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Title by Presenter Name
Fixing the Forward Shoulder Dr. Evan Osar & Jenice Mattek, LMT, IMS
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NEUROFASCIAL INTEGRATION™
FOR FIXING THE FORWARD SHOULDER
Dr. Evan Osar Jenice Mattek, LMT, IMS
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Neurofascial Integration™
Optimal Posture
and Movement
Myofascial System
Neural System
Osseoligamentous System
Neurofascial Integration for the Shoulder ©2015 Fitness Education Seminars™ 3
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Fascia
• Fascia – Neuro-
proprioceptive structure
– Myofibrils – Suspensory
structures
Neurofascial Integration for the Low Back ©2015 Fitness Education Seminars™ 4
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©2015 Fitness Education Seminars™ 5
Why do so many of our clients have problems?
Developing Optimal Shoulder Function
Neurofascial Integration for the Shoulder
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Our ________!!!
©2015 Fitness Education Seminars™ 6 Neurofascial Integration for the Shoulder
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• The thing we do most of our lives…
©2015 Fitness Education Seminars™ 7
What’s the number one cause?
Neurofascial Integration for the Shoulder
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• Shoulder ring • Thoracic ring • Pelvic ring
©2015 Fitness Education Seminars™ 8
The Shoulder Complex
Neurofascial Integration for the Shoulder
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• Scapula and Thorax – Shoulder ring sitting
upon the thorax
©2015 Fitness Education Seminars™ 9
The Scapulo-thoracic Articulation
Neurofascial Integration for the Shoulder
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• Concave-convex relationship ©2015 Fitness Education Seminars™ 10
Scapulo-thoracic Articulation
Neurofascial Integration for the Shoulder
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©2015 Fitness Education Seminars™ 11
Neutral Alignment
Neurofascial Integration for the Shoulder
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©2015 Fitness Education Seminars™ 12
• Optimal scapular alignment upon thorax
Neutral Scapular Alignment
Neurofascial Integration for the Shoulder
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• Upward rotators – A. _________________ – B. __________________ – C. __________________
Posterior view right scapula
©2015 Fitness Education Seminars™ 13
Scapular Control
Neurofascial Integration for the Shoulder
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• Downward rotators – A. __________________ – B. __________________ – C. _________________
Posterior view right scapula
©2015 Fitness Education Seminars™ 14
Scapular Control
Neurofascial Integration for the Shoulder
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• Scapula should not come into excessive downward rotation or anterior tilt
©2015 Fitness Education Seminars™ 15
Key Point
Neurofascial Integration for the Shoulder
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• Downward rotation
• Anterior tilt • Depression
©2015 Fitness Education Seminars™ 16
The Forward Shoulder
Neurofascial Integration for the Shoulder
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• The levator scapula sign • Common during:
• Rows • Lat pull downs / pull
ups • Triceps push down /
biceps curls
©2015 Fitness Education Seminars™ 17
Exercises That Perpetuate Shoulder Dysfunction
Neurofascial Integration for the Shoulder
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• Cardio exercises
©2015 Fitness Education Seminars™ 18
Exercises That Perpetuate Shoulder Dysfunction
Neurofascial Integration for the Shoulder
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• “Retract your shoulder blades back (and I mean pull them back, and keep them back) … keep your shoulder blades together…”
©2015 Fitness Education Seminars™ 19
Cuing That Perpetuates Poor Stereotypes
Neurofascial Integration for the Shoulder
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©2015 Fitness Education Seminars™ 20
• How is your client controlling their movement?
Perpetuation of Shoulder Dysfunction
Neurofascial Integration for the Shoulder
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• Achieving neutral alignment and control
©2015 Fitness Education Seminars™ 21
Optimal Suspension
Neurofascial Integration for the Shoulder
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©2015 Fitness Education Seminars™ 22
Lack of Suspension
Neurofascial Integration for the Shoulder
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• Common sign: Abdominal distension ©2015 Fitness Education Seminars™ 23
Lack of Suspension
Neurofascial Integration for the Shoulder
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• Can be caused by myofascial gripping – Latissimus dorsi – Pectoralis minor – Rhomboids – Serratus anterior – Thoracolumbar erector
spinae
©2015 Fitness Education Seminars™ 24
Lack of Suspension
Neurofascial Integration for the Shoulder
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Optimal shoulder function is reliant upon an efficient control strategy
Optimal function is reliant upon a balance of the myofascial systems around the shoulder complex
Shoulder dysfunction is set up by non-optimal strategies – inhibition of the upward rotators and/or habits leads to ‘gripping syndromes’ limiting optimal stability and movement
25
Recap
©2015 Fitness Education Seminars™ Neurofascial Integration for the Shoulder
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26 ©2015 Fitness Education Seminars™ Neurofascial Integration for the Shoulder
The Principles of Posture and Movement
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27
Development Dictates Decision-making
©2015 Fitness Education Seminars™ Neurofascial Integration for the Shoulder
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28 ©2015 Fitness Education Seminars™ Neurofascial Integration for the Shoulder
Principle #1: Alignment
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• Regulates internal pressure
• Activates the deep myofascial system
• Supports optimal alignment and mobility
29 ©2015 Fitness Education Seminars™ Neurofascial Integration for the Shoulder
Principle #2: Breathing
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• WHAT IS THE ROLE OF PROPER BREATHING IN IMPROVING FUNCTION? – One of most effective ways of entering the central
nervous system – Direct and dramatic effect on every system in the
body – Down regulates sympathetic nervous system and up
regulates parasympathetic nervous system – Activates deep myofascial system – Improves a client’s awareness of their body
©2015 Fitness Education Seminars™ 30
Breathing
Neurofascial Integration for the Shoulder
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31 ©2015 Fitness Education Seminars™ Neurofascial Integration for the Shoulder
Principle #3: Control
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©2015 Fitness Education Seminars™ 32 Neurofascial Integration for the Shoulder
Alignment and Control
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©2015 Fitness Education Seminars™ 33
Alignment and Control
Neurofascial Integration for the Shoulder
• Points of stability (circles)
• Points of mobility (arrows)
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©2015 Fitness Education Seminars™ 34 Neurofascial Integration for the Shoulder
Happy Baby
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Squatting Lunging Bending Rotation Pushing Pulling Gait
35
The Integrative Movement System™
©2015 Fitness Education Seminars™
Posture & Movement
Alignment
Control Breathing
Neurofascial Integration for the Shoulder
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• Purpose: – To determine starting joint
position – Static posture often relates to
movement pattern – Goal is not to make posture
look ‘ideal’ however with improved joint centration posture should look more optimal
36 ©2015 Fitness Education Seminars™ Neurofascial Integration for the Shoulder
Postural Assessment
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• OPTIMAL ALIGNMENT – Head – Thorax - suspended – Pelvis
• Anterior pelvic tilt –ASIS slightly anterior to
pubic symphysis
37 ©2015 Fitness Education Seminars™ Neurofascial Integration for the Shoulder
Postural Assessment
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• 3 Common Postures • Sway back (left) • Flat back (middle) • Lower crossed
syndrome (right)
38 ©2015 Fitness Education Seminars™ Neurofascial Integration for the Shoulder
Postural Assessment
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• Patient can be seated or standing; • Stand behind client and gently cup under
their GH region as close to lateral scapular border as possible;
• Client should be totally relaxed as you try to gently lift the scapula superiorly off their thorax;
• Also check posterior scapular glide by gently pulling the scapula posteriorly off the thoracic wall
• Note ease and any mobility restrictions – note also direction of pull
©2015 Fitness Education Seminars™ 39 Neurofascial Integration for the Shoulder
Scapular Lift Off Test
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• Myofascial restriction can be from several sources:
• Anterior pull – tends to be from serratus anterior or pectoralis minor
• Inferior pull – tends to be from latissimus dorsi and pectoralis major
• Overall restriction of scapula on top of thorax – fascial restriction from pleural dome
©2015 Fitness Education Seminars™ 40 Neurofascial Integration for the Shoulder
Scapular Lift Off Test
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• Optimal – Rib cage
should be mobile to enhance three-dimensional breathing
41 ©2015 Fitness Education Seminars™ Neurofascial Integration for the Shoulder
Rib Cage Mobility Test
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• Optimal three-dimensional breathing
• Apical and abdominal –top-to-bottom
• Laterally –side-to-side
• Anterior-posterior –front-to-back
42 ©2015 Fitness Education Seminars™ Neurofascial Integration for the Shoulder
Assessment: Breathing
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• Inspiration (left); expiration (right)
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Non-optimal diaphragm movement during inhalation
Non-optimal rib cage movement during exhalation
©2015 Fitness Education Seminars™ Neurofascial Integration for the Shoulder
Breathing Assessment
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• Lie and reach up towards ceiling
• Reach overhead with elbow straight
• Compare side to side
44 ©2015 Fitness Education Seminars™ Neurofascial Integration for the Shoulder
Overhead Length Assessment
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• Note the difference: – TPC connected
(top) – Thoracolumbar
hinge (bottom)
45 ©2015 Fitness Education Seminars™ Neurofascial Integration for the Shoulder
Overhead Length Assessment
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RELEASE ACTIVATE INTEGRATE
©2015 Fitness Education Seminars™ 46
I.M.S.™ Corrective Strategy
Neurofascial Integration for the Shoulder
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• Scapulo-thoracic dissociation – Pectoralis minor – Latissimus dorsi – Superior fibers of serratus anterior – Anterior pectoral fascia
• Glenohumeral dissociation – Teres major – S.I.T.S. – Deltoid
©2015 Fitness Education Seminars™ 47
I.M.S.™ Corrective Strategy - Release
Neurofascial Integration for the Shoulder
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48
I.M.S.™ Corrective Strategy
©2015 Fitness Education Seminars™
• Release anterior thorax – One hand under client’s neck as
to ‘lightly traction. – Other hand over sternum or
abdomen – Instruct client to take a deep
breath in, hold. – As they exhale your intention is
bring gently traction neck long and gently bring rib cage in direction of pelvis.
– There is no stretching or gliding.
Neurofascial Integration for the Shoulder
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49
I.M.S.™ Corrective Strategy
©2015 Fitness Education Seminars™
• Release fascial connections between latissimus dorsi and thorax – NFR lat/teres – Place hand over area to be released – Have cl. contract with 10-20% of
strength – Cl. deep breath – As cl. releases breath instructed to let
muscle relax or go long under your hand
Neurofascial Integration for the Shoulder
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• Release for latissimus
dorsi • Pin rib cage/ contract
lats for 5 second isometric with ~25% max effort
• Client releases and lengthens under arm
• Repeat 3-5x
50
I.M.S.™ Corrective Strategy
©2015 Fitness Education Seminars™ Neurofascial Integration for the Shoulder
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• Release for pectoralis minor
• Traction humerus/ contract pec minor for 5 second isometric with ~25% max effort
• Release and lengthen muscle/ cue to go ‘wide’ through front of shoulders
• Repeat 3-5x/side
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I.M.S.™ Corrective Strategy
©2015 Fitness Education Seminars™ Neurofascial Integration for the Shoulder
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• ‘…visualization and imagery activates specific patterns in the brain and can be added to enhance formation and long-term maintenance of new brain maps.’ – Diane Lee
• The Pelvic Girdle 4th
©2015 Fitness Education Seminars™ 52
I.M.S.™ Corrective Strategy - Activation
Neurofascial Integration for the Shoulder
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I.M.S.™ Corrective Strategy – Cuing
• *Deep myofascial system – ‘Imagine’ – ‘Think about’ – ‘Visualize’ – ‘Activate’ – ‘Feel’ or ‘connect’
• * Superficial myofascial system • ‘Move’ • ‘Contract’ • ‘Tighten’ or ‘squeeze’ • ‘Pull in’ • ‘Brace’ or ‘pack’
©2015 Fitness Education Seminars™ 53 Neurofascial Integration for the Shoulder
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• Respiration –Activation of
the deep myofascial system
»Align »Breath »Control
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I.M.S.™ Corrective Strategy
©2015 Fitness Education Seminars™ Neurofascial Integration for the Shoulder
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©2015 Fitness Education Seminars™ 55
• Cues: – ‘suspend your ribs’ – ‘think long’ – ‘suspend your shoulders’ – ‘relax and open through the front
of your shoulders’ – ‘wrap your scapula’
Improving Function Through Visualization
Neurofascial Integration for the Shoulder
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©2015 Fitness Education Seminars™ 56 Neurofascial Integration for the Shoulder
Prone Lengthening
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• Muscle Activation
• Modified quadruped with elbow extension
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I.M.S.™ Corrective Strategy
©2015 Fitness Education Seminars™ Neurofascial Integration for the Shoulder
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• Muscle Activation – Isometric
hold – Arm
slides – Rotations
©2015 Fitness Education Seminars™ 58
Modified Wall Plank for Shoulder Stabilization
Neurofascial Integration for the Shoulder
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• Suspension and alignment of TPC and rings
–Visualizing lifting gently superiorly and postero-medially
»‘up and back’
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I.M.S.™ Corrective Exercise Strategy - Integration
©2015 Fitness Education Seminars™ Neurofascial Integration for the Shoulder
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• PUSHING PATTERNS • Horizontal
• Push ups • Chest press • Chest flys
• Vertical • Overhead presses
• PULLING PATTERNS
• Horizontal
• Rows
• Reclined pull ups
• Vertical
• Pull ups
• Pull downs
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Integration into Fundamental Movement Patterns
©2015 Fitness Education Seminars™ Neurofascial Integration for the Shoulder
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Pulling Patterns
• Wide shoulders and scapular wrapped – optimal (left) • Scapula overly retracted – non-optimal (right)
©2015 Fitness Education Seminars™ 61 Neurofascial Integration for the Shoulder
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• Optimal - wide shoulders and scapular wrapped (left)
• Over-retraction (middle); forward shoulder
©2015 Fitness Education Seminars™ 62
Pulling Patterns
Neurofascial Integration for the Shoulder
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• Wide shoulders and scapular wrapped (left) • Scapula overly retracted (right)
©2015 Fitness Education Seminars™ 63
Pushing Patterns
Neurofascial Integration for the Shoulder
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• Scapula wrapped – optimal (left) • Scapula overly retracted – non-optimal (right)
©2015 Fitness Education Seminars™ 64
Pushing Patterns
Neurofascial Integration for the Shoulder
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• Strategy: – 3-dimensional breathing – Cue to think ‘long’ and
‘suspend’ – Relax gripping
©2015 Fitness Education Seminars™ 65
Improved Strategy
Neurofascial Integration for the Shoulder
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©2015 Fitness Education Seminars™ 66
Improved Strategy with Breathing and Suspension
Neurofascial Integration for the Shoulder
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Breathing and prone lengthening
©2015 Fitness Education Seminars™ 67
Improved Strategy with Breathing and Suspension
Neurofascial Integration for the Shoulder
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• Primary cause of postural and movement dysfunction
• Principles of posture and movement
• Passion and empowerment
68
©2015 Fitness Education Seminars™
Optimal posture & movement
A
C B
Conclusion
Neurofascial Integration for the Shoulder
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• Cohen, R. 2011. Introduction to Reflex Locomotion According to Vojta. Naperville, IL; Course Handouts.
• Cohen, R. 2009. Introduction to Reflex Locomotion According to Vojta. Philadelphia, PA. Course Handouts.
• Kolar, P. 2009. Dynamic Neuromuscular Stabilization: A Developmental Kinesiology Approach. Chicago, IL; Course Handouts.
• Kolar, P. 2009. Exercise and the Athlete: Reflex, Rudimentary and Fundamental Strategies. Chicago, IL; Course Handouts.
• Kobesova, A and Jezkova, M. 2011. Dynamic Neuromuscular Stabilization According to Kolar. Course B. St. Louis, MO; Course Handouts.
• Lee D. 2011. The Pelvic Girdle. Fourth ed. Churchill Livingstone: Edinburgh. • Lee D and Lee LJ. 2013. Treating the Whole Person with The Integrated Systems Model. Discover Physio Course handouts:
Vancouver, CA.
• Osar, E. 2014. Integrative Movement Specialist Certification. Fitness Education Seminars. Chicago, IL; Course handouts.
• Osar, E. 2012. Corrective Exercise Solutions to Common Movement Dysfunction of the Hip and Shoulder. Lotus Publishing; Chinchester, UK.
• Richardson C, Hides J, Hodges PW. 2004. Therapeutic Exercise for Lumbopelvic Stabilization: a Motor Control Approach for the Treatment and Prevention of Low Back Pain. 2nd ed. Churchill Livingstone: Edinburgh.
• Suzan, Zuzana. 2010. Kolar’s Approach to Dynamic Neuromuscular Stabilization: Developmental Kinesiology Approach. Chicago, IL; Course Handouts
©2015 Fitness Education Seminars™ 69
References
Neurofascial Integration for the Shoulder
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