most 7

8 arm exercises. And lastly, because of my short and overactive lats, I also found raising my arms overhead to be a struggle. In order to keep my arms straight up, my body would have to compensate by flaring the ribs and overextending the thorax. So far, AHG has not caused me any serious issues or injuries. I occasionally experience minor shoulder pain, but it has never been debilitating to the point that it affects my daily life. I understand, however, that with every repetition of this poor motor pattern I allow, I am one step closer to a permanent movement dysfunction, which can lead to a whole host of problems as I get older, including shoulder impingement, labral tears, biceps tendonitis, bursitis, shoulder dislocation, etc. To combat AHG, I have made a drastic change in my lifestyle by trying to be more aware of my posture in everyday life, quitting my desk job for good, and getting trained to become a Pilates instructor! Plus, I have developed a winning strategy and a conditioning program using the BASI block system to correct the muscle imbalances and achieve optimal shoulder health. Winning Strategy 1. Improve the shoulders range of motion with more focus on external and posterior rotation. 2. Focus on movement awareness and correct muscle recruitment patterns. 3. Strengthen the serratus anterior, lower trapezius and subscapularis to improve scapular stabilization. 4. Daily stretching of the pectoralis minor (door stretch & wall angels) and latissimus dorsi (on a foam roller). 8

9 5. Avoid or minimize doing shoulder dips, such as Long Back Stretch and Frog Back. Although these are great shoulder exercises, they might not be suitable for people with AHG, because the majority of the motion is derived from driving the humeral heads forward. Therefore, they tend to perpetuate or even worsen AHG. Conditioning Program (Intermediate Level) Pre-Warm Up (Mat) Roll down Rationale Scanning the body and centering oneself Warm Up (Mat) Roll up, spine twist supine, double-leg stretch, single-leg stretch, crisscross Rationale Warming up the entire body. Cultivating mindfulness of the body and breath. Foot Work (Cadillac) Foot work series with palms facing up Rationale I had an opportunity to take a private session with Rael Isacowitz earlier this year. After noticing my forward shoulders, he suggested I do the foot work series with palms up instead of down on the carriage, as it favors external shoulder rotation. Thus, in addition to strengthening the muscles in the lower extremities, I am also working toward correcting AHG with this slight modification. Abdominal Work (Cadillac) Bottom Lift with Roll-Up Bar Rationale Strengthening the abs. Improving spinal flexibility and shoulder control. 9

10 Hip Work (Cadillac) Supine Leg Series with palms up Rationale These exercises strengthen hip adductors, hip extensors and hamstrings, as well as improve pelvic-lumbar stabilization. And again, the modified hand position works in the favor of shoulder external rotation. Spinal Articulation (Cadillac) Monkey original and Tower Prep Rationale Strengthening the abs and hip extensors. Stretching the hamstrings. Improving spinal mobility. Stretches (Mat) Pole Series Rationale Stretching the shoulder and chest muscles. Improving scapula and trunk stabilization. Full Body Integration (F/I) (Reformer) Up stretch 1 and long stretch Rationale Up Stretch 1 is a great shoulder-stretch exercise whereas Long Stretch works the subscapularis, which needs to be strengthened in people with AHG. Both are also very effective in enhancing scapular stabilization. Arm Work (Reformer) Rowing series Rationale Increasing the shoulders range of motion and control. Improving scapular stabilization. Full Body Integration (A/M) Not applicable Rationale Because this is an intermediate program, advanced and master-level exercises are not applicable. 10

11 Leg Work (Reformer) Single-leg skating Rationale Strengthening hip abductors and knee extensors. Improving pelvic-lumbar stabilization. Lateral Flexion and Rotation (Reformer) Mermaid Rationale Improving spinal flexibility and scapular stabilization. Stretching the latissimus dorsi. Back Extension (Reformer) Pulling Straps 2 Rationale In this exercise, the shoulders remain externally rotated throughout; the serratus anterior and lower trapezius are also constantly engaged, thus making it a commendable corrective exercise for AHG. Cool Down (Mat) Roll down Rationale Gradually slowing down the heart rate. Allowing the body to safely readjust to the resting state. 11

12 Conclusion Having used this conditioning program twice a week for two months, I have already noticed some improvement in my condition. The anterior tilt of my humeral heads seems less pronounced in the humeral resting position as well as in extension. The clunking sensation in the shoulders during arm exercises is completely gone, and episodes of minor shoulder pain have become a lot less frequent. Most importantly, my movement awareness has got keener and more instinctive, allowing me to perform Pilates exercises more correctly. This conditioning program has proven to be quite effective in correcting the Anterior Humeral Glide Syndrome. I will continue to use the program until my optimal shoulder health is achieved and am positive that I will reach the desired outcome. 12

13 Bibliography Isacowitz, Rael. Auxiliary: Movement Analysis Workbook. Costa Mesa, California: Body Arts and Science International, Isacowitz, Rael. Mat: Movement Analysis Workbook. Costa Mesa, California: Body Arts and Science International, Isacowitz, Rael and Karen Clippinger. Pilates Anatomy. Champaign, Illinois: Human Kinetics, Isacowitz, Rael. Reformer: Movement Analysis Workbook. Costa Mesa, California: Body Arts and Science International, Isacowitz, Rael. Study Guide: Comprehensive Course. Costa Mesa, California: Body Arts and Science International, Oscar, Evan. Corrective Exercise Solutions to Common Hip and Shoulder Dysfunction. Chichester, United Kingdom: Lotus Publishing,