Dr. Moshenberg discusses how to prevent a shoulder or spine injury

2. Shoulder and Thoracic Spine
Injury and Prevention
Dr. Jonathan Moshenberg, DPT, CAMT

3. About Me
Education
¤ B.S., Rehabilitation Science
University of Pittsburgh, Pittsburgh, PA
¤ Doctor of Physical Therapy
University of Pittsburgh, Pittsburgh, PA
¤ CAMT
Certificate in Advanced Manipulative Therapy
¤ SFMA Certification
Certified in Selective Functional Movement Assessment
¤ COMT
Certified Orthopedic Manual Therapist (in progress)

4. Performance Rehabilitation &
Regenerative Medicine
Our mission is to provide a premier, comprehensive and
multidisciplinary office dedicated to treating simple and
complex orthopedic injuries, acute, chronic or disabling pain.
¤ We are deeply committed to improving the health of our
patients and their quality of life through non-invasive, non-
surgical procedures, without over-use of medications.
¤ We have invested in the most innovative and cutting-edge
technologies and combined them with the best specialists
available. This approach assures excellence and access to
the most effective and complete treatment for each of our
patients.

5. Eight Specialties Under One Roof
¤ Regenerative Medicine
¤ Adult Stem Cell Therapy
¤ Platelet Rich Plasma (PRP) Therapy
¤ Prolotherapy
¤ Tenex™
¤ Sports Medicine
¤ Physical Medicine and Rehabilitation
¤ Interventional Pain Management
¤ Physical Therapy
¤ Chiropractic
¤ Acupuncture
¤ Massage Therapy

6. Today’s Outline
¤ Anatomy
¤ Common Injuries of the Shoulder
¤ Thoracic Spine Dysfunction
¤ Injury Prevention

7. Shoulder Anatomy

8. The Shoulder
¤ Ball and socket joint
¤ Humerus
¤ Scapula
¤ Clavicle
¤ Very mobile and yet stable joint

9. Shoulder Injuries and Pain
¤ Shoulder Impingement
¤ Rotator Cuff Pathology
¤ Adhesive Capsulitis- Frozen Shoulder
¤ Superior Labral Anterior Posterior Tears
¤ Fractures/Arthritis- Shoulder or Thoracic Spine
¤ Posture

10. Signs and Symptoms Shoulder Pain
¤ Pain, achiness, burning, weakness, instability
¤ Popping, clicking, catching through the range of motion
¤ Pain with reaching certain planes, overhead, sleeping,
throwing a ball

11. Thoracic Spine and Shoulder Complex

12. Anatomy of Thoracic Vertebrae

13. Thoracic Vertebra
¤ Spinous and Transverse processes
¤ Intervertebral Disc
¤ Articular Pillar for segment above and below
¤ Costovertebral Joint- where Ribs Attach

14. Common Injuries to Thoracic Spine
¤ Muscle Strain
¤ Degenerative Disc Disease
¤ Disc Herniation
¤ Joint Dysfunction-> can lead to shoulder impingement

15. Signs and Symptoms Thoracic Spine
¤ Local, referred, or radiating pain
¤ Difficulty/catch with breathing
¤ Pain into abdomen, low back, groin
¤ Numbness or Tingling into rib cage

16. Normal Joint Motion
¤ Shoulder: Roll and Glide are OPPOSITES
¤ Thoracic Spine: Flexion/Extension, side bend, Rotation: all
can produce a fixated or rotated segment
¤ Scapula: Upward Rotation
¤ Normal Function: NO PAIN
¤ Dysfunction: one or more joints will fixate in position of
restriction producing impingement- usually strong weakness
component

17. Impingement Check List
¤ Thumbs inward
¤ Locked Internal Rotation
¤ Tightness seen in Paraspinals, Pectorals, Biceps, Rotator Cuff.
Collectively lead to IMPINGEMENT

18. Posture- Preferred
¤ Thumbs Forward
¤ Open external rotation
¤ Rhomboids activate
¤ Traps unlocked
¤ Abdominal notch
¤ Broad Pectorals
“READY STATE”

19. Time to Think
¤ How can we absorb force or exert force in poor positions?
¤ What are the mechanisms causing impingement?
¤ What are your activities causing impingement?

20. How do we deal with Impingement?
¤ How do we fix this?
¤ We cannot actively change the accessory motion and /
or accessory muscle activation
¤ Correct the Mechanics:
¤ Activate primary muscle groups
¤ Need to open up the joint spaces
¤ Mobilize into restricted ranges

21. Clear the way- treat the following
Traffic jam
1. Tight thoracic spine
2. Decreased strength of shoulder external rotation
3. Overhead motion correction

22. Thoracic Spine Extension

23. Thoracic Extension 2

24. Lacrosse Ball

25. Lacrosse Ball – Part 2

26. Overhead Levator Scapulae

27. Overhead First Rib

28. Thoracic Extension With Weight

29. Prevention Exercises
¤ Strengthen rotator cuff muscles- external rotation exercises
¤ Strengthen the Paraspinals:
-Rhomboid, Latissimus Dorsi, Mid and Lower Trapezius
¤ Thoracic Extension
¤ Muscle Stretching: Upper Trapezius, Levator Scapula
Thoracic Paraspinals, Pectorals, rotator cuff, biceps
¤ Core Muscle Recruitment- Transverse Abdominis
Contraction

30. Final Thoughts
The problem is
not in the program.
The problem is in the activityà
leads to modification

31. Discussion:
What are the activities
causing you impingement?

32. Thank You