Pain, Practice and Performance: The Shoulder. Tim Keeley B.Phty, Cred MDT, APA Prinicipal Physiotherapist Director

Transcription

1 Pain, Practice and Performance: The Shoulder Tim Keeley B.Phty, Cred MDT, APA Prinicipal Physiotherapist Director

2 Functional Anatomy Shoulder Joint Vs Hip Joint Ligaments and Bursae, Tendons Serratus Anterior - Protraction and flattening the Scapular Important role in; abduction and raising of arm horizontal arm movements pushing, punching; boxer s muscle. If not working properly or weak: WINGING of scapula, decrease control of scapula elevation difficulty loss of power with pressing movements incorrect angle of glenoid cavity anterior humeral head translation compensation of rhomboids / Overactivity of upper traps to stabilize scapula increased problems. Lower Trapezius Depression and Scapular Control stabiliser and works in combination with upper & middle trapezius In abduction - antagonist against over activity on upper traps upper fibres stronger, and gravitational pull assists antagonist with Serratus Anterior works in unison to coordinate rotational movements of scapula If not working properly or weak: irregular rotational movement, snapping movement in combination with serratus anterior weakness compensation in shoulder presses, racket sports, pushing, pulling, throwing balls etc, decreased scapular postural control in sitting, running, walking Rotator Cuff Stabilisation, Rotational Movements, Assistance stabilisation of the Humeral head ALL Rotational movements of the Humerus / involved in ALL movements of the shoulder If not working properly or weak: tightness in joint, loss of range and flexibility irregular rotational movement impingement in the shoulder joint of soft tissue over dominance of power groups / compensation of other rotator cuff muscles in group trigger points, pain reduced over all shoulder power and humeral stability anterior translation of humeral head, instability in hypermobile people Pectoralis Major/Minor Deltoid Latissimus Dorsi Teres Major Rhomboid Major/Minor Levator Scapulae

3 Shoulder Pain and Shoulder Injuries Rotator Cuff Tendons: Tendonitis / Tears GHJ Dislocations / Subluxations Labral Tears Hypermobility and Instability Impingement: Suprapsinatus and Sub-acromial Bursae A/C Joint Rupture / Sprain / Dysfunction / Wear (Weightlifters Shoulder) Reconstructive Surgery Medial Scapular Pain / Upper Traps Trigger Points Why Do We Test Our Clients? to assess; ROM and flexibility strength and weakness presence of pain movement and muscle dysfunction which assists in; preventing injury helping clients with pain helping clients with past and current injuries improving program design and implementation improving outcomes in training and sport PT Testing What you are LOOKING FOR Winging Irregular movement of the scapula Painful arc Loud click in shoulder joint Clunking/crunching over the A/C or Scapular Common Problem Exercises Bench Press (It actually WILL) Full Press Ups Seated Row Pump Class Front Raises Shoulder Press / Military Press Upright Row Boxing / Boxercise What s Going Wrong? pain inhibition cervical spine (neck) pain or injury cervical disc problems (pain referral) Shoulder injuries incoordination and poor muscle awareness global muscle dominance and muscle atrophy heavy weights one arm sport general muscle weakness or non-development poor core stability - poor scapular stability poor posture, sedentary lifestyles, computer workstation work Closed Kinetic Chain Exercises The hand (for arm movement) is fixed and cannot move. The body then moves relative to the hand; Make compressive forces, while open-chain ones make shearing forces; Are nearer to activities of daily living; Work multiple muscle groups simultaneously rather than concentrating on just one, as many open-chain exercises do

4 Shoulder & Scapulo-thoracic Rehabilitation Exercises Level 1 and 2 Please Note: Make sure you activate your core and control your breathing as instructed, and do not breath hold during the exercises. If exercises become painful, reduce the amount. If pain continues, stop your exercises and consult your Physiotherapist as soon as possible. 1 ACTIVE/PASSIVE ROM Level 1 (Pendulum) Level 1 (Flexion) Rep/Set/Comment Pendulum: start with small circles slowly increasing to larger circles. Repeat in both directions. Flexion: Let opposite arm take injured arm over head to tightness and return. 2 ASSISTED ROM Level 1 (Abduction) Level 1 (Flex-Abd) Rep/Set/Comment Abduction: Slowly squat / lean away to abduct arm. Alternatively lie on side and raise arm, letting gravity assist Flexion-Abduction: Let opposite arm take injured arm out and up in a larger circle as you can and return. 3 SCAPULA SETTING Level 1 Level 2 Rep/Set/Comment Roll shoulders forward, up, back and down into a V. Keep a broad feeling in front. For level 2: Opposite hand behind back touching bottom corner of shoulder blade. Press hand to wall and Move arm out to 45º without letting scapula move from finger. Add theraband to advance 4 CAT PRESS Level 1 Level 2 Rep/Set/Comment Keep elbows straight push your chest up into your shoulder blades towards the ceiling. DON T round your spine keep it flat. Slowly drop chest down to floor so shoulder blades come together. Now push away again so your ribs push into your shoulder blades and they come apart again. 5 WALL PRESS Level 1 Level 2 Rep/Set/Comment Keep elbows straight push your chest out into your shoulder. Slowly drop chest into wall so shoulder blades come together. Now push away again so they come apart again. Level 2: Bend elbows and drop into wall. All images and text 2009 Tim Keeley & Physio Fitness Australia

5 6 ARM/LEG RAISES Level 1 Level 2 Rep/Set/Comment START: Keep elbows straight push youribs up into your shoulder blades towards the ceiling. DON T round your spine keep it flat. Slowly transfer weight into opposite hand and leg and raise the other. * DON T shift away from shoulder. * Keep level shoulders (bend elbow for L2) Use Dura Disc or BOSU to advance 7 SEMI PUSH UPS Level 1 Level 2 Rep/Set/Comment START: Keep elbows straight push your chest up into your shoulder blades towards the ceiling. DON T round your spine keep it flat. Slowly release your scapula on downward movement. DON T let them crash together. Push you ribs into your shoulder blades on the upward movement. Reset on each rep. 8 SUPERMANS Level 1 Level 2 Rep/Set/Comment Rotate hand(s) outward and upward towards ceiling. Thumb up. Pull scapula down and back, NOT together. Keep head down and long at the back of the neck. Feel the squeeze below your shoulder blades. Do not lift off the ball/floor. 9 ROTATIONS Level 1 Level 2 Rep/Set/Comment Opposite hand behind back touching bottom corner of shoulder blade. Set scapula. Keep elbow close by side. Do External and Internal (unless instructed) for Level 1 and 2 Level 2: Arm at 80 Abd / 80 Horz Flex 10 ONE ARM ROWS Level 1 Level 2 Rep/Set/Comment Pull scapula back first and set keeping elbow straight. Then pull arm through. Hold scapula set and slowly return arm. Then release scapula. Keep elbow close by side through movement. *DON T let shoulder pop up or forward. 11 BALL ROLLS Level 1 Level 2 Rep/Set/Comment Start with hips forward and spine neutral, weight through elbows and elbows under chest. Push your chest up into your shoulder blades towards the ceiling. Roll ball forward keeping weight on ball greater than knees. Stop when you start to shake and pull ball back under. DON T move weight back onto knees. All images and text 2009 Tim Keeley & Physio Fitness Australia

6 Shoulder & Scapulo-thoracic Rehabilitation Exercises Level 3 and 4 Please Note: Make sure you activate your core and control your breathing as instructed, and do not breath hold during the exercises. If exercises become painful, reduce the amount. If pain continues, stop your exercises and consult your Physiotherapist as soon as possible. 1 ONE ARM DIAGONALS Level 3 (Low to High) Level 3 (High to Low) Rep/Set/Comment Set Scapula to start. Keep scapula down and back when arm is in low and mid position. *DON T let scapular pop forward or rise too early. Level 4: Stand on BOSU 2 FRONT PRESS Level 3 Level 4 Rep/Set/Comment Set Scapula to start. Keep scapula down and back when arm is in low and mid position. Release into elevation when arm moves above 90º *DON T let scapular pop forward or rise too early. 3 ADVANCED PUSH UP Level 3 Level 4 Rep/Set/Comment Keep elbows straight push your chest up into your shoulder blades towards the ceiling. Slowly release your scapula on downward movement. DON T let them crash together. Push apart on the upward movement. Keep scapula down and back resisting the band tension. 4 ONE ARM PRESS Level 3 Level 4 Rep/Set/Comment Start with hips up using glutes and spine neutral. Push shoulder up to ceiling to initiate press. Avoid rotational movement is possible Level 4: Resist Band and don t let shoulder elevate Move band to wrist to increase difficulty and activate subscap (medial rotator) 5 BUNGEE PUSH PULL Level 3 (In Front) Level 4 (Behind) Rep/Set/Comment DON T let scapula rise during first part of movement. Add in trunk rotational movement to advance Level 4: Stand on Dura Discs or Bosus, Add in Jump onto BOSU All images and text 2009 Tim Keeley & Physio Fitness Australia

7 6 BALL BOUNCES Level 3 Level 4 Rep/Set/Comment Bounce and catch ball onto wall at shoulder height. Move away from wall and move ball to shoulder height to advance. *Avoid excessive lateral rotation *USE SMALL/MINI SWISS BALL IF POSSIBLE 7 ASSISTED CHINS Level 3 (Eccentric) Level 4 (Concentric) Rep/Set/Comment Pull scapula back down into V. Level 3: Pull up with two arms, release one and lower with one arm. Level 4: Up and down with one arm *DON T let shoulder pop up at bottom of movement 8 FULL PLANK RAISES Level 3 Level 4 Rep/Set/Comment Keep elbows straight push upper body to the ceiling. DON T arch back keep it flat. Slowly transfer weight into opposite hand and leg and raise the other. * DON T shift away from shoulder. Level 4: Don t go back past Vertical Add in dumbbells to advance 1 CUSTOM SPECIFIC #1 TRAINING NOTES / PLAN TRAINING DIARY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY All images and text 2009 Tim Keeley & Physio Fitness Australia

8 Further Information me: Ask the Physio Forum: www. Appointments: Our Clinics: Bondi Fitness First Platinum Dee Why Fitness First Carlingford Fitness First Castle Hill Fitness First