Corrective Ex for the Shoulder
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Agenda
• Anatomy
• Positioning/Dysfunction
• Assessments
• Mobility
• Stability
• Strength
Corrective Ex for the Shoulder
Skeletal Anatomy
Corrective Ex for the Shoulder
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Skeletal Anatomy
Corrective Ex for the Shoulder
Muscular Anatomy
Corrective Ex for the Shoulder
Pectorals
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Levator scapula
Corrective Ex for the Shoulder
Latissimus dorsi
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Posterior oblique subsystem
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Rotator cuff
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Rotator cuff
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Neural Anatomy
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Brachial Plexus
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Corrective Ex for the Shoulder
Kinetic Chain
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Shoulder Impingement
Nordt, W.W., Garrelston, R.B., & Plotkin, R. (1999). The measurement of subacromial contact pressure in
patients with impingement syndrome. Journal of Arthroscopic Surgery, 15, 121-125
Braman, J., et al. (2013). Shoulder impingement revisited: Evolution of diagnostic understanding in
orthopedic and physical therapy. Med Biology Eng Comput. [Epub]
Corrective Ex for the Shoulder
Scapula Position
Associated with impingement
syndrome: • Internal rotation
• Anterior tilt
• Downward rotation
Struyf, F., Nijs, J., Baevens, J.P., Mottram, S., & Meeusen, R. (2011). Scapular positioning and movement in
unimpaired shoulders, shoulder impingement syndrome, and glenohumeral instability. Scandinavian Journal
of Medicine & Science in Sports, 21, 352-358
Corrective Ex for the Shoulder
Scapulohumeral Rhythm
Norkin, C.C., & Levangie, P.K. (1992). The shoulder complex. In: Joint structure and function: A
comprehensive analysis (2nd ed.). 240-261. Philadelphia, PA: FA Davis
Inman, V.T., Saunders, S.J., & Abbott, L.C. (1996). Observations on the function of the shoulder joint.
Clinical orthopedics, 330, 3-12
Neumann, D.A. (2002). Shoulder complex. In: Kinesiology of the musculoskeletal system: Foundations for
physical rehabilitation. 189-248. St. Louis, MO: Mosby
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Posture
Forward head posture
• 1”=10lbs
• Loads exceed tissue
tolerance
• Decreased lung
capacity
• Increased stress
Kapandji, I.A. (2007). The physiology of the joints (6th ed.). Philadelphia, PA: Elsevier Health Sciences
Corrective Ex for the Shoulder
What “allows” forward head?
Nuchal Ligament
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What “allows” forward head?
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Shoulder Assessments
Corrective Ex for the Shoulder
Assessing the Shoulder
Riddle, D.L., Rothstein, J.M., & Lamb, R.L. (1987). Goniometric reliability in a clinical setting: Shoulder
assessments. Physical Therapy, 67, 668-673
Corrective Ex for the Shoulder
Subacromial Impingement
Silva, L., Andreu, J.L., & Munoz, P. (2008). Accuracy of physical examination in subacromial impingement
syndrome. Rheumatology, 47, 679-683
Corrective Ex for the Shoulder
Corrective Ex for the Shoulder
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Supine Flexion
Riddle, D.L., Rothstein, J.M., & Lamb, R.L. (1987). Goniometric reliability in a clinical setting: Shoulder assessments. Physical Therapy, 67, 668-673
Corrective Ex for the Shoulder
GH Internal Rotation
Borstad, J.D., Mathiowetz, K.M., & Minday, L.W. (2007). Clinical measurement of posterior shoulder
flexibility. Manual Therapy, 12, 386-389
Corrective Ex for the Shoulder
Thoracic Rotation
Johnson, K.D., Kim, K.M., Yu, B.K., Saliba, S.A., & Grindstaff, T.L. (2012). Reliability of thoracic spine range
of motion measurement in healthy adults. Journal of Athletic Training, 46(1), 52-60
Neumann, D.A. (2002). Shoulder complex. In: Kinesiology of the musculoskeletal system: Foundations for
physical rehabilitation. 189-248. St. Louis, MO: Mosby
Corrective Ex for the Shoulder
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Thoracic Rotation
Johnson, K.D., Kim, K.M., Yu, B.K., Saliba, S.A., & Grindstaff, T.L. (2012). Reliability of thoracic spine range
of motion measurement in healthy adults. Journal of Athletic Training, 46(1), 52-60
Neumann, D.A. (2002). Shoulder complex. In: Kinesiology of the musculoskeletal system: Foundations for
physical rehabilitation. 189-248. St. Louis, MO: Mosby
Corrective Ex for the Shoulder
Breathing
Gulick, D. (2009). Ortho notes clinical examination pocket guide (2nd ed.). Philadelphia, PA: FA Davis
Corrective Ex for the Shoulder
Practical Application—SMR
1. Thoracic Spine
2. Pectorals
3. Latissimus dorsi
4. Posterior deltoid
5. Levator scapulae
6. Biceps
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Thoracic Spine
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Pecs
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Latissimus Dorsi
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Posterior Deltoid
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Levator Scapula
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Biceps
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Practical Application—Lengthening
1. Pectoral stretch
2. Latissimus dorsi stretch
3. Thoracic extension
4. Thoracic rotation
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Pec Stretch
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Lat Stretch
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Thoracic Extension
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Thoracic Rotation
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Stabilize or Strengthen?
“Compression structures fall due to a lack
of stability, not strength” James Edward Gordon, Structures or Why Things
Don’t Fall Down
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Stabilize or Strengthen?
Tissue mobility or lengthening is only as good
as the exercise that comes after it
Progressions
1. Scapular stabilizers
2. Internal rotators
3. External rotators
4. Complex movement
Progressions
1. Non-weight bearing
2. Weight bearing
3. Upright
4. Endurance and
proprioception
Senbursa, G., et al. (2007). Comparison of conservative treatment with and without manual physical therapy
for patients with shoulder impingement syndrome: A prospective, randomized clinical trial. Knee Surgery
Sports Traumatology Athroscopy, 15, 915-921
Lombardi, I. et al. (2008). Progressive resistance training in patients with shoulder impingement syndrome: A
randomized controlled trial. Arthritis & Rheumatism, 59(5), 615-622
Cools, A.M., et al. (2008). Internal impingement in the tennis player: Rehabilitation guidelines. British Journal
of Sports Medicine, 42, 165-171
Corrective Ex for the Shoulder
RC Exercise Review
1. Exercise has statistically and clinically significant
effects on pain reduction and improving function
2. Manual therapy augments the effects of exercise
3. Scapular plane before sagittal, sagittal before
frontal
Kuhn, J.E. (2009). Exercise in the treatment of rotator cuff impingement: A systematic review and
synthesized evidence-based rehabilitation protocol. Journal of Shoulder and Elbow Surgery, 18(4), e33-e36
Corrective Ex for the Shoulder
Progression Matrix
Progressions
1. Scapular stabilizers
2. Internal rotators
3. External rotators
4. Complex movement
Progressions
1. Non-weight bearing
2. Weight bearing
3. Upright
4. Endurance and
proprioception
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Scapula—non-weight bearing
Cools, A.M., et al. (2007). Rehabilitation of scapular muscle balance: Which exercises to prescribe? The
American Journal of Sports Medicine, 35(10), 1744-1751.
Corrective Ex for the Shoulder
Scapula—weight bearing
Lister, J.L., et al. (2007). Scapular stabilizer activity during bodyblade, cuff weights, and thera-band use.
Journal of Sports Rehabilitation, 16, 50-67.
Corrective Ex for the Shoulder
Scapula—weight bearing
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Corrective Ex for the Shoulder
Internal rotators—weight bearing
Corrective Ex for the Shoulder
Sakita, K., Seeley, M.K., Myrer, J.W., & Hopkins, J.T. (2015). Shoulder-muscle electromyography during
shoulder external rotation exercises with and without slight abduction. Journal of Sport Rehabilitation, 24,
109-115
Internal rotators—non-weight bearing
External rotators—non-weight bearing
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External rotators—weight bearing
Corrective Ex for the Shoulder
Complex Stability
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Complex Movement
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Total Body Integration
Corrective Ex for the Shoulder
Reactive
Corrective Ex for the Shoulder
Example Template
Exercise Time/Reps Sets
SMR T-spine, pecs, lats, levator, post. delt
30-60 seconds 1
Stretch Pecs, lats, extension, rotation
30-45 seconds 1
Stabilization/Ac
tivation
Retraction, depress,
eccentric scaption,
plank, IR, ER,
12 repetitions 2-3
Complex Bear crawl, Crab walk, Modified down dog
12 repetitions 2-3
Total Body Squat w/shoulder RNT
12 repetitions 2-3
Reactive Side plank ball throw 8 each side 2-3
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