Download Principle 4 - Organization of Head, Neck

Organization of the Head, Neck & Shoulders
Anatomy & Physiology
Skeletal
Jaw (mandible), Hyoid, Clavicle, Scapula, Humerus, Cervical Spine (c/s), Thoracic Spine (t/s)
Muscular
Scapulo-thoracic Muscles - Rhomboid Major & Minor, Trapezius, Latissimmus Dorsi (sometimes),
Pectoralis Minor, Levator Scapulae, Serratus Anterior,
Scapulo-humeral muscles - Supraspinatus, Infraspinatus, Subscapularis, Teres Minor and Major, Deltoid,
Coracobrachialis, Biceps (Long head), Triceps (Long head)
Humero-thoracic Muscles - Latissimus Dorsi, Pectoralis Major
Biomechanics & Arthrokinematics
Congruency (Maintaining optimal surface contact @ the articulation between bony surfaces of the joint).
The function of the shoulder complex is to maintain maximum congruency between the head of the humerus
and the glenoid fossa
Joints of the Shoulder - Glenohumeral joint, Scapulothoracic Joint, Acromioclavicular joint, Sternoclavicular joint
Force Couples
A force couple are two forces that are equal in magnitude and, acting in opposite directions, produce roatation about an axis.
Rotator Cuff, Posterior Oblique Sling, scapular rotators
Joints of the Head & Neck
OA joint: Flexion/Extension and Lateral flexion
AA joint: Rotation
Force Couples of Shoulder Rotator Cuff
These muscles arise from scapula & connect to head of humerus forming cuff at shoulder joint. They hold head
of the humerus in glenoid fossa of scapula. During elevation of arm, rotator cuff compresses
glenohumeral joint to allow deltoid to further elevate arm W/out rotator cuff, humeral head would ride up
partially out of glenoid fossa & efficiency of deltoid would be less
Rotator Cuff Muscles - Supraspinatus, Infraspinatus, Teres Minor (core of the shoulder girdle)
Posterior Oblique Sling - Latissimus Dorsi, Thoracolumbar Fascia, (Contralateral) Gluteus Maximus
Scapular Rotators - movement
Upward Rotation - Upper Trapezius, Lower Trapezius, Serratus Anterior
Downward Rotation - Pectoralis Minor, Levator Scapula
Motor Control
1. Normal Movement/Organization
Good integration of upper extremity to trunk
Good integration of head to trunk
Scapular stability & mobility - maintaining congruency of glenohumeral joint and providing enough stiffness
for the anticipated load, Ability to maintain a "scapular neutral" position when appropriate
2. Faulty movement/organization
Loss of congruency of joints, Over recruitment to execute movement increases energy
expediture & decreases endurance & quality of movement, Poor postural awareness; forward head,
round shoulders, etc.
Structural Limitations
Tight muscles; pectoralis minor, suboccipitals, scalenes, etc. Insufficient thoracic mobility
3. Faulty in Cervical Pain Syndromes
Poor scapular muscle control - Loss of postural holding capacity
Upper, middle, lower traps or serratus anterior
Over activity of:
Levator scapulae, pectoralis major, pectoralis minor or scalenes
4. Poor cervical Muscle Control
Poor activation & holding capacity of deep neck flexors
Longus capitis and Longus colli
Over activity of superficial cervical muscles
Levator scapulae, Scalenes, Sternocleidomastoid
Decreased co-contraction of deep neck flexors & extensors to increase segmental stiffness,
Tightness of subocciptal muscles
5. Acquisition of new movement
Relaxation of jaw, sternum & face w/ breath Increase lateral width of shoulder & thorax
Optimize space between ears & shoulders Maintain the above throughout movement
Bio-Energetics
Meridians - Lung & Gall Bladder
Balanced strength & flexibility on all sides of shoulder enables a balanced flow of energetic pathways.
A protracted shoulder compresses the "mu point", which is the alarm point for the lung meridian.
Could stagnate the process of emotion
Hypertonicity in the upper trapezius restricts the flow of the gall bladder meridian,
responsible for bringing yang energy down to the feet
Practical Application of Movement Principle
Ease of breath & O2 exchange
"As much as necessary, as little as possible."
Optimal Postural alignment
Optimal width between ears and shoulders
Biomechanically safer
Increased tension in shoulder region can cause faulty motor patterning, disrupting normal shoulder
organization, jeopardizing structures such as rotator cuff, thoracic & cervical vertebrae, and ribs
Improved Integration
Integration of upper extremity to trunk increases functional reach & maximizes dexterity.
Integration of head on trunk helps increase awareness of the world through improved access to our
senses of vision & hearing enabling us to be more sensitive to sight & sound
Cueing
Verbal
exhale, relax jaw, throat, root of tongue
exhale, slide shoulder blades down rib wall
exhale, touch tip of tongue behind upper teeth
exhale, widen across your collarbones
exhale, make the sounds AH, or OO, or EE
exhale, slide inferior angle of scapula towards opposite PSIS
Lead into space w/ little finger side of shoulder blade, arm, hand
Tactile
Hands guiding the inferior angle of the scapula
Thumb depressing spine of scapula & fingers distracting laterally the clavicles
Softly stroking from upper cervical to outer border of acromion
Guide scapula through normal elevation & depression w/ hands
Imagery
Pretend you could drool
Imagine/feel root of tongue softening
Imagine/feel your face soften
Imagine your collarbones could extend out through your outstretched arms right out through your middle fingers
Imagine sending your collar bones out to the sides of the room
Feel as if you were sliding your shoulder blades into your opposite hip pockets
Mat
Arm Arcs
Prone Extension
Assisted Roll-up