laura abbott, ms, lmt - exercise...

Webinars on Deand 2017

(C) 2016 by Exercise ETC Inc. All rights

reserved. 1

Understanding

Shoulder Dysfunction

Laura Abbott, MS, LMT • Master’s Degree, Sports

Medicine

• Licensed Massage Therapist

• Undergraduate degree in Exercise Science

• Instructor of Kinesiology, Georgia State University

• ACE Certified Personal Trainer

• Guest speaker at Atlanta area massage schools and at the Georgia State University Physical Therapy department.

• Owner of Premier Performance, Atlanta, GA

How to Get Your CE Certificates

• View the complete webinar • Make sure your printer is “on” • Log on to our website: www.exerciseetc.com • Click on “Administration” • Click on “Webinar on Demand Certificates” • Complete all required fields & click “submit” • Your CE certificate will appear on the screen; you

may either save or print your certificate; even if you do not have a working printer, make sure to complete this form

• Remember: The WebEx program records when you log on and off; logging off early or fast forwarding to the end of the meeting may result in denial of your CEs.

http://www.exerciseetc.com/



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Learning Objectives (5)

• After viewing this webinar you will be able to:

– Identify common shoulder conditions and the

statistics associated with them

– Explain common causes for impingement

syndrome

– Describe causes for imbalances that lead to

unstable scapulae

– List the functions of the rotator cuff

– List tips and modifications to prevent shoulder

injuries

REMINDER

Obtain medical clearance and physician’s release

prior to beginning

an exercise program

for clients with medical or

orthopedic concerns

What is a “healthy” shoulder?

• Is it having the capacity

for pain-free movement?

• Is it having optimal range

of motion?

• Is it being functional

based on personal

needs?

• Is there such a thing as

a healthy shoulder?



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Shocking Shoulder Statistics

• > 50% of adults over 60 have

rotator cuff tears

– Sher et al (1995)

• MRI’s of 30 asymptomatic

shoulders resulted in “no

completely ‘normal’ rotator

cuffs”

– Miniaci et al (1995)

Common Shoulder Conditions

• Impingement

• Rotator Cuff Tears

• Labrum Tears

• Dislocation

• A-C Joint Separation

Impingement Syndrome

• Primary – Anatomical or bony

abnormalities

– Arthritic changes

• Secondary

– Muscle imbalances

– Scapula dysfunction

– Poor exercise technique

– Overuse overhead



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Sub-acromial Impingement

• Part of Rotator Cuff is

compressed beneath

the Acromion process

Impingement Clearing Screen

• Have client place right

hand on left shoulder

while raising the elbow as

high as possible

• The presence of pain

indicates impingement

• Refer client to appropriate

Medical professional for

further evaluation

Shoulder & Scapulae Position

• Check for “winging”

– Both standing/seated

and in Tall Plank

• Distance from medial

border of each

scapula to the spine

should be no more

than 3”



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Preventing Impingement

• Improve Scapula Stability

• Awareness of Joint

Centration

• Increase Gleno-humeral

Mobility

• Balance Push-Pull

Strength

• Avoid Excessive

Overhead Exercise

• Use Smart Exercise

Technique

Correcting Poor Respiratory

Function

• Deep Breathing

Exercises

– Diaphragmatic

Breathing

– Various Positions

– Relaxing Neck and

Shoulders

– Check Shoulder

Range of Motion

before and after

Breath-work.

Identifying T-Spine Shape



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Driving T-Spine Flexion

• Isolate Thoracic

Flexion

• Incorporate Breath

Awareness

• Change Position

– ½ Kneeling

– Standing

– Squatting

Improving T-Spine Extension

• Place Foam Roller

at T-Spine

• Alternatives to

Foam Roller

– Double Tennis Ball

• Follow-up with

Quadruped T-

Spine Exercise

Bench T-Spine Mobility



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Quadruped T-Spine Opener

Improves T-Spine Extension & Rotation

Can Alternate Head Position from Neutral to Right to Left

Address Imbalances That Lead

to Unstable Scapulae

• Stretch/Lengthen

– Pec Minor

– Posterior Capsule

– Subscapularis

• Tighten/Activate using

scapula stabilization drills

– Rhomboids

– Serratus Anterior

– Lower & Middle Trapezius

SMFR + Stretch - Triceps / Lats



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Stretching the Posterior Joint

Capsule • Fixate the scapula

while horizontally

adducting the

shoulder

• Stretch should be felt

on the posterior

shoulder

SMFR -Subscapularis

Scapula Stabilization Drills

• Exercises to improve

stability of the

shoulder girdle

– Blackburn's

• Y-T-W-L

– Serratus Anterior



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‘Y’ Arm Raises Strengthen Lower Trapezius

Prone ‘T’ Exercises Strengthens Rhomboids, Middle Trapezius, and

Rear Deltoid

External Rotation is NOT necessary

Elbow Plank w/ Shoulder

Centration

• “Pack” the shoulder

• Cue scapulae tight to

ribs



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Scapulae Wall Slides

Scapula Protraction Push-Up

Strengthens Serratus Anterior

Use Shoulder Angle of 100-110 Degrees

Single Arm Retraction - Row

Teaches Client to Retract the Scapula without Flexing the Elbow or

Extending the Shoulder Simultaneously



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Use the Plane of Scaption (The plane of the scapula)

• 30 to 45

degrees anterior

to the frontal

plane

Rotator Cuff Strain / Tears

• Supraspinatus

• Infraspinatus

• Teres Minor

• Subscapula

Labrum Tears

• SLAP Tear

– Superior Labrum from

Anterior to Posterior

• Bankart Lesion

• Posterior Labral Tear



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What Does the Cuff Do?

• Maintains the position

of the humeral head

against the glenoid

during movement

• Balanced strength &

flexibility is essential

• External Rotators are

typically weakest link

• Supraspinatus is most

common to tear

Stats

• Failure Rate for RC

Surgery – 25-90%

• 75% of people with

full thickness RC

tears avoided surgery

with PT

Goals for Direct Rotator Cuff

Training

• Proprioception

– Isolation

– Perturbation

• Rate of Force

Development



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Side Lying DB External Rotation

• Trains infraspinatus &

teres minor, external

rotators

• EMG Studies have

shown this to be best

exercise for the external

rotators of the cuff

– Reinhold et al

Dynamic Isometric Holds

Rhythmic Stabilizations

• With Client in Supine

Lying Position Trainer

Presses on Wrist in

Various Directions to

Challenge Reactive

Stabilization of the

Shoulder Girdle



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Perturbation Drills

Body Blade

When Should You Train the Cuff?

• Recommendations Vary

– Low Rep / Low Fatigue

before Training or During

Warm-Up Sets

• 5-10 Reps

– Higher Rep / Higher Fatigue

after Training

• 15+ Reps



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Anterior Shoulder Instability

• Hyper-mobility of the

humeral head forward

leading to possible

subluxation or

dislocation

• High risk positions:

– External rotation with

> 90 abduction,

horizontal abduction

Contraindicated Activities

• Push ups / Presses with

wide hands

• Pec Deck / Chest Flyes

• Behind the Neck Pull-

downs / Presses

• Shoulder Extension

Stretches

• Shoulder Abduction

Stretches

Additional Tips & Modifications

for Shoulder Injury Prevention

• Stick to DB’s vs.

Barbells

• Minimize Overhead

Strengthening in

Overhead Athletes

• Scapula Stability warm-

ups before all activities

involving the shoulder



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How to Get Your CE Certificates

• View the complete webinar • Make sure your printer is “on” • Log on to our website: www.exerciseetc.com • Click on “Administration” • Click on “Webinar on Demand Certificates” • Complete all required fields & click “submit” • Your CE certificate will appear on the screen; you

may either save or print your certificate; even if you do not have a working printer, make sure to complete this form

• Remember: The WebEx program records when you log on and off; logging off early or fast forwarding to the end of the meeting may result in denial of your CEs.

Post-course Learning Assessment This assessment must be completed if you are certified by BOC, CSCS

or NSCA

Question 1

Over ____ % of adults over the age of 60

have rotator cuff tears

Question 2

Which of the following is a primary cause of

impingement syndrome?

A. Poor exercise technique

B. Arthritic changes

C. Muscle imbalances

D. Scapula dysfunction

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Question 3

Which of the following muscles typically

needs to be strengthened in order to help

stabilize the scapula?

A. Serratus anterior

B. Pec minor

C. Subscapularis

D. Posterior capsule

Question 4

True or False

The external rotators of the shoulder are

typically the weakest link of the rotator cuff.

Question 5

True or False

Dumbbells are a better choice for weights

than barbells in order to reduce the risk of

shoulder injuries.



reserved. 18

Correct Your Work:

Answer Key

1. 50%

2. B

3. A

4. True

5. True

Make sure to keep this assessment with your other

recertification documents for 4 years. Questions about

any answer? Email us at: [email protected]

PLEASE NOTE:

• Remember to complete this

webinar and print the certificate

by December 31 of this year.

• Certificates with next year’s

date may not be accepted by

your credentialing organization.

mailto:[email protected]



laura abbott, ms, lmt - exercise...

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