9/27 - RC Nonop Therex Considerations Flashcards
what are the goals of therex when treating RC (5)
- joint compression
- dynamic ligament tension
- NM control
- ST control
- mobility»_space; stability»_space; controlled mobility»_space; skill
what is an important concept to consider when treating pts when RCs
mobility
> stability
» controlled mobility
»> skill
what other ms should be considered when prescribing therex for RC
delt, upper trap, pec minor
think ab exercises that would be good for RC without activating those ms
how can you prescribe therex for RC without overwhelming the pt
couple exercises that will minimize other ms group activation
exercises that target multiple ms groups
empty vs full can motion
empty can - thumb down, elevation, IR
full can - thumb up, depression, ER
which can is more irritating for impingement
empty
- IR - greater tub isn’t clearing acromion
what path is sidelying ER therex great for
posterior RC
what are the 2 ways that ER therex can be set up? what are the pros/cons of each?
- arm at side - stable environment
- arm up - challenging
- scap musculature need to work harder to stabilize
- more functional
what is a general rule for how to make stability exercises more difficult
as gets further away from body
what ms are specifically activated in sidelying ER
infra & teres minor (aka posterior cuff)
how does adding a towel roll to sidelying ER change the exercise
inc infra activity
- keeps motion in scap plane
improves the form by keeping arm at side
how is ER at 90deg ABD more functional than when arm is at side
more functional for overhead athletes/workers
when should ER at 90deg ABD be avoided and/or why with caution
avoid in early stage of rehab
caution - inc strain on capsule in 90-90 position
where & how should force be applied for manual resistance in ER
at medial border of inferior scap angle and at arm
work to get concentric and eccentric contractions thru whole motion
what is a characteristic of subscap ms fibers that should be considered for therex
upper and lower fibers act independently
what therex motions had the greates subscap activity
pushup plus
diagonal exercises (ie tennis forehand)
what position is not ideal for optimal subscap activation and why
IR at 0deg
d/t co-contraction of:
- ant delt
- pec major
- lats
what is a consideration of upper vs middle vs lower trap when determining therex
upper almost always strong
- will compensate for middle & lower trap weakness
want to prevent upper trap involvement when prescribing middle and lower trap exercises
optimal exercises for upper, middle, and lower traps
upper - unilateral shrug
middle - prone elevation & H - ext (“T”)
lower - prone elevation (“Y”)
how do T vs Y motions change the activation of middle vs lower traps
changes alignment of fibers
- T = middle
- Y = lower
what is a consideration of ms activation for unilateral scap retractions
see more upper trap than lower trap activation
what exercises minimize upper trap while activating lower trap
SL flex
SL ER
prone H-ABD in ER
what exercises minimize upper trap while activating middle trap
SL flex
SL ER
prone ext
what is the difference in sidelying flex compared to sitting or standing flex
sitting or standing, prime position for UT to work
sidelying limits mechanical advantage to use UT
in what positions elicit the greatest the upper trap activation and what positions elicit the least
greatest - standing
- highest in 60-120deg range
least - prone, SL, supine
what determines serratus anterior activation
position of scapula
- activated first when scapula retracted (ie low row, inferior glide)
serratus anterior activated last when scapula protracted
- ex: lawnmower and robbery
what is an optimal exercise to activate serratus anterior while minimizing the upper trap
standard push-up plus
when on wall, highest upper trap activation
what is something w pushup plus exercises that can inc RC activation
open hand
what are serratus anteiror exercises (5)
serratus punch
wall slide (@ >90deg elevation)
push up plus
elevation in scapular plane
elevation w ER and Tband
what exercise is best for serratus w least pec minor involvement
serratus punch
progression and regression for serratus anterior wall slides
progression - band around arms
- activates ER also
regression - foam roll b/w wall to roll up
what ms are we trying to minimize in exercises targeting RC and serratus
UT
delt
pec minor
what serratus ms exercise do you see UT activation in
scaption
what serratus ms exercise do you see middle and lower trap activation in
elevation & ER
what serratus ms exercise do you see pec minor activation in
wall slide
what are RC exercises that facilitate neuromuscular control
reactive drills
sport-specific positions
perturbation @end range
concentric & eccentric resistance
- 90-90 ER
what are some plyometric exercises for RC
all one hand progressions:
- ball drop
- catch from a toss behind
- wall dribbles - stationary or semi-circular
- small wall circles (inc infraspinatus)
prognosis for a non-op RC tear rehabed by PT
do well early on in first 2 years
after that decline d/t fatty infiltration
- changes quality of tissue
- if repaired, fat already there will stay there
what patients is PT not the first intervention for a RC tear
small-medium tears in younger active patients
- know it will get worse over time
- plenty of time for fatty infiltration
- higher demands
what is a super important thing to advocate for if a pt has a RC tear when you are forming your POC
advanced imagery asap
- see how much fatty infiltration already
POC for a traumatic full thickness RC tear
referral
delayed surgery = (-) outcomes
what type of RC full thickness tears are most common
chronic/degenerative
what is seen in chronic/degenerative full thickness RC tears
RC atrophy
fatty infiltration (via MRI)
what is a consideration of chronic/degenerative fullthickness RC tears that should be noted when deciding POC
tear size, atrophy, and fatty infiltration all may progress over time (5-10yrs)
- even tho may acutely improve in PT
what is a characteristic of fatty infiltrate
once it is present, won’t be removed by PT or surgery
