Exercise Interventions for the Shoulder Girdle Flashcards
Classification systems to guide treatment for non-operative shoulder conditions
- stage approach for rehab of shoulder disorders (STAR-Shoulder): includes screening tool, pathoanatomic diagnosis, & rehab classification based on irritability rating & primary impairments
- allows for matching of intervention strategies & tactics with the categories of classification
- results in directed rehab treatment program
What makes a patient not appropriate for physical therapy
- tumor
- infection
- fracture or unreduced dislocation
- neurologic lesion
- visceral pathology
Pathoanatomic diagnosis for subacromial pain syndrome
- Rule in: impingement signs (Near, Hawkins, Jobe tests), painful arc, pain with isometric resistance, weakness, atrophy
- Rule out: significant loss of motion & signs of instability
Pathoanatomic diagnosis for adhesive capsulitis
- Rule in: spontaneous progressive pain. loss of ROM, external rotation most limited, pain at end range
- Rule out: normal motion & age <40
Pathoanatomic diagnosis for glenohumral instability
- Rule in: age <40, history of dislocation or subluxation, apprehension test, relocation test, generalized laxity
- Rule out: no history of dislocation or subluxation, no apprehension with testing
What movement systems contribute to insufficient scapular upward rotation
- insufficient lower serratus anterior force or activation
- insufficient lower trapezius force or activation
What movement system contributes to excessive scapular internal rotation
- insufficient lower or middle trapezius force or activation
What is the importance of scapular muscles
- weakness may result in abnormal positioning of the scapula, impaired rhythm, & generalized shoulder disfunction
- the serratus anterior & lower trapezius are most commonly involved
- impacts on the force couple relationship may cause a decrease in the subacromial space
Parameters for different shoulder deficits
- Strength/power deficit: low reps, high load
- Coordination/control deficit: motor control retraining
- Endurance deficit: high reps, low load
- Soft tissue flexibility deficit: stretching. mobilization
Exercise techniques for acute/early subacute
- Early motion of the GH joint: wand/cane exercises, ball rolling or table top dusting, wall/window washing, & pendulum (Codman’s exercise)
- Early motion of the scapula: PROM and AAROM of the scapula
- Early neuromuscular control: protected weight bearing, multiple angle muscle setting
Exercise techniques for flexibility & ROM
- self stretching directional techniques used to improve ROM
- flexion & horizontal adduction (Cross chest stretch)
- flexion & elevation of the arm in sitting with use of pulley system
- external & internal rotation stretches
- abduction & elevation of the arm in sitting using different body positions, a table top or theraball
Shoulder exercises for performance initiation, motor control, and stability
- isometrics with scapular focus: scapular squeezes/pinches, “robbery” pinches
- multiple angle isometrics with GH focus: ER, IR, ABD, ADD, scapular elevation, extension, elbow flexion with supination
- progress to self applied multiple angle isometrics
- stabilization exercises: scapular stability is trained in closed chain, GH stability is trained in open chain
What exercises will activate each part of trapezius the most/least
- standing exercises will increase upper trap activation the most (60-120 degrees elevation)
- prone exercises will produce the least upper trap activation but increase middle & lower trap activation
What does scapular retraction strengthen
- rhomboids
- middle trapezius
What does scapular retraction with shoulder horizontal abduction/extension strengthen
- rhomboids
- middle trapezius
- poster deltoid
What does scapular retraction & shoulder horizontal abduction combined with external rotation strengthen
- rhomboids
- middle trapezius
- poster deltoid
- teres minor
- infraspinatus
What does scapular depression strengthen
- lower trapezius
- lower serratus anterior
What does scapular upward rotation with depression strengthen
- lower trapezius
- serratus anterior
Prone horizontal abduction variations to focus lower trapezius
- 75-120 abduction ROM ideal to recruit lower traps
- Hand neutral: lowest activation
- Hand ER “thumbs up”: good activation from 90-120 degrees abduction
- Hand IR “thumbs down”: best activation at 120 degrees abduction
- spinal rotation can further help reduce upper trap involvement to improve lower trap focus
Surface consideration based on your goal
- Goal to strengthen: stable surface, unilateral focus
- Goal of symmetry or motor performance/control: unstable surface, bilateral focus
What exercises are trapezius focus
- prone horizontal abduction
- I’s, T’s, and Y’s
- cheerleader exercise: I’s, T’s, & Y’s standing with TheraBand (lower traps & rhomboids focus)
What exercises are serratus anterior focus
- wall slide with foam roll
- serratus anterior wall walks with theraband
- dynamic hug
- scapular punch variation: scapular push-ups
- dumbbell pull overs
- bear crawls
What does shoulder external rotation strengthen
- infraspinatus
- teres minor
What does shoulder internal rotation strengthen
- subscapularis
What does shoulder abduction & elevation of the arm in scapular plane strengthen
- deltoid
- supraspinatus
What does shoulder flexion strengthen
- anterior deltoid
- rotator cuff
- serratus anterior
What does shoulder adduction strengthen
- pec major
- teres major
- latissimus dorsi
What does shoulder horizontal adduction strengthen
- anterior deltoid
- coracobrachialis
- pec major
What does shoulder extension strengthen
- posterior deltoid
- latissimus dorsi
- rhomboids
What does elbow flexion strengthen
- biceps brachii
Examples of upper extremity plyometric activities
- catch/throw a weighted ball
- stretch shortening drills with elastic tubing in anatomical & diagonal planes
- swinging a weighted object
- dribbling a ball on the floor or against the wall
- push “offs” from the floor, wall, or countertop
- drop push-ups
- clap push-ups
