Agenda. Skeletal Anatomy. Anatomy Positioning/Dysfunction Assessments Mobility Stability Strength. Corrective Ex for the Shoulder
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1 Agenda Anatomy Positioning/Dysfunction Assessments Mobility Stability Strength Skeletal Anatomy 1
2 Skeletal Anatomy Muscular Anatomy Pectorals 2
3 Levator scapula Latissimus dorsi Posterior oblique subsystem 3
4 Rotator cuff Rotator cuff Neural Anatomy 4
5 Brachial Plexus Kinetic Chain 5
6 Shoulder Impingement Nordt, W.W., Garrelston, R.B., & Plotkin, R. (1999). The measurement of subacromial contact pressure in patients with impingement syndrome. Journal of Arthroscopic Surgery, 15, Braman, J., et al. (2013). Shoulder impingement revisited: Evolution of diagnostic understanding in orthopedic and physical therapy. Med Biology Eng Comput. [Epub] Scapula Position Associated with impingement syndrome: Internal rotation Anterior tilt Downward rotation Struyf, F., Nijs, J., Baevens, J.P., Mottram, S., & Meeusen, R. (2011). Scapular positioning and movement in unimpaired shoulders, shoulder impingement syndrome, and glenohumeral instability. Scandinavian Journal of Medicine & Science in Sports, 21, Scapulohumeral Rhythm Norkin, C.C., & Levangie, P.K. (1992). The shoulder complex. In: Joint structure and function: A comprehensive analysis (2nd ed.) Philadelphia, PA: FA Davis Inman, V.T., Saunders, S.J., & Abbott, L.C. (1996). Observations on the function of the shoulder joint. Clinical orthopedics, 330, 3-12 Neumann, D.A. (2002). Shoulder complex. In: Kinesiology of the musculoskeletal system: Foundations for physical rehabilitation St. Louis, MO: Mosby 6
7 Posture Forward head posture 1 =10lbs Loads exceed tissue tolerance Decreased lung capacity Increased stress Kapandji, I.A. (2007). The physiology of the joints (6th ed.). Philadelphia, PA: Elsevier Health Sciences What allows forward head? Nuchal Ligament What allows forward head? 7
8 Shoulder Assessments Assessing the Shoulder Riddle, D.L., Rothstein, J.M., & Lamb, R.L. (1987). Goniometric reliability in a clinical setting: Shoulder assessments. Physical Therapy, 67, Subacromial Impingement Silva, L., Andreu, J.L., & Munoz, P. (2008). Accuracy of physical examination in subacromial impingement syndrome. Rheumatology, 47,
9 Supine Flexion Riddle, D.L., Rothstein, J.M., & Lamb, R.L. (1987). Goniometric reliability in a clinical setting: Shoulder assessments. Physical Therapy, 67, GH Internal Rotation Borstad, J.D., Mathiowetz, K.M., & Minday, L.W. (2007). Clinical measurement of posterior shoulder flexibility. Manual Therapy, 12, Thoracic Rotation Johnson, K.D., Kim, K.M., Yu, B.K., Saliba, S.A., & Grindstaff, T.L. (2012). Reliability of thoracic spine range of motion measurement in healthy adults. Journal of Athletic Training, 46(1), Neumann, D.A. (2002). Shoulder complex. In: Kinesiology of the musculoskeletal system: Foundations for physical rehabilitation St. Louis, MO: Mosby 9
10 Thoracic Rotation Johnson, K.D., Kim, K.M., Yu, B.K., Saliba, S.A., & Grindstaff, T.L. (2012). Reliability of thoracic spine range of motion measurement in healthy adults. Journal of Athletic Training, 46(1), Neumann, D.A. (2002). Shoulder complex. In: Kinesiology of the musculoskeletal system: Foundations for physical rehabilitation St. Louis, MO: Mosby Breathing Gulick, D. (2009). Ortho notes clinical examination pocket guide (2nd ed.). Philadelphia, PA: FA Davis Practical Application SMR 1. Thoracic Spine 2. Pectorals 3. Latissimus dorsi 4. Posterior deltoid 5. Levator scapulae 6. Biceps 10
11 Thoracic Spine Pecs Latissimus Dorsi 11
12 Posterior Deltoid Levator Scapula Biceps 12
13 Practical Application Lengthening 1. Pectoral stretch 2. Latissimus dorsi stretch 3. Thoracic extension 4. Thoracic rotation Pec Stretch Lat Stretch 13
14 Thoracic Extension Thoracic Rotation Stabilize or Strengthen? Compression structures fall due to a lack of stability, not strength James Edward Gordon, Structures or Why Things Don t Fall Down 14
15 Stabilize or Strengthen? Tissue mobility or lengthening is only as good as the exercise that comes after it Progressions 1. Scapular stabilizers 2. Internal rotators 3. External rotators 4. Complex movement Progressions 1. Non-weight bearing 2. Weight bearing 3. Upright 4. Endurance and proprioception Senbursa, G., et al. (2007). Comparison of conservative treatment with and without manual physical therapy for patients with shoulder impingement syndrome: A prospective, randomized clinical trial. Knee Surgery Sports Traumatology Athroscopy, 15, Lombardi, I. et al. (2008). Progressive resistance training in patients with shoulder impingement syndrome: A randomized controlled trial. Arthritis & Rheumatism, 59(5), Cools, A.M., et al. (2008). Internal impingement in the tennis player: Rehabilitation guidelines. British Journal of Sports Medicine, 42, RC Exercise Review 1. Exercise has statistically and clinically significant effects on pain reduction and improving function 2. Manual therapy augments the effects of exercise 3. Scapular plane before sagittal, sagittal before frontal Kuhn, J.E. (2009). Exercise in the treatment of rotator cuff impingement: A systematic review and synthesized evidence-based rehabilitation protocol. Journal of Shoulder and Elbow Surgery, 18(4), e33-e36 Progression Matrix Progressions 1. Scapular stabilizers 2. Internal rotators 3. External rotators 4. Complex movement Progressions 1. Non-weight bearing 2. Weight bearing 3. Upright 4. Endurance and proprioception 15
16 Scapula non-weight bearing Cools, A.M., et al. (2007). Rehabilitation of scapular muscle balance: Which exercises to prescribe? The American Journal of Sports Medicine, 35(10), Scapula weight bearing Lister, J.L., et al. (2007). Scapular stabilizer activity during bodyblade, cuff weights, and thera-band use. Journal of Sports Rehabilitation, 16, Scapula weight bearing 16
17 Internal rotators non-weight bearing Internal rotators weight bearing External rotators non-weight bearing Sakita, K., Seeley, M.K., Myrer, J.W., & Hopkins, J.T. (2015). Shoulder-muscle electromyography during shoulder external rotation exercises with and without slight abduction. Journal of Sport Rehabilitation, 24,
18 External rotators weight bearing Complex Stability Complex Movement 18
19 Total Body Integration Reactive Example Template SMR Stretch Stabilization/Ac tivation Complex Total Body Exercise Time/Reps Sets T-spine, pecs, lats, levator, post. delt Pecs, lats, extension, rotation Retraction, depress, eccentric scaption, plank, IR, ER, Bear crawl, Crab walk, Modified down dog Squat w/shoulder RNT seconds seconds 1 12 repetitions repetitions repetitions 2-3 Reactive Side plank ball throw 8 each side
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