Shoulder Girdle

 Shoulder Girdle

Movement Analysis, Sub-classification & Neuromuscular Retraining for Functional Movement Control of the Shoulder Girdle

Course description
Shoulder girdle symptoms can arise from trauma, but frequently it is an insidious, recurrent and an ongoing problem for many people. This is often related to their movement patterns and neuromuscular control around the scapula-thoracic and glenohumeral joints.

Alteration of muscle activation of the scapula-thoracic muscles can result in the scapula adopting a downwardly rotated resting position and / or a loss of dynamic control of the scapula in functional arm movements. This can cause tissue impingement under the subacromial arch or the coracoid causing or provoking the patient’s pathology. The glenohumeral joint frequently displays a dysfunctional pattern of excessive anterior translation, which is often combined with other neuromuscular deficits. This translation control deficit can contribute to an impingement and / or glenohumeral joint pathology. It is also a common neurodynamic interface.

This course involves a detailed assessment of neuromuscular control deficits of the scapula-thoracic and glenohumeral joints. Motor control retraining strategies will be introduced using a comprehensive and evidence based clinical reasoning process. This involves; specific activation of the appropriate stability muscles to control segmental translation of the glenohumeral joint and scapulothoracic joints; the retraining of specific muscles to correct movement pattern control deficits; dynamic control of the scapula in functional movements; and the integration of these training strategies into a wider base of rehabilitation options. This can remove the tissue provocation and promote the normal healing process. Assessing and correcting scapula and glenohumeral movement can significantly improve post operative results as well.

Also covered are the relationship between scapular control and cervical movement control deficits and the diagnostic accuracy of shoulder girdle orthopaedic tests. Some beneficial taping techniques will also be used.
The exercise progressions are described and strategies for the integration into function are discussed with participant examples and case studies.

Course Objectives

The participant will be equipped to:

  • Make an accurate movement pattern control diagnosis and relate this to the client’s presentation
  • Distinguish shoulder pain between the scapula, glenohumeral joint and cervical spine with a movement pattern control assessment
  • Understand the relationship of scapular dysfunction and cervical dysfunction
  • Use movement patterns as a clinical reasoning tool to help guide manual therapy and other techniques
  • Integrate the treatment of movement patterns and translation control into clinical practice

WHAT WILL YOU GET FROM THIS COURSE THAT YOU MAY NOT ALREADY HAVE?

Grasp Reflex
The grasp primitive reflex is present in about 40% of the population. This contributes to increased muscle tone in the shoulder girdle and upper limb. We will show you how to treat it and how other primitive reflexes and sensory motor deficits are related to ongoing motor control deficits.

Kinetic Medial Rotation Test
The Kinetic Medial Rotation test is a newly validated test of shoulder girdle function (Morrisey, 2005). This test differentiates between scapular and glenohumeral joint problems within the shoulder girdle. This helps give us a diagnosis and also lets us set priorities in rehabilitation.

Upper Trapezius is a Good Guy Muscle

Upper trapezius does not elevate the scapula – it has a local and global stability role for the neck and shoulder girdle. It has a major stability influence on the neck, shoulder and thoracic spine. It has an anticipatory timing pattern and is delayed with pain – similar to Transversus. It also experiences sudden atrophy – similar to Multifidus. It rarely loses extensibility so assessment and retaining needs to be specific. Lower trapezius does not pull the inferior angle of the scapula down and in. There are better ways to train lower trapezius for scapular stability!

Inferior Anterior Glenoid (IAG)
The IAG is the position the scapula orientates following pain. This position is controlled by the stability muscles of the scapula and also helps stabilize the cervical spine.

Myofascial Trigger Point Release (MTPR)
Mobilizer muscles tend to get short and/or dominate movements which contribute to faulty patterns and pain. MTPR to the mobilizer muscles can create a good window of opportunity to change movement quality and help manage symptoms.

Neurodynamics
Neurodynamic reactivity can significantly affect the way people move. We’ll show how movement can be used to treat neurodynamic reactivity.

Taping
There are some great taping techniques for the shoulder girdle, forearm and neurodynamics!

Program & Pre-course Reading

 

Suggested pre-course reading
Revision of the Sub-classification course (if taken)

Free articles available at: http://www.ncbi.nlm.nih.gov/sites/gquery http://pubmedcentralcanada.ca/

There are quite a few free articles available by searching “impingement”, “gleno-humeral joint” or “trapezius” as well as other key words for the shoulder girdle.

Scapular and rotator cuff muscle activity during arm elevation: A review of normal function and alterations with shoulder impingement
V Phadke, PR Camargo, and PM Ludewig
Rev Bras Fisioter. Author manuscript; available in PMC 2010 April 20.
PMCID: PMC2857390

The Association of Scapular Kinematics and Glenohumeral Joint Pathologies
PAULA M. LUDEWIG and JONATHAN F. REYNOLDS
J Orthop Sports Phys Ther. Author manuscript; available in PMC 2009 August 21.
PMCID: PMC2730194

Co-occurrence of outlet impingement syndrome of the shoulder and restricted range of motion in the thoracic spine - a prospective study with ultrasound-based motion analysis
Christina Theisen, Ad van Wagensveld, Nina Timmesfeld, Turgay Efe, Thomas J Heyse, Susanne Fuchs-Winkelmann, and Markus D Schofer
BMC Musculoskelet Disord. 2010; 11: 135. Published online 2010 June 29. doi: 10.1186/1471-2474-11-135.
PMCID: PMC2903509

Subacromial impingement in patients with whiplash injury to the cervical spine
Ali Abbassian and Grey E Giddins
J Orthop Surg. 2008; 3: 25. Published online 2008 June 27. doi: 10.1186/1749-799X-3-25.
PMCID: PMC2443117

Shoulder rhythm in patients with impingement and in controls: Dynamic RSA during active and passive abduction
Erling Hallström and Johan Kärrholm
Acta Orthop. 2009 August 7; 80(4): 456–464. Published online 2009 August 1. doi: 10.3109/17453670903153543.
PMCID: PMC2823181

Impact of movement training on upper limb motor strategies in persons with shoulder impingement syndrome
Jean-Sébastien Roy, Hélène Moffet, Bradford J McFadyen, and Richard Lirette
Sports Med Arthrosc Rehabil Ther Technol. 2009; 1: 8. Published online 2009 May 17. doi: 10.1186/1758-2555-1-8.
PMCID: PMC2694775
Coracoid impingement syndrome: a literature review
T. Okoro, V. R. M. Reddy, and Ashvin Pimpelnarkar
Curr Rev Musculoskelet Med. 2009 March; 2(1): 51–55. Published online 2009 January 27. doi: 10.1007/s12178-009-9044-9.
PMCID: PMC2684954

Does Scapula Taping Facilitate Recovery for Shoulder Impingement Symptoms? A Pilot Randomized Controlled Trial
Peter Miller and Peter Osmotherly
J Man Manip Ther. 2009; 17(1): E6–E13.
PMCID: PMC2704341

The impact of subacromial impingement syndrome on muscle activity patterns of the shoulder complex: a systematic review of electromyographic studies
Rachel Chester, Toby O Smith, Lee Hooper, and John Dixon
BMC Musculoskelet Disord. 2010; 11: 45. Published online 2010 March 9. doi: 10.1186/1471-2474-11-45.
PMCID: PMC2846868

SHOULDER KINEMATICS DURING THE PUSH-UP PLUS EXERCISE
Jason B Lunden, Jonathan P Braman, Robert F LaPrade, and Paula M Ludewig
J Shoulder Elbow Surg. Author manuscript; available in PMC 2011 March 1.
PMCID: PMC2841059
Published in final edited form as: J Shoulder Elbow Surg. 2010 March; 19(2): 216–223. Published online 2009 September 4. doi: 10.1016/j.jse.2009.06.003.

Differential control of the scapulothoracic muscles in humans
C Alexander, R Miley, S Stynes, and P J Harrison
J Physiol. 2007 May 1; 580(Pt 3): 777–786. Published online 2007 January 11. doi: 10.1111/j.1469-7793.2000.t01-1-02034.x.
PMCID: PMC2075462

Altered neuromuscular control mechanisms of the trapezius muscle in fibromyalgia
Björn Gerdle, Christer Grönlund, Stefan J Karlsson, Andreas Holtermann, and Karin Roeleveld
BMC Musculoskelet Disord. 2010; 11: 42. Published online 2010 March 5. doi: 10.1186/1471-2474-11-42.
PMCID: PMC2839982

Scapular winging: anatomical review, diagnosis, and treatments
Ryan M. Martin and David E. Fish
Curr Rev Musculoskelet Med. 2008 March; 1(1): 1–11. Published online 2007 November 2. doi: 10.1007/s12178-007-9000-5.
PMCID: PMC2684151

Reliability of clinical tests to evaluate nerve function and mechanosensitivity of the upper limb peripheral nervous system
Annina B Schmid, Florian Brunner, Hannu Luomajoki, Ulrike Held, Lucas M Bachmann, Sabine Künzer, and Michel W Coppieters
BMC Musculoskelet Disord. 2009; 10: 11. Published online 2009 January 21. doi: 10.1186/1471-2474-10-11.
PMCID: PMC2653029

 

Program
Day 1
8:30 – 9:00 Overview of motor system changes with chronic pain & Sub-classification
9:00 – 10:30 Review of anatomy, impingement & instability mechanisms
10:30 – 10:45 Break
10:45– 11:00 Land mark palpation practical
11:00– 12:00 Postural alignment practical
12:00– 1:00 Lunch
1:00 – 1:45 Translation control: scapulothoracic joint with upper trapezius
1:45– 2:30 Translation control: scapulothoracic joint with lower trapezius
2:30 – 3:15 Translation control: glenohumeral joint
3:15 – 3:30 Break
3:30– 4:30 Shoulder girdle flexion and abduction
Day 2
8:30 – 9:30 Shoulder girdle lateral rotation
9:30 – 10:30 Shoulder girdle medial rotation
10:30– 10:45 Break
10:45– 11:15 Shoulder girdle protraction
11:15– 12:00 Shoulder girdle full range movements
12:00 – 1:00 Lunch
1:00 – 1:45 Lower trapezius training
1:45– 2:30 Serratus anterior training
2:30– 3:00 Rotator cuff training
3:00– 3:15 Break
3:15– 4:00 Addressing myofascial restrictions to movement
4:00 – 4:30 Clinical integration, Summary

 


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