Understanding Shoulder Dysfunction REMINDER Obtain medical clearance and physician s release prior to beginning an exercise program for clients with medical or orthopedic concerns What is a healthy shoulder? Is it having the capacity for pain-free movement? Is it having optimal range of motion? Is it being functional based on personal needs? Is there such a thing as a healthy shoulder? Shocking Shoulder Statistics > 50% of adults over 60 have rotator cuff tears Sher et al (1995) MRI s of 30 asymptomatic shoulders resulted in no completely normal rotator cuffs Miniaci et al (1995) Common Shoulder Conditions Impingement Syndrome Impingement Rotator Cuff Tears Labrum Tears Dislocation A-C Joint Separation Primary Anatomical or bony abnormalities Arthritic changes Secondary Muscle imbalances Scapula dysfunction Poor exercise technique Overuse overhead rights reseerved. 1
Sub-acromial Impingement Part of Rotator Cuff is compressed beneath the Acromion process Impingement Clearing Screen Have client place right hand on left shoulder while raising the elbow as high as possible The presence of pain indicates impingement Refer client to appropriate Medical professional for further evaluation Shoulder & Scapulae Position Check for winging Both standing/seated and in Tall Plank Distance from medial border of each scapula to the spine should be no more than 3 Preventing Impingement Improve Scapula Stability Awareness of Joint Centration Increase Gleno-humeral Mobility Balance Push-Pull Strength Avoid Excessive Overhead Exercise Use Smart Exercise Technique Postural Observation Cervical Curvature 1 st Rib Angle Scapula Position Thoracic Curvature Correcting Poor Respiratory Function Deep Breathing Exercises Diaphragmatic Breathing Various Positions Relaxing Neck and Shoulders Check Shoulder Range of Motion before and after Breath-work. rights reseerved. 2
Identifying T-Spine Shape Driving T-Spine Flexion Isolate Thoracic Flexion Incorporate Breath Awareness Change Position ½ Kneeling Standing Squatting Improving T-Spine Extension Bench T-Spine Mobility Place Foam Roller at T-Spine Alternatives to Foam Roller Double Tennis Ball Follow-up with Quadruped T- Spine Exercise Quadruped T-Spine Opener Improves T-Spine Extension & Rotation Can Alternate Head Position from Neutral to Right to Left Address Imbalances That Lead to Unstable Scapulae Stretch/Lengthen Pec Minor Posterior Capsule Subscapularis Tighten/Activate using scapula stabilization drills Rhomboids Serratus Anterior Lower & Middle Trapezius rights reseerved. 3
Stretching Pectoralis Minor SMFR + Stretch - Triceps Lats On a corner wall or door jam place the shoulder at 90/90 (abduction/external rotation) Rotate the torso away, increasing horizontal abduction Retract and tilt scapula posteriorly Stretching the Posterior Joint Capsule Fixate the scapula while horizontally adducting the shoulder Stretch should be felt on the posterior shoulder SMFR -Subscapularis Stretching Subscapularis Scapula Stabilization Drills Exercises to improve stability of the shoulder girdle Blackburns Y-T-W-L Serratus Anterior rights reseerved. 4
Y Arm Raises Strengthen Lower Trapezius Prone T Exercises Strengthens Rhomboids, Middle Trapezius, and Rear Deltoid External Rotation is NOT necessary Elbow Plank w/ Shoulder Centration Scapulae Wall Slides Pack the shoulder Cue scapulae tight to ribs Scapula Protraction with Bands Scapula Protraction Push-Up Strengthens Serratus Anterior Use Shoulder Angle of 100-110 Degrees rights reseerved. 5
Single Arm Retraction - Row Use the Plane of Scaption (The plane of the scapula) 30 to 45 degrees anterior to the frontal plane Teaches Client to Retract the Scapula without Flexing the Elbow or Extending the Shoulder Simultaneously Rotator Cuff Strain / Tears Supraspinatus Infraspinatus Teres Minor Subscapula SLAP Tear Superior Labrum from Anterior to Posterior Bankart Lesion Posterior Labral Tear Labrum Tears What Does the Cuff Do? Maintains the position of the humeral head against the glenoid during movement Balanced strength & flexibility is essential External Rotators are typically weakest link Supraspinatus is most common to tear Failure Rate for RC Surgery 25-90% 75% of people with full thickness RC tears avoided surgery with PT Stats rights reseerved. 6
Goals for Direct Rotator Cuff Training Proprioception Isolation Perturbation Rate of Force Development Side Lying DB External Rotation Trains infraspinatus & teres minor, external rotators EMG Studies have shown this to be best exercise for the external rotators of the cuff Reinhold et al Dynamic Isometric Holds Rhythmic Stabilizations With Client in Supine Lying Position Trainer Presses on Wrist in Various Directions to Challenge Reactive Stabilization of the Shoulder Girdle Perturbation Drills Body Blade rights reseerved. 7
When Should You Train the Cuff? Recommendations Vary Low Rep Low Fatigue before Training or During Warm-Up Sets 5-10 Reps Higher Rep Higher Fatigue after Training 15+ Reps Anterior Shoulder Instability Hyper-mobility of the humeral head forward leading to possible subluxation or dislocation High risk positions: External rotation with > 90 abduction, horizontal abduction Contraindicated Exercises High Risk Stretches Push up with wide hand spacing Bench press Pec Deck Chest Flye Behind the back lat pull down Shoulder press Shoulder extension Shoulder abduction Use a Safety Block for Pressing or Pushing A rolled up towel or ½ foam roll on or below the chest decreases range of motion w/out changing deceleration demands Forcing a stop before range of motion naturally terminates increases rotator cuff stress Additional Tips & Modifications for Shoulder Injury Prevention Stick to DB s vs. Barbells Minimize Overhead Strengthening in Overhead Athletes Scapula Stability warmups before all activities involving the shoulder rights reseerved. 8