KatyFitness.com Seminar Series Pain Management : Shoulder Impairment

Objectives Describe the shoulder impairment as it relates to the human movement system Detail the functional anatomy comprising and effecting the shoulder Detail the assessment finding relative to shoulder impairment Develop a corrective exercise strategy for shoulder impairment ©2006 Life Time Fitness

Describe the shoulder impairment as it relates to the human movement system

Detail the functional anatomy comprising and effecting the shoulder

Detail the assessment finding relative to shoulder impairment

Develop a corrective exercise strategy for shoulder impairment

Introduction ©2006 Life Time Fitness The human body is susceptible to movement dysfunctions and neruomusculoskeletal imbalances. The shoulder complex is a region of the body that is greatly influenced by other areas of the body above and below it. As one of the most unstable or mobile joints in the human body, it is reliant upon precise muscle activity for support. This means that any muscle imbalance throughout the human body can dramatically alter the support mechanism of the shoulder and lead to dysfunction and eventually injury.

The human body is susceptible to movement dysfunctions and neruomusculoskeletal imbalances.

The shoulder complex is a region of the body that is greatly influenced by other areas of the body above and below it.

As one of the most unstable or mobile joints in the human body, it is reliant upon precise muscle activity for support.

This means that any muscle imbalance throughout the human body can dramatically alter the support mechanism of the shoulder and lead to dysfunction and eventually injury.

©2006 Life Time Fitness Common Injuries Associated with Shoulder Impairment Local Injuries Injuries Above Shoulder Injuries Below Shoulder Biceps Tendonitis Supraspinatus Tendonitis Impingement Syndrome Anterior and Posterior Shoulder Pain Cervical Injuries and Headaches LPHC Low Back Pain Sacroilliac Joint Dysfunction Hamstring, Quadriceps, and Groin Strain Knee Patellar Tendonitis (jumper’s knee) IT Band Tendonitis (runner’s knee) Medial, Lateral, and Anterior Knee pain Chondromalacia patellae Foot Plantar Fasciitis Achilles Tendonitis Posterior Tibialis Tendonitis (shin splints)

©2006 Life Time Fitness Common Injuries Associated with LPHC Impairment Local Injuries Injuries Above LPHC Injuries Below LPHC Low Back Pain Sacroilliac Joint Dysfunction Hamstrings, Quadriceps, and Groin Strain Cervical Injuries and Headaches Knee Patellar Tendonitis (jumper’s knee) IT Band Tendonitis (runner’s knee) Medial, Lateral, and Anterior Knee pain Chondromalacia patellae Foot Plantar Fasciitis Achilles Tendonitis Posterior Tibialis Tendonitis (shin splints)

©2006 Life Time Fitness Common Injuries Associated with Knee Impairment Local Injuries Proximal Injuries Distal Injuries Patellar Tendonitis (jumper’s knee) IT Band Tendonitis (runner’s knee) Medial, Lateral, and Anterior Knee pain Chondromalacia patellae Low Back Pain Shoulder and Upper Extremity Injuries Hamstrings, Quadriceps, and Groin Strain Plantar Fasciitis Achilles Tendonitis Posterior Tibialis Tendonitis (shin splints)

©2006 Life Time Fitness Common Injuries Associated with Foot & Ankle Impairment Local Injuries Proximal Injuries Plantar Fasciitis Achilles Tendonitis Posterior Tibialis Tendonitis (shin splints) Patellar Tendonitis (jumper’s knee) IT Band Tendonitis (runner’s knee) Low Back Pain Hamstring, Quad, and Groin Strain

©2006 Life Time Fitness Functional Anatomy Probable Over- and Underactive Muscles for Shoulder Impairment Region Compensation Overactive Underactive Upper Body Arms Fall Forward Latissimus Dorsi Pectoralis Major/Minor Coracobrachialis Teres Major Mid/Lower Trapezius Rhomboids Posterior Deltoid Rotator Cuff

©2006 Life Time Fitness Functional Anatomy Latissimus Dorsi Pectoralis Major Pectoralis Minor

©2006 Life Time Fitness Functional Anatomy Coracobrachialis Teres Major

©2006 Life Time Fitness Functional Anatomy Middle & Lower Trapezius Rhomboids Posterior Deltoid

©2006 Life Time Fitness Functional Anatomy Subscapularis Teres Minor Infraspinatus Supraspinatus

©2006 Life Time Fitness Corrective Exercise Strategy There are essentially four steps in the Corrective Exercise Continuum: Inhibit the overactive muscles – reduces unwanted tension to prepare for lengthening. Lengthen the overactive/short muscles – increases extensibility and length-tension relationships. Activate the underactive muscles – re-educates the underactive tissues increasing intramuscular connection. Integrate the muscles back into their functional synergies – establishes intermuscular coordination and increases neuromuscular efficiency

There are essentially four steps in the Corrective Exercise Continuum:

Inhibit the overactive muscles – reduces unwanted tension to prepare for lengthening.

Lengthen the overactive/short muscles – increases extensibility and length-tension relationships.

Activate the underactive muscles – re-educates the underactive tissues increasing intramuscular connection.

Integrate the muscles back into their functional synergies – establishes intermuscular coordination and increases neuromuscular efficiency

©2006 Life Time Fitness

©2006 Life Time Fitness Corrective Exercise Strategy Sample Corrective Exercise Program for Shoulder Impairment Phase Modality Muscle(s) Acute Variables Inhibit SMR Latissimus Dorsi Thoracic Spine Hold on Tender Area for 30 seconds Lengthen Static Stretching or NMS Posterior Cuff Latissimus Dorsi Pectoralis Major 30-sec hold OR 7-10-sec isometric contract, 30-sec hold Activate Positional Isometrics and/or Isolated Strengthening Rotator Cuff Middle and Lower Trapezius 4 reps of increasing intensity 25, 50, 75, 100% OR 10-15 reps with 2-sec isometric hold and 4-sec eccentric Integrate Integrated Dynamic Movement Squat to Row 10-15 reps under control

Final Thoughts / Questions ©2006 Life Time Fitness

Contact Us ©2006 Life Time Fitness Jason Hodge [email_address] 281-536-6415 Doniece Russell [email_address] Marcia Noyes [email_address] Patrick Richardson [email_address] www.KatyFitness.com