LECTURE 8A: SHOULDER TREATMENT Flashcards
Principles for conservative shoulder complex rehab
- Rx determined by stage of healing and level of irritability (pain at rest? high irritability)
- Use scapular planes to improve function
- Obtain stable scapular platform ASAP
- short levers easier than long levers
- Promote activities in patient’s available ROM (push as tolerated - if they have it, use it! do not increase pain)
- Mimic patient’s functional demands with forces and load rates
- Rx proximal to distal: 1st T spine, 2nd scapula, 3rd humeral head
acute phase goals
- protect: if torn, be careful
- restore pain free ROM (t spine ex.)
- retard mm atrophy (use as much as you can but not if it hurts)
- limit effects of immobilization (all mm around will get tight, capsule tight, nerves more irritable, swelling, decreased BF)
- maintain general fitness (walking, lunging)
- independent with HEP
acute phase: why perform table exercises/supine?
increased proprioception, scapular input when in supine
progress to seated, then standing
acute phase: strengthening should be loaded or not?
AROM against gravity may be sufficient resistance
T or F: modalities for acute phase is great
F: lacks support from research, but can be used if you like it
4 criteria for progression to sub acute phase
- evidence of tissue healing
- pain free ROM over 120 elevation
- strength in non-patho areas 4+/5
- scapular-control present (compare affected to non affected)
subacute phase goals
pain free ROM, normal joint kinematics
improve strength to normal limits
improve NM control
restore force couples
T or F: subacute phase sets and reps are pre-determined by endurance/strength/NM control guidelines
F: based on # the patient can perform correctly!
What phase do you initiate CKC?
sub-acute phase
*need good scapular control
*need structures to heal first, calm pain/inflammation before compression
PT joint mobilizations: how to progress inferior glide?
more abduction in scapular plane
*stay perpendicular to joint! Turn with them
PT joint mobilizations: maybe they can’t do a combined motion (F, ABD, ER)
posterior glide in FABER prone
progressive posterior glide: increases….
- flexion
- internal rotation
- horizontal adduction (don’t care unless thrower, like javelin lol)
progressive posterior glide in horizontal adduction improves
Flexion, IR AND ER
GH Joint – Inferior Capsule/ER is specific to____
adhesive capsulitis
Should you train your baseball player to push?
NO train IRs, lots of ER motion needed, stabilize ERs
eccentric plyometric training:
which muscles?
shoulder ERs
biceps at elbow
concentric plyometric training:
phasic mover muscles such as
pecs, lats teres major (IRs)
triceps
angular velocity in pitching arm exceeds
7000 degrees/second
shoulder ERs are usually injured during
____ phase
late cocking
deceleration phase
(need eccentric training)
