-----------------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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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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Do you need CEUs? Do you want to learn quality content on human movement?

Then you need to check out Pinnacle Training & Consulting Systems home study courses.

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*Functional anatomy

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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