Just a quick post today .I had a new client in who was complaining of shoulder pain and knee pain .
As always I checked his breathing first and sure enough he was a chest breather so i had him work on crocodile breath then turned over and taught him how to keep the ribs down ,activate the core and breath over a brace .
The most interesting thing for me was when I asked him to lift his arm up on the problem side , as soon as he went into shoulder flex ion his neck side bent and rotated to that side . That is a huge compensation strategy for a lack of scapula stability . At the moment he has shoulder pain but I am willing to bet that not too far off down the road he will develop neck pain because of all this compensatory movement .
SO WHAT DID I DO ???
I made life a bit easier by asking him to sit in a chair , push gently into the wall to activate his shoulder stabilisers and perform the same movement with no compensatory neck movement . SIMPLE BUT EFFECTIVE !! let the brain figure out what needs to stabilise and strengthen , my job was just to identify the faulty movement pattern .
We could get all anatomical and talk about the scapula downward rotators dominating the upward rotators and length tension relationships but I love simplicity and this is super simple . We should all be able to lift our arm above our head without moving out necks , if our clients move their necks and they have neck or shoulder pain the make them aware of the faulty movement pattern and let the brain take care of the rest .
In this case though many of the muscles that attach to the scapula and cervical spine ( upper traps , levator scapula ) others that attach from the scapula to the humerus or ribs ( serattus anterior , lower traps ) are not strong enough to stabilise the scapula through a full range of upward rotation so the next anchor point which is the neck is pulled on and asked for support . A situation that leads to compensation and eventual pain in the neck .
I could also have made this even easier by asking him to lie down and performing shoulder flexion with even less gravity , If you think your client is still compensating make it easier so they learn good movemnt patterns and do not go back to their old compensation patterns .
The next most interesting movement was a dynamic lunge . He had no idea what I was looking for all I did was demonstrate the lunge on both sides and ask him to repeat it .
He could not control his knee on both sides but more so on the right which is his painful side . This is a great example of lack of control of femoral internal rotation or ( valgus collapse ) a prime cause of anterior knee pain and anterior cruciate ligament strains .
SO WHAT DID I DO ????
I made life easier by taking some gravity out of the equation and putting him into a half kneeling lunge position . keeping the lumbar spine in neutral , the glutes activated on the back leg , a tall straight spine , looking straight ahead and activating the core and belly breathing . keeping still and stable for 10 easy breathes .
The skill in correcting movement dysfunction is to identify the faulty movement and then regress the client into a position that is challenging enough for them to learn from but not so difficult that they revert back to compensation patterns and pain again .
In this case as soon as my client displays good control we will progress to more dynamic and challenging positions .
Have a good week .