I did not intend for this video material to be on my blog it was just to show my client the position of his scapula . The quality is not very good but I believe the information is valuable .
Last week Andrew experienced discomfort in his left shoulder with shoulder flex ion and a clunking feel and sound which is very obvious if You were to put your hand over his shoulder blade . It is clear that he moves his neck to the left when he raises his left arm above his head .
SO WHAT DID WE DO ??
Put Andrew in a position with less gravity ( seated ) and reproduced the movement but with emphasis on keeping the neck still . Our job here is to identify a faulty movement pattern and make our client aware of this . Then we get them to reproduce the movement as perfectly as possible .
This type of treatment is based on the principal of ( direction susceptible to movement ) or even more simply ( something that moves too much will become painful ) Shirley Saharman PT PHD. I just told Andrew to stop moving his neck when he raised his arm overhead .
Very simple and effective because it does not really matter what muscle is tight or weak , as soon as you have spotted the bad movement pattern your client is made aware and tries to correct it . The brain will take over and wake up the muscles that are not working and relax the muscles that are working too much .
WE CAN ONLY SUGGEST A NEW MOVEMENT , IT IS THE BRAIN THAT WILL DECIDE TO GIVE THE ORDER TO THE NERVOUSE SYSTEM AND MUSCLES TO CHANGE A BAD MOVEMENT PATTERN .
With repetition of perfect movement the muscle imbalance and compensation that is causing pain will balance itself out and the tight muscles will relax and the weak ones will become stronger .
OK fast forward one week . Andrew came back to see me and we retested his shoulder flex ion . If he did his home exercise programme and was a diligent client I expected to see him raise his arm with no compensatory neck movement .
Andrew is a great client and he did his homework . His own efforts paid off , he can now raise his arm overhead without compensatory movement in his neck . hooray !!
He still has discomfort and clunking in his shoulder though so our work here is still not done . I understand a little about shoulder mechanics so I stood back and had a look at his scapula . His left scapula is downwardly rotated and his right one is upwardly rotated .
WHAT DO DOWNWARDLY ROTATED SCAPULA LOOK LIKE ?
This guy has downwardly rotated scapula , the arrows points are showing the bottom of the scaps are very close to the spine . Neutral scaps would be straight .
This young chap underneath has upwardly rotated scapula especially the left one . Can you see how the lowest point of the scap points away from the spine ?
Very simply , for Andrew to lift his arm up into flex ion he is starting from a position of downward rotation which means he still has to get to neutral before before going into upward rotation .
His upper traps are in a stretched position which weakens them and put them in a mechanical disadvantage , the same situation is evident for his lower traps . As soon as Andrew gets to about 160 degrees of shoulder flex ion he experiences discomfort and a feeling of weakness and also the clunking which suggests instability .
OK SO WHAT WILL WE DO ??
Strengthen his upward rotators ( upper traps and lower traps ) Put Andrew in a position that is less challenging , ask him to reproduce the movement ( shoulder flex ion ) that was uncomfortable and causing clunking in a standing position and now is easier with no clunking .
After repetition of this movement we will hope to see Andrew flex his shoulder in a standing position with no discomfort and no clunking .
I know there are therapists out there that would have a totally different approach and treatment plan to this situation . I think that is fantastic , who cares what the heck you do to help your clients . As long as you can explain your actions and you get results . That is why all of us passionate body workers are always learning , investing in our education and reading crazy blogs like mine .
Thanks for reading .