Download Pain, Practice And Performance

Pain, Practice and Performance:
The Shoulder
Tim Keeley
B.Phty, Cred MDT, APA
Prinicipal Physiotherapist | Director
19.04.2009
1300 233 300
physiofitness.com.au
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
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Shoulder Pain and Shoulder Injuries
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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
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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
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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
Level 1 (Abduction)
Level 1 (Flex-Abd)
Rep/Set/Comment
Level 1
Level 2
Rep/Set/Comment
Level 1
Level 2
Rep/Set/Comment
Level 1
Level 2
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.
Special Instructions:
2
ASSISTED ROM
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.
Special Instructions:
3
SCAPULA SETTING
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
Special Instructions:
4
CAT PRESS
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.
Special Instructions:
5
WALL PRESS
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.
Special Instructions:
All images and text © 2009 Tim Keeley & Physio Fitness Australia
1300 233 300
physiofitness.com.au
6
ARM/LEG RAISES
Level 1
Level 2
Rep/Set/Comment
Level 1
Level 2
Rep/Set/Comment
Level 1
Level 2
Rep/Set/Comment
Level 1
Level 2
Rep/Set/Comment
Level 1
Level 2
Rep/Set/Comment
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)
Special Instructions:
Use Dura Disc or BOSU to advance
7
SEMI PUSH UPS
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.
Special Instructions:
‘Reset’ on each rep.
8
SUPERMANS
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.
Special Instructions:
9
ROTATIONS
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
Special Instructions:
10
ONE ARM ROWS
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.
Special Instructions:
11
BALL ROLLS
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.
Special Instructions:
All images and text © 2009 Tim Keeley & Physio Fitness Australia
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
Level 3
Level 4
Rep/Set/Comment
Level 3
Level 4
Rep/Set/Comment
Level 3
Level 4
Rep/Set/Comment
Level 3 (In Front)
Level 4 (Behind)
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
Special Instructions:
2
FRONT PRESS
‘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.
Special Instructions:
3
ADVANCED PUSH UP
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.
Special Instructions:
4
ONE ARM PRESS
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
Special Instructions:
Move band to wrist to increase difficulty
and activate subscap (medial rotator)
5
BUNGEE PUSH PULL
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
Special Instructions:
All images and text © 2009 Tim Keeley & Physio Fitness Australia
1300 233 300
physiofitness.com.au
6
BALL BOUNCES
Level 3
Level 4
Rep/Set/Comment
Level 3 (Eccentric)
Level 4 (Concentric)
Rep/Set/Comment
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
Special Instructions:
7
ASSISTED CHINS
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
Special Instructions:
8
FULL PLANK RAISES
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
Special Instructions:
Add in dumbbells to advance
1
CUSTOM SPECIFIC #1
Special Instructions:
TRAINING NOTES / PLAN
TRAINING DIARY
MONDAY
TUESDAY
WEDNESDAY
All images and text © 2009 Tim Keeley & Physio Fitness Australia
THURSDAY
FRIDAY
SATURDAY
SUNDAY
Further Information
Email me:
[email protected]
‘Ask the Physio’ Forum:
www.physiofitness.com.au
Appointments:
1300 233 300
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