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Mini-course Goals
This course is designed for clinicians who wish to enhance their
ability to assess and rehabilitate shoulder dysfunction. We will
discuss and practice advanced clinical techniques to assess scapular
function and integrate scapula control exercises into shoulder
rehabilitation.
We will review material using brief PowerPoint presentations
followed by demonstrations and hands-on experience applying the
assessment and rehabilitation techniques.
We will
z Review the role of scapula in shoulder function and dysfunction
z Demonstrate and practice clinical assessment techniques and special
tests to evaluate scapular function
z Identify and discuss components of scapular rehabilitation
z Demonstrate and practice methods to integrate scapular stability
exercises into shoulder rehabilitation
Agenda
1. Clinical Exam
2. Shoulder Foundation Understanding Function of the Scapula
Components of Scapular Control
3. Posture / Postural Awareness
4. Flexibility, Neuromuscular Control, Strength and Endurance
Developing Stability
5. Continuum of Stability
6. Engraining Functional Stability
Integrating Scapular Control into Rehabilitation
7. Progressive Variation
Take Home Points
Questions
6.
7.
Scapular Motion
Goal = Identify issues
NORMAL and ABNORMAL Scapular Motion
Rotations about 3 axes, in 3 planes
Sagittal
Plane of
Motion
Frontal
Resting
Position
2 5
Normal
Range
50 5
Resting Position
2 5
Resting Position
2 5
Normal Range
50 5
Normal Range
50 5
Vertical
Plane of
Motion
Transverse
Resting
Position
-30 15
Normal
Range
25 10
-30 15
Normal Range
25 10
-8 5
30 15
Resting Position
-30 15
Normal Range
25 10
Horizontal
Plane of
Motion
Sagittal
Resting
Position
-8 5
Normal
Range
30 15
-8 5
30 15
Clinical Exam
Clinical Exam
Clinical Exam
EXAMPLES
Result:
Clinical Exam
PRACTICAL EXAMPLES
Goal = Identify
1.
2.
Agenda
1. Clinical Exam
2. Shoulder Foundation Understanding Function of the Scapula
Components of Scapular Control
3. Posture / Postural Awareness
4. Flexibility, Neuromuscular Control, Strength and Endurance
Developing Stability
5. Continuum of Stability
6. Engraining Functional Stability
Integrating Scapular Control into Rehabilitation
7. Progressive Variation
Take Home Points
Questions
Result:
Scapula: less PT (~4 less)
less UR (~5 less)
a more superior position
on thorax
GH Joint: less shoulder abduction
(~24less)
Muscular Inflexibility
Pectoralis Minor or Biceps (short head)
Pulls coracoid anterior/inferiorly
Result: Decreased ER and PT,
fwd rounded shoulders
Serratus Anterior
Fatigue
Tsai, McClure 2003
PT, ER, UR
McQuade, 1998
loss of scapular control
McQuade, 1995
PT, UR
Rehab Goals
Build Endurance!
Maintain Form!
1.
2.
3.
4.
Agenda
1. Clinical Exam
2. Shoulder Foundation Understanding Function of the Scapula
Components of Scapular Control
3. Posture / Postural Awareness
4. Flexibility, Neuromuscular Control, Strength and Endurance
Developing Stability
5. Continuum of Stability
6. Engraining Functional Stability
Integrating Scapular Control into Rehabilitation
7. Progressive Variation
Take Home Points
Questions
Developing Stability
Stability is a continuum, develop it as a continuum
single multi-joint functional
static dynamic functional
Rhythmic Stabilization
1.
2.
3.
4.
5.
Examples?
Scapular Clock
Developing Stability
Engrain motor patterns that begin with scapular setting
6.
Agenda
1. Clinical Exam
2. Shoulder Foundation Understanding Function of the Scapula
Components of Scapular Control
3. Posture / Postural Awareness
4. Flexibility, Neuromuscular Control, Strength and Endurance
Developing Stability
5. Continuum of Stability
6. Engraining Functional Stability
Integrating Scapular Control into Rehabilitation
7. Progressive Variation
Take Home Points
Questions
Progressive Variation
progressing distally
Address posture and pain first
Develop each component of stability
Develop stability as a continuum progressing to functional
Emphasize beginning movement with a stable base
EXAMPLES
Examples
Progressive Variation
Examples
Progressive Variation
10
Exercises
Examples
Progressive Variation
Inferior Glide
Robbery
Video
Exercises
Exercises
Low Row
Scapular Clocks
Lawnmower
Rhythmic Stabilization
Exercises
Exercises
Progression
Forward Punch
Downward Rows
Push-ups with +
11
Examples
Address Posture / Increase Flexibility
Internal Rotation and Posterior Capsule (GIRD)
Sleeper Stretch
Agenda
1. Clinical Exam
2. Shoulder Foundation Understanding Function of the Scapula
Components of Scapular Control
3. Posture / Postural Awareness
4. Flexibility, Neuromuscular Control, Strength and Endurance
Developing Stability
5. Continuum of Stability
6. Engraining Functional Stability
Integrating Scapular Control into Rehabilitation
7. Progressive Variation
Take Home Points
Questions
Pectoralis minor
Short head of the biceps
Coracobrachialis
Thank You
Questions?
12