Welcome

J
emarkel
Health-Tech, LLC

April 29, 2004 Bethlehem, PA

Presents Building an Upper Extremity Rehabilitation Practice

Featured Speakers
Dr. Sidney M. Maycock, Jr.
• 1983 Graduate of Cleveland Chiropractic College, Kansas City. • Inventor of the Wristiciser • Featured Speaker on Television and Radio Programs • Expert on Upper Extremity Rehabilitation • Practices in Williamstown, NJ. Operates Cash-only Practice.

J

emarkel
Health-Tech, LLC

Home of the Wristiciser®

Dr. George K. Petruska
• 1979 Graduate of Palmer Chiropractic College, Davenport. • Lectures Nationally and Internationally in Adjunctive Procedures and Rehabilitation. • Certified by OSHA in General Industry and Ergonomics • Published author of Rehabilitation and Chiropractic articles. • Diplomat status of the ACRB, a Fellow of the ACCRS in Rehabilitation & served on Rehab Board. • Maintains a private practice in Red Hill, PA.

Today’s Topics
• The “Better” Equation for Success • Anatomy as it Relates to Common Upper Extremity Conditions • The Wristiciser-PROplusTM System

J

emarkel
Health-Tech, LLC

Home of the Wristiciser®

• Why Build an Upper Extremity Practice?

• Rehabilitation & Therapy Protocols • Common Billing Codes for U.E. Rehabilitation • The Wristiciser – One Device: Over 50 Exercises

are affected by a repetitive stress type injury to the upper extremities. . • Each year 12 million people in the U.Why Build an Upper Extremity Practice? J emarkel Health-Tech. • 35% of all acute injuries seen in an emergency involve the upper extremities.S. • Carpal Tunnel Syndrome reportedly costs industry 100 billion dollars in lost work days. • 25% of all work related injuries involve the Upper Extremities. LLC Home of the Wristiciser® • Approximately 20 million people in the United States are affected by an upper extremity disorder or injury every year.

LLC Home of the Wristiciser® • Better Tools • Better Patient Compliance • Better Results .The “Better” Equation for Success • Better Patient Education J emarkel Health-Tech.

LLC Home of the Wristiciser® • Elbow • Forearm • Wrist/Hand • Arthritic Change .Anatomy as it Relatives to Common Upper Extremity Conditions Topics to be Covered: • Shoulder J emarkel Health-Tech.

biceps brachii Anterior infraspinatus. LLC Home of the Wristiciser® The shoulder joint involves three bones: the shoulder blade (scapula). Bones of the Shoulder Joint Muscles of the Shoulder Joint pectoralis major. coracobrachialis. teres minor. subscapularis. latissimus dorsi.Shoulder Basic Anatomy J emarkel Health-Tech. supraspinatus Posterior Superior . the collarbone (clavicle) and the upper arm bone (humerus). teres major triceps brachii. long head deltoid.

Bursitis.Shoulder Common Disorders J emarkel Health-Tech. LLC Home of the Wristiciser® • Rotator Cuff Injuries. Tendonitis & Impingement .

Shoulder Common Disorders J emarkel Health-Tech. Tendonitis & Impingement . LLC Home of the Wristiciser® • Rotator Cuff Injuries. Bursitis.

The rim deepens the socket by up to 50 percent so that the head of the upper arm bone fits better. it serves as an attachment site for several ligaments. Because the head of the upper arm bone is usually much larger than the socket.Shoulder Common Disorders J emarkel Health-Tech. In addition. a soft fibrous tissue rim called the labrum surrounds the socket to help stabilize the joint. . LLC Home of the Wristiciser® The head of the upper arm bone (humeral head) rests in a shallow socket in the shoulder blade called the glenoid.

Shoulder Common Disorders J emarkel Health-Tech. LLC Home of the Wristiciser® .

brachialis. Bones of the Elbow Joint Muscles that cross the elbow can produce flexion or extension: Muscles of the Elbow Joint extensor carpi radialis longus Muscles that flex the elbow joint (from attachments superior to the lateral epicondyle): pronator teres. Muscles that flex the elbow joint: triceps. LLC Home of the Wristiciser® The elbow joint involves three bones: the arm bone (humerus). anconeus . palmaris longus Muscles that flex the elbow joint (from attachments on the medial epicondyle): Muscles that flex the elbow joint (from other sites of attachment): biceps. brachioradialis. flexor carpi radialis.Elbow Basic Anatomy J emarkel Health-Tech. the forearm bones (ulna and radius).

Elbow Common Disorders J emarkel Health-Tech. LLC Home of the Wristiciser® • Lateral and Medical Epicondylitis .

LLC Home of the Wristiciser® • Lateral and Medical Epicondylitis .Elbow Common Disorders J emarkel Health-Tech.

LLC Home of the Wristiciser® • Lateral and Medical Epicondylitis .Elbow Common Disorders J emarkel Health-Tech.

Elbow Common Disorders J emarkel Health-Tech. LLC Home of the Wristiciser® • Lateral and Medical Epicondylitis .

LLC Home of the Wristiciser® Muscles that cross the radio-ulnar joint can produce pronation or supination: Muscles of the anterior forearm (pronators) pronator quadratus pronator teres flexor carpi radialis Muscles of the posterior forearm (supinators) supinator biceps (extensor pollicis longus) (extensor indicis) .Forearm Basic Anatomy J emarkel Health-Tech.

Forearm Common Conditions • Nerve Entrapments Median Nerve Ulnar Nerve Radial Nerve J emarkel Health-Tech. LLC Home of the Wristiciser® Pronator teres syndrome Anterior interosseous syndrome Carpal tunnel syndrome nerve Cubital tunnel syndrome Guyon’s canal compression Axilla Spiral groove Radial tunnel syndrome Posterior interosseous nerve .

Pronator syndrome may resemble carpal tunnel syndrome. .Forearm Common Conditions • Nerve Entrapments Pronator Syndrome refers to a disturbance in function of the median nerve due to some mechanical abnormality at the level of the forearm. and weakness is confined to the pronator quadratus. but is much less common than carpal tunnel syndrome. This is most often related to the path normally taken by the nerve through the middle of the pronator teres muscle. LLC Home of the Wristiciser® With anterior interosseous nerve involvement. there is no sensory loss. J emarkel Health-Tech. although other areas may be the site of the difficulty.

It may be caused by constricting fascial bands. Bony abnormalities like cubitus valgus as a result of previous fracture around the elbow or bony spur may also cause ulnar neuropathy.Forearm Common Conditions • Nerve Entrapments Cubital Tunnel Syndrome syndrome is the most common pathological entrapment of the ulnar nerve. a tumor. LLC Home of the Wristiciser® . Subluxation of the ulnar nerve over the medial epicondyle with elbow flexion will also result in frictional injury to the nerve. a ganglion etc. J emarkel Health-Tech. hypertrophied synovium.

consists of scaphoid. triquetrum and pisiform. which occur in two rows (proximal and distal). J emarkel Health-Tech. lunate. and the first three of these articulate with the distal ends of the radius or ulna. capitate and hamate.Wrist & Hand Basic Anatomy Bones of the Wrist Joint (Carpals) Eight bones of the carpus. trapezoid. LLC Home of the Wristiciser® Bones of the Hands Metacarpals and Phalanges . The proximal row. articulates with the bases of the metacarpal bones. The distal row. made up of the trapezium.

and flexor digitorum superficialis together with their synovial sheaths pass through this tunnel to the digits. This bony gutter is converted into a tunnel by the flexor retinacular on the volar aspect. LLC Home of the Wristiciser® The floor is formed by the carpal bones which are concave in its flexor surface.Wrist & Hand Carpal Tunnel Syndrome J emarkel Health-Tech. The median nerve and the long flexor tendons namely flexor pollicis longus. flexor digitorum profundus. .

LLC Home of the Wristiciser® .Wrist & Hand Carpal Tunnel Syndrome J emarkel Health-Tech.

This is followed by decreased sensation and eventually weakness and clumsiness in the hand as the small muscles of the hand are involved. Symptoms begin with a feeling of pins and needles in ring and little finger.Wrist & Hand Guyon’s Canal Compression Guyon's Canal Syndrome is numbness and tingling in the ring and small fingers caused by irritation of the ulnar nerve in the Guyon's canal. J emarkel Health-Tech. LLC Home of the Wristiciser® .

Upper Extremity Degenerative Joint Disease J emarkel Health-Tech. . LLC Home of the Wristiciser® Osteoarthritis is one of the oldest and most common diseases in humans and the most common joint disease.

J emarkel Health-Tech. LLC Home of the Wristiciser® The Wristiciser-PROplusTM System .

George K.Introducing J emarkel Health-Tech. Petruska • Rehabilitation & Therapy Protocols • Common Billing Codes for U. Rehabilitation . LLC Home of the Wristiciser® Dr.E.

LLC Home of the Wristiciser® Specific Adaptation to Imposed Demands Sherrington's Law Symmetrical Associated Movements Cross Reflex Physiological Overflow Awareness Functional Model .J Case Studies *Rehab Pearls emarkel Health-Tech.

our bodies become stronger. we do recognize that the spine functions very differently when it is not weight-bearing. In fact. hearts. if we practice balance and coordination skills. and we become better at doing whatever it is that we do most often. As Chiropractors. rolling ship or a pair of skates). That certainly must include the specific stress of gravity in the upright position. LLC Home of the Wristiciser® The "SAID" concept is one of the underlying tenets of the strength and conditioning field. It has taken quite a while for those specialists in the treatment of spinal problems to incorporate the SAID concept into neck and back rehab programs. And. Recently. some of us have begun to use the same thought processes to design spinal exercises that we have used for decades to determine appropriate x-ray positions. If we frequently perform aerobic activities. When we spend more time in activities requiring force and providing resistance. . then our lungs.J Specific Adaptation to Imposed Demands emarkel Health-Tech. [1] It describes the observation that our bodies will predictably change in response to the demands that are placed on them. we improve our ability to function easier on unstable surfaces (such as on an incline. and muscles become more efficient at taking in and processing oxygen. We now know that an ideal way to help our patients return to normal function is with exercises that imitate as closely as possible the real conditions under which the spine must function day after day. these improvements in our abilities are quite specific.

J Sherrington's Law emarkel Health-Tech. Through the use of passive and passive assistive exercises this loss can be minimized. repetition of possible new compensatory motor patterns may alter proper mechanism eventually leading to pathological motor patterns. LLC Home of the Wristiciser® One of the most important concepts in early rehabilitation is the maintenance of proper functional motor patterns. the body through conservation of energy chooses motions that are the most productive or energy efficient. This repetition of motor pattern reduces the resistance to this pathway as stated by Sherrington's Law of Facilitation. . Through facilitation. Learned motor pattern in the functional activities of motion are ingrained or facilitated through repetition. During an injury state. Although the symptomatic treatment of this new injury may prove to be an easy task. If not attended these dysfunctional compensatory motor patterns may develop into a seemingly unrelated new injury. the corrections of the true cause may be difficult without an understanding of compensatory facilitations.

. immobilization either through inflammation. casting and/or pain during motion." It involves exercising the unaffected limb in the specific motions and planes that the injured limb is unable to perform due to the injury. LLC Home of the Wristiciser® Symmetrical Associated Movements Once an injury has occurred to a limb.J emarkel Health-Tech. supports. rehabilitation of the injured limb can occur through "symmetrical associated movements.

which can greatly affect prognosis time.. 1992. Dynamics of Clinical Rehabilitative Exercise. . and Grand L. and Cole K. LLC Home of the Wristiciser® Physiologically the injured side has similar gains/maintenance of strengths as the uninjured side..J Cross Reflex emarkel Health-Tech. Journal of Neurophysiology. if an injury occurs in the right elbow affecting both flexion and extension exercising the left elbow in these motions will have a positive enhancement in the performance of the right elbow function.) Yoe G. For example. May 1992. No. (Ordet S. Vol. William and Wilkins. 67. 5. This process is labeled "cross reflex" and it has been observed dramatically in hemi-palegic rehabilitation exercise programs.J. Study.

) . LLC Home of the Wristiciser® Due to inhibitory reflex effects of pain on exercise all passive movements should be limited to pain free ranges of motion. S & S Publishers. 1984. Compendium of Isokinetics. J.J Physiological Overflow emarkel Health-Tech. (Davies G. Based on the principle of "Physiological Overflow" there is a 15 degree progression into the painful motion to each side of the exercised range of motion even though that area of the range of motion has not been exercised..

but awareness. Beginning the awareness component of an exercise program involves a number of questions directed to the patient. LLC Home of the Wristiciser® Although it is important for the patient to give attention/focus to an exercise.J Awareness emarkel Health-Tech. it will hopefully become a new habit not requiring repetition. Learning is not accomplished if the patient is toll what is occurring by the clinician instead of feeling and sensing within. The essential element in the awareness process is that the patient learns how to use their body. The goal in this approach of learning the movement is to reorganize the neuromuscular system with reorganization of the movement. Once identified. . Only through awareness and knowledge is learning of motion activity obtained. "the feeling" experienced as muscles contract and joints move is emphasized. No right or wrong answer should be supplied by the clinician. it is even more important for the patient to be aware (show realization or knowledge) of the exercise activity as the movement takes place. the patient can then focus more specifically on where the movement is or is not occurring. The questions are designed to assist the patient in focusing on one part of the body as well as to the whole.

J Functional Model emarkel Health-Tech. It aims to restore function in the locomotor system involving a broad approach that uses exercise. Such rehabilitation focuses on the entire locomotor system. . education and manipulation. LLC Home of the Wristiciser® Functional restoration opposes the application of an injury/inflammation model when significant trauma is not present. not just the area of complaint. This model embraces emerging rehabilitation standards. joint dysfunction and muscle dysfunction. thus focusing on softtissue healing only when appropriate. Functional restoration addresses improper motor control (spinal instability).

J emarkel Health-Tech. LLC Home of the Wristiciser® Carpal Tunnel Syndrome .

At that time it was localized. . Her symptoms started about 1 year ago. She is not pregnant. She states that each episode has become progressively worse.J History emarkel Health-Tech. LLC Home of the Wristiciser® A 32 year old right handed female presented with complaints of “pins and needles” in her right hand. The patient has 3 children. She wakes up at night and has to shake her hands to relieve her symptoms. Since the initial incident. she has had numerous episodes of symptoms.

Occurs in women 58% of the time .J emarkel Health-Tech. It is often diagnosed when a patient complains of a feeling of 'pins and needles' in the hand and wrist. LLC Home of the Wristiciser® Clinical Presentation Carpal tunnel syndrome is a general term used to describe a myriad of conditions. 1/1000 is true CTS Vibration Temperature changes Prolonged positions and actions. Usually occurs as a repetitive stress disorder.

LLC Home of the Wristiciser® Areas of Deficit Histologic. and Neurological. . Structural.J emarkel Health-Tech.

overactive muscles are the forearm flexors Inhibited or weak muscles forearm extendsors. . LLC Home of the Wristiciser® Histologic Usually tight.J emarkel Health-Tech.

hemorrhage.J Structural emarkel Health-Tech. unreduced dislocation of the carpal bones. LLC Home of the Wristiciser® Carpal tunnel syndrome (CTS) is defined as an entrapment of the median nerve in the area of the volar wrist canal beneath the flexor retinaculurn which causes neural symptoms that refer into the hand. The carpal arch and the flexor retinaculum help form the carpal tunnel.There are eight irregularly shaped carpal bones that articulate with one another by arthrodial joints connected by interosseous ligaments. wrist. The volar carpal ligament is attached to the pisiform and hamate on one side and the scaphoid and trapezium on the other. *Acute CTS may be caused by trauma from bums. or Colle's fracture . displaced fracture. and upper extremity (1).

These conditions can be ruled out by lab test. . gout and Lupus can cause carpal tunnel-like symptoms. RSD.J emarkel Health-Tech. LLC Home of the Wristiciser® Endocrine Edematous conditions such as pregnancy.

Paresthesia Dysesthesia .J Neurological emarkel Health-Tech. LLC Home of the Wristiciser® Decreased proprioception Lack of Neuromuscular coordination.

Oswestry Neck. CTS. Pain Drawing. Shoulder.J emarkel Health-Tech. LLC Home of the Wristiciser® OA Forms General Health.VAS. Wrist. . Elbow.

ULTT2. LLC Home of the Wristiciser® Functional Testing Postural Analysis Proprioception Muscle ULTT1. ULTT3 Empty Can Test .J emarkel Health-Tech.

LLC Home of the Wristiciser® Palpable band with a local twitch response (positive “Jump Sign”) Trigger points Decreased grip and pinch strength Impaired circulation Diminished proprioception on the involved side Tight forearm flexors. radialis lonus and brevis . carpi. flexor retinacuum Weak or inhibited forearm extenders. flexor pollicis longus. digiti. brachioradialis. abductor and extensor pollicis.J Findings emarkel Health-Tech. flexor digitorurn profundus. carpi radialis & ulnaris.

brachioradialis can lead to “Tennis elbow”  Treatment is similar to CTS  Use cryocuff compression therapy and sequential EMS to progress to rehab as soon as possible.J emarkel Health-Tech. LLC Home of the Wristiciser® *Tight forearm flexors. .

LLC Home of the Wristiciser® CTS Abnormal Posture Muscle Imbalances Muscle Incoordination .J Diagnosis emarkel Health-Tech.

LLC Home of the Wristiciser® *SAID principal *Awareness *Physiological Overflow *Symmetrical associated Movements *Sherrington’s Law of reciprocal inhibition. *Neuromuscular Cross Over Effect .J Prescription Concepts emarkel Health-Tech.

J
Primary Focus

emarkel
Health-Tech, LLC

Home of the Wristiciser®

*Increase strength of forearm extensors (Wristiciser) *Stretch Tight Muscles: forearm flexors (Wristerciser *Activate thenar musculature (Wristiciser) *Increase proprioception and neuromuscular coordination. *Correct Biomechanics (lunate key carpal bone) (manipulation)

J

emarkel
Health-Tech, LLC

Home of the Wristiciser®

Primary focus is strengthening core and postural stabilizers.
This is the manner in which we use the joints and connective tissue during most daily, work and sports activities, and it requires the co-contraction of accessory and stabilizing muscles. Weaker or injured muscles can be quickly strengthened with the use of isotonic resistance to stimulate increases in strength with the wristerciser.

J

emarkel
Health-Tech, LLC

Home of the Wristiciser®

Teach correct breathing patterns beginning from the lower abdomen ending in the upper chest. (Correct breathing patterns activates postural stabilizers, facilitates a cortical response) Use stretching techniques to stretch flexors, and exercise to strengthen extensors with the Wristiciser Activate and strengthen postural stabilizers by using Wristiciser to strengthen the involved muscles.

LLC Home of the Wristiciser® Once the patient’s progress reaches a plateau new more challenging procedures should be added utilizing the Wristiciser. .J emarkel Health-Tech. Now hand protocols can be performed on the Wristiciser.

J

emarkel
Health-Tech, LLC

Home of the Wristiciser®

The home care should engage the patient in the participation of Wristiciser protocols. *This should be done until the patient functional progress reaches a plateau. *Testing should be perform every 4 to 6 weeks.

J

emarkel
Health-Tech, LLC

Home of the Wristiciser®

*If the patient has “Sunrise Sign” surgery is necessary. Rehab is the same just longer. Rehab the surgery not the injury. Rehab the patient as if they were symptom free from conservative care.

J

emarkel
Health-Tech, LLC

Home of the Wristiciser®

Evaluation, Diagnosis and treatment of “Double Crush” would be the similar to CTS.

he has had numerous episodes of symptoms. Since the initial incident. His symptoms started about 1 year ago. He wakes up at night and has to shake his hands to relieve his symptoms. .J History emarkel Health-Tech. LLC Home of the Wristiciser® A 32 year old left handed male presented with complaints of “pins and needles” in his left hand. Operates a jack hammer. Has a history of neck pain. Works 60 hours a week. At that time it was localized. He states that each episode has become progressively worse.

J emarkel Health-Tech. inhibited and weak on the other. (“Upper Crossed Syndrome”) . LLC Home of the Wristiciser® The differential diagnosis is that there is C6-T3 involvement. (overactive and tight on one side. The imbalances are on involved sided.

Serratus Anterior Weak Upper Trap and Levator Scapulae. Peck Major and SCM Myofascial trigger points in the Lower and Middle Trap.J emarkel Health-Tech. Neck Flexors . Sub Occipitals. LLC Home of the Wristiciser® Findings (additional) Square shoulders Gothic Shoulders” Military neck Tight Lower and Middle Trap Tight Neck flexors.

LLC Home of the Wristiciser® Inhibited spinal stabilizers eg.J emarkel Health-Tech. (Shallow breathing) . Mutifdus Strength differences greater than expected values. Abnormal breathing patterns.

Peck Major . Sub Occipitials. LLC Home of the Wristiciser® Additional Treatment *Stretch Lower and Middle Trap.J emarkel Health-Tech. SCM. Levator Scap. Serratus Anterior *Strengthen Upper Trap. Neck Flexors.

LLC Home of the Wristiciser® *Activate Spinal Stabilizers *Increase proprioception *Correct Spinal Biomechanics .J emarkel Health-Tech.

Mirror Image exercise protocols with the Wristiciser should be performed in cervical flexion.J emarkel Health-Tech. PARQ should be negative for contraindication. extension and lateral bending. LLC Home of the Wristiciser® *Proper clearance should be obtained. .

LLC Home of the Wristiciser® Evaluation. Diagnosis and Treatment of Reflex Sympathetic Dystrophy (RSD) .J emarkel Health-Tech.

J Differential Diagnosis emarkel Health-Tech. (overactive and tight on one side. temperature sensitive. There is C6-T3 involvement. limb guarding. and exacerbation from emotional upset. LLC Home of the Wristiciser® Diffuse severe pain. inhibited and weak on the other. The imbalances are on involved sided.(upper crossed syndrome) . burning.

Peck Major and SCM Myofascial trigger points in the Lower and Middle Trap.J emarkel Health-Tech. Neck Flexors . LLC Home of the Wristiciser® Findings (additional) Square shoulders Gothic Shoulders” Military neck Tight Lower and Middle Trap Tight Neck flexors. Sub Occipitals. Serratus Anterior Weak Upper Trap and Levator Scapulae.

(Shallow breathing) .J emarkel Health-Tech. LLC Home of the Wristiciser® Inhibited spinal stabilizers eg. Mutifdus Strength differences greater than expected values. Abnormal breathing patterns.

LLC Home of the Wristiciser® Additional Treatment *Stretch Lower and Middle Trap. SCM. Peck Major *Activate Spinal Stabilizers *Increase proprioception *Correct Spinal Biomechanics .J emarkel Health-Tech. Sub Occipitials. Serratus Anterior *Strengthen Upper Trap. Neck Flexors. Levator Scap.

PARQ should be negative for contraindication. but eventually markedly improves the overall condition due to increased VO2 Max. . extension and lateral bending.J *Proper clearance should be obtained. *Vigorous aerobic exercise is initially difficult to perform. LLC Home of the Wristiciser® Mirror Image exercise protocols with the Wristiciser were performed in cervical flexion. circulation and scar tissue reformation. emarkel Health-Tech.

J emarkel Health-Tech. LLC Home of the Wristiciser® Evaluation. Diagnosis and Treatment of Shoulder Impingement Syndrome .

LLC Home of the Wristiciser® A 38 year old right handed female presented with complaints of chronic shoulder pain. The frequency has increased. The patient is an assembly line worker.J History emarkel Health-Tech. She works constantly over head. The symptoms occur on a intermittent basis. She was also a tennis player. .

J emarkel Health-Tech. LLC Home of the Wristiciser® Clinical Impression Areas of Deficit Histologic. Structural and Neurological .

LLC Home of the Wristiciser® Usually tight.J Histologic emarkel Health-Tech. Inhibited or weak muscles on the opposite side. Backward posterior antalgic translation . overactive muscles on the involved side.

extension decrease with endpoint pain. “Gothic Shoulders”. Upward rotation of the scapula. right and left rotation WNL with discomfort on the right. Neurological Decreased proprioception . right lateral flexion decreased with end point pain.J Structural emarkel Health-Tech. left lateral flexion WNL. LLC Home of the Wristiciser® Cervical range of motion is as follows: flexion increase.

J emarkel Health-Tech. LLC Home of the Wristiciser® OA Forms General Health. Oswestry Headache. Pain Drawing. Oswestry Neck. Shoulder. Headache Disability Index. . VAS. Copenhagen Neck Disability Index. .

J emarkel Health-Tech. LLC Home of the Wristiciser® Functional Testing Postual Analysis Proprioception Muscle Testing .

J Findings emarkel Health-Tech. Serratus Anterior Diminished proprioception on involved side Worse with the eyes closed. LLC Home of the Wristiciser® Square shoulders Altered arm swing Shoulder elevation with arm flexion Altered scapulohumeral rythem Military neck Tight Lower and Middle Trap Tight Neck flexors. .

(Paradoxial breathing) .J emarkel Health-Tech. Peck Major and SCM Myofascial trigger points was in the Lower and Middle Trap. Mutifdus Strength differences greater than expected values. may be the reason the condition occurred to begin with) Weak Upper Trap and Levator Scapulae. LLC Home of the Wristiciser® *Upper cross syndrome (usually present. Abnormal breathing patterns. Neck Flexors Inhibited spinal stabilizers eg. Sub Occipitals.

LLC Home of the Wristiciser® Shoulder Impingement Syndrome Abnormal Posture Abnormal Gait Muscle Imbalances Muscle Incoordination Post Traumatic Headaches complicated by a cervicogenic component. .J Diagnosis emarkel Health-Tech.

J Prescription Concepts *SAID principal emarkel Health-Tech. *Neuromuscular Cross Over Effect *Neuromuscular Over flow (physiologic) . LLC Home of the Wristiciser® *Sherrington’s Law of reciprocal inhibition.

Levator Scap. SCM. Neck Flexors. Subscapularis. Serratus Anterior *Stretch Upper Trap.J Primary Focus emarkel Health-Tech. Peck Major *Activate Spinal Stabilizers *Increase proprioception *Correct Spinal Biomechanics . Sub Occipitials. LLC Home of the Wristiciser® *Strengthen Lower and Middle Trap.

Serratus Anterior Teach correct breathing patterns beginning from the lower abdomen ending in the upper chest. LLC Home of the Wristiciser® *Manipulation should be performed on a PRN basis. Use PIR. (Correct breathing patterns activates spinal stabilizers) .J Stage I emarkel Health-Tech. Neck Flexors. PNF or FlexBuilding muscle energy technique with the Wristiciser to stretch and strengthen Lower and Middle Trap. *Sequencial EMS should reduce the symptoms.

Serratus Anterior . LLC Home of the Wristiciser® *Manipulation should be perform on a PRN basis. PNF or Flex Building muscle energy technique with the Wristiciser to stretch and strengthen Lower and Middle Trap. *Sequencial EMS should reduce the symptoms on a PRN basis. Neck Flexors. Use PIR.J Stage II emarkel Health-Tech.

*Sequencial EMS should reduce the symptoms on a PRN basis. Use PIR. Serratus Anterior .J Stage III emarkel Health-Tech. PNF or Flexes muscle energy technique with the Wristiciser to stretch and strengthen Lower and Middle Trap. Neck Flexors. LLC Home of the Wristiciser® *Manipulation should be perform on a PRN basis.

LLC Home of the Wristiciser® Mirror Image exercise protocols with Wristiciser should be performed in cervical flexion. emarkel Health-Tech.J *Proper clearance should be obtained. The rehabilitation program baseline began with shoulder protocols performed to patient tolerance. The patient began a specific rehabilitation program focused to functional restoration. extension and lateral bending. Rehabilitation continued three times a week with the number of protocols increasing to patient tolerance until the patient reached a plateau. . based on the patient activities of daily living. PARQ was negative for contraindication.

LLC Home of the Wristiciser® Stretching within the pain free ROM utilizing the Wristiciser stretch and strengthening protocols. their function decreased or their symptoms reoccurred. The patient should be released from treatment once their functional progress reached a plateau. . They should be instructed only to return if their condition deteriorated.J Home Care emarkel Health-Tech.

LLC Home of the Wristiciser® Evaluation. Diagnosis and Treatment of Upper Crossed Syndrome *Would be similar to Shoulder Impingement Syndrome (“Winging of Scapula”) .J emarkel Health-Tech.

Diagnosis and Treatment of Rotator Cuff Syndrome *Would be the same except there would be a tear. LLC Home of the Wristiciser® Evaluation. (Usually the Supraspinatus) Positive Codman’s .J emarkel Health-Tech.

LLC Home of the Wristiciser® Essentially Shoulder Impingement Syndrome is a “Sloppy shoulder” that progress if left untreated to Rotator Cuff syndrome.J emarkel Health-Tech. .

J emarkel Health-Tech. . Rehab would progress as if the patient was symptom free from conservative care. LLC Home of the Wristiciser® *Post Surgery Rotator Cuff Evaluation and treatment would be the same except that you would treat the surgery not the condition.

George K. Petruska .Questions  To request additional information please contact: Dr. Jr. Dr. Sidney M. Maycock.

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