Preventing Shoulder Pain Flashcards
How many planes of motion does the scapula move in?
3
What are the 3 planes of movement the scapula moves in?
- Elevation & Depression
- Protraction & Retraction
- Upward Rotation & Downward Rotation
What is the starting position for Scapular Mobilization: Elevation?
Position the patient with feet flat on the floor and pelvis in a neutral position, out of a posterior pelvic tilt.
Handling - Scapular Mobilization: Elevation
- Cup your hand and place it over the head of the humerus.
- Place the other hand along the medial and inferior border of the scapula. Use the heel of your hand.
- Bring your elbows down to your side.
- Apply pressure through the heels of your hands and bring the entire shoulder girdle into elevation.
- Elevate the scapula to end range, hold for a few seconds and allow it to return to a resting position.
What is the most common mistake therapists make in scapular elevation?
They don’t move the scapula into end range.
What is the starting position for Scapular Mobilization: Protraction?
Position the patient with feet flat on the floor and pelvis in a neutral position, out of a posterior pelvic tilt. Evaluate scapular excursion in elevation before proceeding.
Handling - Scapular Mobilization: Protraction
- Stand in front of your patient.
- Gently take the involved arm and bring it into forward flexion of no more than 90 degrees.
- Support the arm at the elbow and tuck it along your side.
- With your other hand, reach along the scapula and find the medial border. With a flat open hand press along the medial border and glide the scapula forward into protraction.
- Maintain this position for a second or two and then return to the starting position.
- As the scapula returns to its resting position, allow it to follow the natural curvature of the rib cage.
- With repetition, the scapula will begin to glide forward. Once you’ve achieved protraction, you may begin upward rotation.
What is the starting position for Scapular Mobilization: Upward Rotation?
Position the patient with feet flat on the floor and pelvis in a neutral position, out of a posterior pelvic tilt. Evaluate scapular excursion in elevation before proceeding.
Handling - Scapular Mobilization: Upward Rotation
- While the scapula is forward in protraction, slide one hand from the patient’s scapula to the elbow and hook onto the epicondyles.
- Slide the other hand from the elbow to the hand.
- Put your middle finger along the base of the MCP joints, your index finger along the thenar eminence, and the other fingers along the patient’s fingers.
- Keeping the arm in forward protraction, give a slight amount of external rotation and gently bring the arm in forward flexion.
- Remember go only to the point of resistance or any discomfort.
- Carefully watch the patient’s facial expression for any signs of discomfort.
Scapular Mobilization: Upward Rotation - Factors to Consider which may contribute to loss of range.
- Increased tone of muscles acting on the scapula.
- Soft-tissue tightness.
- Loss of scapulohumeral rhythm (2:1).
- Loss of range between humerus and scapula (the scapula glides fine but the soft-tissue tightness is between the humerus and scapula).
Scapula Mobilization in Supine Progression
- Begin with scapular elevation and depression.
- Follow with scapular protraction, below 90 degrees of flexion.
- If the scapula is gliding and the shoulder is pain free, mobilize the scapula in upward rotation.
Scapula Mobilization in Supine Tips
- Cradle the arm to support the weight.
- Externally rotate the upper arm before exceeding 90 degrees of shoulder flexion.
- Supine position is often easier for patients, and will not restrict movement.
- Have patient clasp hands together.
Therapeutic Method for Treating Soft Tissue Tightness - Starting Position
Begin with the patient supine, on the mat table or in bed.
Handling - Therapeutic Method for Treating Soft Tissue Tightness
- Gently bring the hips and knees into flexion and leave the arm down to the side.
- Gently guide both knees from one side to the next, giving a slow and gentle stretch.
- Carefully bring the arm into some shoulder abduction.
- With the arm resting supported on the mat in abduction, slowly and gently bring the knees over to the side again.
- If you want to maximize the stretch through the pectoralis, bring both arms into horizontal abduction.
Therapeutic Method for Treating Soft Tissue Tightness Tips
Supine is nice for self ROM, especially with someone with heavy arms or poor trunk control. You may want to have patients do their exercises (in supine) after the preparation.
Facilitating Muscles Acting on the Scapula - Starting Position
Begin with the patient positioned in sidelying on the involved side, on the mat table or in their bed. The involved arm should be fully supported.
Handling - Facilitating Muscles Acting on the Scapula
- Have your patient reach slowly forward with their non-involved hand.
- Now, have your patient reach slowly back, rotating their upper trunk toward a more supine position.
- Continue for several repetitions.
