-----------------Tip of the DAY! --------------

Rotator Cuff Breakdown

By Chris Gelllert, PT, MMusc & Sportsphysio, MPT, CSCS, C-IASTM

Background:

Rotator cuff tears come in all shapes and sizes. A small tear (<1cm) typically can heal typically without surgery and would benefit from physical therapy, addressing soft tissue restrictions, restoring functional mobility then stability. A medium tear (2-5cm) may or may not require surgery. Finally, a large or massive tear (5cm or >), will not respond to physical therapy and conservative treatment, requiring surgery followed with physical therapy.

Therefore, understanding the location and type of rotator cuff tear will provide clarification regarding the client’s shoulder.

Most tears affect the supraspinatus muscle. Why? Beccause the supraspinatus is biomechanically weaker and has poor blood supply as compared the surrounding muscles.

Stage 1- Patients are usually 25 years old and have pain with activity that usually resolves with rest. The condition is reversible, and treatment is conservative.

Stage 2-Fibrosis and tendonitis. Patients are typically between 25-40 year old and experience recurrent pain with activity that does not always abate with rest. According to Neer MD, subacromila decompression should be considered if all other conservative treatment fails.

Stage 3-bone spur and tendon rupture. Patients are older than 40 year and have a history of progressive disability. Rotator cuff repair is advised.

Stage 4-Cuff tear arthopathy(disease of the joint). Patients are typically older than 60 years and have a history of progressive disability with a torn rotator cuff. Clinical management consists of a RTC repair, hemi-arthoplasty or total shoulder replacement.

Effective exercises: Based on evidenced based research and biomechanics, it is important to design a program that tailors to the need of post-rehabilitative client. Understanding the anatomy, biomechanics, forces, functional anatomy and exercise selection is paramount!

Teaching the client the following exercises is beneficial:

·     Mid row exercise targets the weaker phasic rhomboid muscles, helping unload the anterior shoulders and improving posture

·     Low trapezius pulldowns targets the weaker phasic low trapezius.

·     External rotation with cable exercise targets the weaker infraspinatus and teres minor muscles(see picture)

·     Pullaparts with tubing targets the posterior deltoid.

Exercises that are contraindicated include with rationale:

•      Seated dumbbell shoulder press (creates excessive load to the medial deltoid).

•      Lat pull downs behind the head (at end or range places greatest stress on all glenohumeral ligaments as well as on the labrum).

•      Upright row (at end of range-shoulder is maximally internally rotated which places stress on all glenohumeral ligaments, labrum and connective tissue).

 

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www.pinnacle-tcs.com

 

Feature: Training the Spondylosis and Spinal Stenosis Clients

What is spondylosis?

A degenerating of the spine between the bones or thinning of the disc due to aging, type of work, lifestyle, poor posture, and biomechanical factors.

Spinal stenosis is a narrowing of the spinal canal--either central or lateral. This can be due to aging, present bone spurs that decrease vertebral space, or impinges on a nerve root. Conservative physical therapy can really help clients with spondylosis, spinal stenosis improve mobility before regaining proximal to distal stability.

Which exercises are safe for spondylosis? Because this is a degenerative condition, improving mobility should be the focus. Stretching, integrating yoga, pilates are a few great modalities.

Strengthen the core unidirectonal and multdirectional, but avoid teaching,having client perform vertical loading exercises. Such as barbell squats or back hyperextension, as this narros the spine, creating more spinal compression.

Which exercises are safe for spinal stenosis?

Training should focus on stretching the tight hip flexors, hamstrings and erector spinae. Stabilization exercises should include bridging with physioball, standing trunk rotation with cable, prone alternate arm and leg lift over physioball, just to name a few...

Strengthen the core unidirectonal and multdirectional, but avoid teaching, having client perform vertical loading exercises. Such as barbell squats or back hyperextension, as this narrows the spine, creating more spinal compression and potential further injury.

The plank on physioball with lateral resistance challenges the core and then some!! Happy wednesday

#pinnacle #pinnacletrainingconsultingsystems #spinal stenosis

#spondylosis #postrehabtraining #CPRS

www.pinnacle-tcs.com

 

Testimonial Monday!

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#pinnacle #pinnacletrainingconsultingsystems #tva #rehab
www.pinnacle-tcs.com #exercisephysiology

 

Look within the core: Part 2

The core is a synergistic blend of 29 muscles that stabilize both at the spine and the lumbopelvic junction(LPHC).

Two muscles that need special attention are the transverse abdominis and the multifidus.

In the picture below, dead bug on full roll targets both the transvers abdominis as well as the multifidus. How do you perform the exercise? First, lie on the full roll, then perform an anterior pelvic tilt. From here, keep the transverse abdominis(TVA) engaged and then lift one leg up slowly, lower down and then lift the opposite arm. Now lift the leg and opposite arm. This exercise targets the TVA and the multifidus and is a great stabilizing exercise!

#pinnacle #pinnacletrainingconsultingsystems #tva #rehab

www.pinnacle-tcs.com #exercisephysiology

 

Looking within the core: Local and global muscles

What is the difference between local and global muscles?

Local muscle system(stabilization)

The local core stabilizers are muscles that attach directly to the vertebra. These muscles consist of primary type I (slow twitch) muscle fibers with a high density of muscle spindles. Core stabilizing muscles are primarily responsible for intervertebral and intersegmental stability. These muscles also aid in proprioception and trunk control because of their high density of muscle spindles. Examples of the local stabilization system include diaphragm, transverse abdominis, multiifidus, internal obliques.

Global muscle system

These muscles attach from the pelvis to the spine. These muscles act to transfer loads from upper extremity to the lower extremity, provide stability between pelvis/spine and eccentric control of the core. Examples of these muscles include quadratus lumborum, iliopsoas, glute medius, glute minimus.

In the next post we will review sample exercises to target the multifidus, and the Transverse abdominis.

#pinnacle #pinnacletrainingconsultingsystems #tva #rehab

www.pinnacle-tcs.com #exercisephysiology

 

What is a trigger point?

A trigger point is a nasty nuisance that can effect and does irritate the musculoskeletal system. Any trauma to the tissue of the body, creates inflammation. Inflammation in turn activates the body's pain receptors(nocioceptors) and initiates a protective mechanism. Whereby increasing muscle tension, or causing spasm. Heightened activity of muscle spindles, in a particular area creates in essence a microspasm, resulting in adhesions(knots) to form within the soft tissue.

These adhesions decrease the normal elasticity of the soft tissue, resulting in altered length-tension relationships, altering force production, altering force-couple and leads to altered joint motion.

Trigger points can create localized pain or refer pain in an area.

How do you get rid of them? Ice initially for the first 3 days. Then implement heat, massage, stretch and mobilize with various soft tissue equipment(see picture below) If they don't go away, go see your local physical therapy for treatment!!

#triggerpoint. #pinnacle #pinnacletrainingconsultingsystems #pain. #postrehab

www.pinnacle-tcs.com

 

What is neuromuscular efficiency?

The ability of the nervous system to recruit the correct muscles(agonist, antagonists, synergists and stabilizers) to produce force (concentrically), reduce force (eccentrically) and to dynamically stabilize(isometrically) the body's structure in all three planes of motion.

For example, when performing a lat pulldown exercise, the latissimus dorsi(agonist), must be able to concentrically accelerate shoulder extension, adduction, and internal rotation while the middle and lower trapezius/rhomboids(synergists) perform downward rotation of the scapula. At the same time, the rotator cuff muscles stabilize the glenohumeral joint t/o the motion. If these muscles do not work in tandem, compensations may develop, leading to muscle imbalances, altered joint motion and possibly injury.

Therefore it is important to stretch the tight muscles(upper trapezius) and others, and strengthen the weaker phasic (low trapezius and rhomboids).

#pinnacle #pinnacletrainingconsultingsystems #post rehab

#CPRS #latpulldowns. #neuromuscular efficiency

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Training the shoulder impingement client

Shoulder impingement is a shoulder condition that affects clinically men more than women per the research and my 20 yrs experience.

A condition in which there is not enough space for 1)either the humeral head to glide within the glenoid cavity, 2)tightness of the posterior capsule causes the humeral head to migrate superior into the AC joint, or there is 3)weakness of the scapulothoracic junction.

The three best exercises to train the SI client include:

1)Scapular retraction with tubing or band(mid row)

2)low trap pulldown(palms facing up pull tubing or band down at a 45 degree angle)

3)standing external rotation with tubing or cable targets the weaker infraspinatus/teres minor muscles.

Happy monday and if you have questions, please submit below or email PTCS at: ptcg1999@verizon.net

#pinnacle #pinnacletrainingconsultingsystems #postrehab#CPRS

#shoulder impingement #shoulder pain

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 What is shoulder impingement? SI is the inability during shoulder flexion and abduction for the humerus to properly glide down within the glenoid cavity. This is caused by the following:
1)Tightness of the posterior capsule
2)Deceased space of the AC joint affecting the supraspinatus tendon
3)Weakness of the scapulothoracic muscles

What are the best exercises to work with a SI client?
1)Teach posterior capsule, pectoral and upper trap stretching
2)Strengthen the weak rhomboids through mid row exercise
3)Strengthen the weak low trapezius and serratus anterior that will help create a force couple within the ST joint
4)Strengthen the core: trunk rotation with medicine ball, or cable or bridging with physioball to name a few

If you liked this post, please let us know!

#pinnacle #pinnacletrainingconsultingsystems #shoulderimpingement #CPRS #postrehab
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