Download Pilates for Improving Shoulder Stability and Mobility

 Pilates for Improving Shoulder Stability and Mobility By Judith Lee-­‐Squire December , 2016 Body in Motion Studio Meredith Rogers, Trainer Aptos CA 1 ABSTRACT Before the advent of the MRI and arthroscope, orthopedic doctors relied on x-­‐rays that gave little information about function and mechanics of the shoulder. With this new technology, doctors could see soft tissue, the rotator cuff, the labrum and other stabilizing structures and began to understand how these structures change and how these changes are related to injuries (4). Age-­‐related changes happen to everyone. The gradual loss of muscle tissue and collagen leads to age-­‐related changes that result in less pliability and more vulnerability in connective tissues. The rotator cuff is especially affected by these changes. Aging brings wear and tear so that most adults over age 40 have rotator cuffs that have started fraying (4). A balanced exercise routine can help to diminish the effects of this aging process. My case study will look at using pilates to strengthen and improve shoulder mobility and stability. 2 TABLE OF CONTENTS Page Title Page ……………………………………………………………………… 1 Abstract ……………………………………………………………………… 2 Table of Contents ……………………………………………………………………… 3 Anatomy ……………………………………………………………………… 4 Case Study ……………………………………………………………………… 8 Conditioning Program ……………………………………………………………………… 9 Conclusions ……………………………………………………………………… 10 Bibliography ……………………………………………………………………… 11 3 Anatomy of the Shoulder The shoulder girdle consists of the scapulae (posteriorly), and the clavicles and sternum (anteriorly). The clavicle (collar bone) articulates medially with the manubrium of the sternum and laterally with the acromion of the scapula (shoulderblade). The sternoclavicular joint allows the scapula to move backward (extension), forward (flexion), upward (elevation), and downward (depression), and rotates around its longitudinal axis. The scapula’s lateral border contains the glenoid cavity, a shallow oval-­‐shaped depression that articulates the head of the humerus (long bone of the arm). The acromioclavicular joint and the lateral end of the clavicle allow the scapula to move in various directions (3). The gleno-­‐humeral joint, shoulder joint, is a ball-­‐and-­‐socket joint made up of the humerus and the glenoid cavity. Only 1/3 of the head of the humerus sits in the glenoid cavity making it more flexible but less stable in its movement (4). The 4 glenoid joint allows 360 degrees of movement in three planes. Shoulder joint movement takes place around three axes: horizontal axis through the glenoid fossa; axis perpendicular to this (front, back) through the humeral head; and a third axis through the shaft of the humerus. These axes allow flexion and extension, adduction and abduction, and medial and lateral rotation. The combination of these movements allows circumduction, the circular motion of the limb. The muscles of the pectorial girdle (clavicle and sternoclavicular joint) enable these movements and add stability.. Movement of the scapula is essential in providing the widest range of motion at the shoulder joint. Scapular stabilization is very important in protecting the shoulder from injury (5); however, very little bony or ligamentous support exists in the glenohumeral joint, which leaves the shoulder more unstable than other joints in the body. As a result, the shoulder joint is more susceptible to imbalances in strength and flexibility than any other joint. The muscles of shoulder movement include the rotator cuff and larger supporting muscles. The rotator cuff is a set of four very ismall muscles that collectively attach and strengthen the shoulder joint, pulling the humerus into the socket of the joint (glenoid fossa) increasing contact of the bony elements, which is the most important factor in contributing to the stability of the joint (1). It helps raise the arm from the side and rotates the shoulder in many directions. Its primary purpose is to stabilize the humeral head against the glenoid. Apart from their action of mobilizing the humerus, the rotator cuff plays an important role as “active ligaments” in providing mobility to the joint (3). 5 The rotator cuff includes: the subscapularis (internal rotator), the only muscle that attaches to the humerus’ lesser tubercle; the supraspinatus (elevation of the humerus), its belly runs under the acromion and attaches to the humerus’ greater tubercle; the infraspinatus which accounts for 60% of external rotation of the shoulder and holds the humerus in the glenoid cavity; and the teres minor which accounts for 40% of external rotation strength at the shoulder (1). The rotator cuff rotates the humerus laterally (2). These muscles collectively act to strengthen and increase the stability of the shoulder joint and individually act to move the humerus and upper arm. The larger muscles that produce gross movement of the arm include the deltoid, the pectoralis major, teres major, and latissimus dorsi. Although not attached to the humerus, other large muscles that affect movement of the arm include the trapezius, and rhomboid (1). 6 Muscle Action Pectoralis Major: Acts to flex the arm, adducts arm against resistance. Deltoid: Prime mover of abduction, adducts, rotates, flexes (anterior deltoid) and extends the arm (posterior Deltoid). Latissimus Dorsi: Teres Major: Back muscles to move the humerus bone, arm extension Acts with latissimus dorsi to extend the arm. Trapezius: Stabilizes and raises the scapula Rhomboid: Any exercise program that is to successfully address strengthening the Pulls scapula backward. shoulder, needs to focus on both the deep and surface shoulder muscles along with proper mechanics and muscle recruitment. 7 Case Study Client: Myself, Judith Lee-­‐Squire Age: 67 Profession: Retired School Psychologist Limitations: Prior right arm rotator cuff injury My interest in the shoulder joint and shoulder girdle arose out of my own challenges with shoulder injuries. Eight years ago, I suffered a serious rotator cuff tear that was surgically repaired via arthroscopic surgery. When I initially was seen by the orthopedist, he x-­‐rayed my shoulder and indicated that I had spurs in my shoulder that were impinging on my rotator cuff and bursa; however, when he went in to do the surgery, he discovered I had a massive tear. He repaired it and I underwent four months of weekly occupational therapy which eventually restored my shoulder to functionality; however, I still had reduced external rotation in my right shoulder, and when I returned to my regular pilates exercise routine, I found that I had limited strength for some exercises that involved my affected shoulder. Although I could perform exercises without difficulty with my left arm, I tired more readily when using my right arm. I have been doing pilates mat for ten years and apparatus for the last two years. Over the years, I had learned to accommodate for my shoulder imbalance but when I began the comprehensive course, I realized I needed to strengthen the affected arm if I was to do the exercises effectively and teach others to do them. 8 I realize that I may not be able to do all of the exercises involving shoulder strength, but my goal was and is to increase my strength and range of motion so I can be more balanced in my muscle strength and functional movement. I developed a program to augment my mat exercises and focus on building continued core strength and increase the strength in my shoulders. Conditioning Program using the BASI Block System BLOCK EXERCISE Warm-­‐Up Roll down, pelvic curl, spine twist supine, chest lift, chest lift with rotation, criss-­‐cross Chair-­‐ parallel heels/ toes v-­‐position toes, open v-­‐
heels/toes, calf raises , prances. Chair-­‐ standing pike, Reformer-­‐ short box series: round back, flat back, tilt and twist. I added the round-­‐about after five sessions. Reformer-­‐ Frog, up/down circles, openings and extended frog Reformer-­‐Short spine Footwork Abdominal Work Hip Work Spinal Articulation Stretches Full Body Integration Arm Work GOAL To warm up the whole body, focusing on abs, obliques and rotation for later bodywork. Warm up and strengthen ankles, trunk stabilization, hamstrings and quadriceps, to improve stability in posture. Focus on abdominal control, scapular stabilization, and back extensor strength and extension, obliques. Used the pole overhead for twist and round-­‐about for scapular stabilization focus. Pelvic lumbar stabilization, hip adductor strength, hip extensor control Abdominals, hamstring stretch., spinal articulation. Important to take weight on the shoulder girdle in a supported position Step Barrel-­‐ shoulder To stretch out internal and stretch 1 and 2. external shoulder rotators prior to full body integration exercises Sitting Forward and Reach Spinal mobility, abdominal control. Shoulder adductor and oblique stretch Supine arm series Shoulder adductor/extensor (extension, up/down strength focusing on the lats., circles, adduction, anterior/posterior deltoids, triceps)for 3 sessions; biceps, triceps, rhomboids, & 9 Leg Work Sitting Arm series ( chest expansion, biceps, rhomboids, triceps,) Plus Salute after 5 sessions. Skating pectoralis Maintain a neutral pelvis, pelvic lumbar stabilization, hip adductor strength. Lateral Flexion/ Mermaid Focus on obliques and external Rotation shoulder rotation as well as shoulder abduction. Spinal mobility, scapular stabilization. Back Extension Pulling ropes 1 and 2 after Increase back extensor strength, five sessions shoulder adductor strength. Conclusions I have been following this routine with some variations for the past four months and have seen noticeable improvement in my ability to hold positions that require shoulder strength. I have also seen a noticeable improvement in my ability to move my shoulders with less fatigue, more flexibility and increased range of motion. There are still some exercises that are challenging for me but I know how to modify them when needed. My increased shoulder strength has translated into better functional movement in my daily activities. The importance of strong and flexible shoulders cannot be ignored when looking at functional daily movement. Many people are affected by loss of flexibility and strength in the shoulder due to the natural loss of elasticity in muscles, as we grow older; however, they can minimize the chance of shoulder injuries and improve their quality of movement, with proper body mechanics and regular exercise. Pilates addresses these issues through controlled, thoughtful movement. 10 BIBLIOGRAPHY 1. 2. Abrahams, Peter Human Body. London, England: Bright Star Publications, 2002. Trail Guide to the Body: Hands-­‐on guide to locating muscles, bones and more. Boulder, Colorado: Books of Discovery, 2014. 3. Calais-­‐Germain, Blandine Anatomy of Movement. Seattle, WA: Eastland Press Inc. 2007 4. DiNubile, Nicholas A. Framework for the Shoulder: A 6-­‐Step Plan for Preventing and Ending Pain. New York City, NY: Rodale Press Inc. 2011. 5. Isacowitz, Rael Study Guide Comprehensive Course: Module 9. 2000 -­‐ 2013. Illustrations Website: Large Muscles of the Shoulder https://goo.g/images/XzMzVL Website: Images for Bones of the Shoulder Girdle Biel, Andrew 11 12