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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