Categories: shoulder dysfunction

Basic Shoulder Movement Videos

by Greg Lehman
Categories: exercise pictures, Patient Exercise Sheets, shoulder dysfunction, Videos
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Published on: March 17, 2020

Audience: Patients

Purpose: Exercise videos for those doing shoulder rehabilitation

Preamble

The same exercises or movements can be used with different intentions and to achieve a different goal.  Some possible intentions being:

1. Motion is Lotion - we are moving your shoulder in a manner just to calm down nerves, decrease pain and get that pissed off shoulder happy with moving again.  The amount of weight or resistance is not that important

2. Stress loading - for whatever reason we want to stress your shoulder and shoulder girdle musculature.  You might have some weakness (e.g. prolonged immobility, post surgical) or we wish to increase the capacity of your joint and muscles to withstand load.  Appropriate weight selection, speed of movement and technique is important

3. Motor control - certainly there is some overlap with the previous two intentions mentioned.  But with this intention we might look at trying to change how your muscles work together.  An example, is training both the internal and external rotator cuff during alternating movements.  We are trying to get the cuff to pull the humeral head away from the scapula or just get the muscles happy working together again.  Load or stress is important but so is learning the movement.

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Shoulder Pathology - a diagnostic algorithm and summary of dysfunction

by Greg Lehman
Categories: physiotherapy, shoulder dysfunction
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Comments: 1 Comment
Published on: March 28, 2020

Audience: more for me but anyone interested in the shoulder can read it.

Purpose: quick reference card for thinking about a functional shoulder diagnosis

The algorithm below is from Ann Cools work:

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Shoulder Impingement Rehabilitation Part Two - Training the Rotator Cuff

by Greg Lehman
Categories: exercise biomechanics, shoulder dysfunction
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Published on: March 28, 2020

Subscapularis Exercise

Audience: Primarily my Patients in Toronto but other Physiotherapists, ATs, Chiropractors and Strength and Conditioning Pros may like this

Purpose: Review the literature for safe and effective exercises for shoulder rehabilitation of the Rotator Cuff - primarily for the treatment of the finding of shoulder impingement

Sources: Initially, this was going to be a larger review.  However, I have just focused on the main points from the work of Mike Reinold who published a great review in JOSPT (2008), Mike can be read at  (www.mikereinold.com).  A recent review by Rafael Escamilla (Sports Medicine 2009) is also an excellent resource. (more…)

Shoulder Rehabilitation: Minimizing the Upper Trapezius to Serratus Anterior Ratio

by Greg Lehman
Categories: exercise pictures, shoulder dysfunction
Tags: , ,
Comments: 3 Comments
Published on: January 25, 2021

Audience: Therapists

Pushup plus protracted

Purpose: I like the idea of quantifying the “dosage” of an exercise.  We can do this with EMG and this post will be part of a larger theme that catalogues the EMG amplitude of various shoulder rehabilitation exercises.  Further, it will also try to justify a number of exercises for their ability to avoid negative loading on the shoulder and promote a possibly optimal way of working the shoulder.

Caveat:  This review only looks at a few papers addressing the Upper Traps (UT) to Serratus Anterior (SA) ratio.  Other exercises must obviously be incorporated into a rehab program.

Exercises to maximize the Serratus Anterior (SA) to Upper Trapezius (UT) Ratio

To simplify: SA = good, UT = bad.  Basically, activation of the SA moves the scapula out of the way of the humerus while too much or too early activation of the UT tends to

pushup plus retracted

anteriorly tilt the scapula and decrease the space for humeral movement.  Ann Cools has done extensive work in this area.  Here is a taste of her findings and recommendations.  You may want to consider using the exercises when you have a little scapular dyskinesis on your hands - you may see some medial border prominence of the scap, some winging during arm elevation and the scap can get a little jiggy with arm raising and lowering. (more…)

Shoulder Impingement Rehabilitation: Part One

by Greg Lehman
Categories: Patient Exercise Sheets, shoulder dysfunction
Tags: , ,
Comments: 1 Comment
Published on: January 18, 2021

Audience: Health Professionals and Patients

Source of Information: Paula Ludewig, Ben Kibler, Ann Cools, Rafael Escamilla, Mike Reinold, Kevin Wilks

Disclaimer: The information below really just scratches the surface.  References at the end of post are excellent.  The point of this post is to get people to think more about culprits of dysfunction when it comes to the shoulder rather than just labeling shoulders with victim diagnoses (e.g. bursitis, tears, “tendinitis” - I hate that word - a future post will address my disdain).

Shoulder Impingement is not a diagnosis.  It is a finding and can be both a cause and the result of dysfunction.  Impingement is pretty much what it sounds like - something is getting pinched.  Ever reach into your back seat or reach to put your coat on and feel a sharp pain somewhere around your shoulder (and often down to your elbow).  That is impingement.  Some structure under the shoulder blade is getting pinched and does not like it.  Who likes to get pinched? (more…)

Scapular Retraction/Protraction Exercise Sheet

by Greg Lehman
Categories: Patient Exercise Sheets, shoulder dysfunction
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Published on: January 6, 2021

Attached is a simple one page exercise sheet to train the lower/mid trapezius (scapular retraction) and the serratus anterior.  The assumption is that these exercises, along with other training and physiotherapy (ART etc), will position the shoulder blade in a better position.  Ideally, avoiding forward tilt and a position that may be related to impingement.

Below is the pdf file:

thebodymechanic shoulder retraction basic

Adios,

Greg Lehman

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