Please remember that a healthy shoulder is dependent on a healthy thoracic spine . When a client comes in and complains of shoulder pain the first thing i look at is T spine (Thoracic spine) extension and rotation .If one of these movements is lacking i will restore the pattern before looking at the shoulder . please refer to my post on the Thoracic spine if you missed it .
Ok lets assume the T spine is fine and the shoulder is painful we will keep it simple and check two movement patterns .
Arm flexion and scapula humeral rhythm . Healthy pain free overhead shoulder movement requires good scapula rhythm which simply means that the scapula should rotate upwards to make space for the humerus as the arm reaches full shoulder flexion . If the scapula does not rotate fully upwards then we can expect impingement and pain as the humerus pinches the Supraspinatus and long head of the biceps tendons .
- Testing the inferior angle of the scapula
- Testing for restrictions in the lats , Pecs and posterior shoulder .
- Soft tissue work
- Home exercise programme
- Reach roll lift
- Pull ups
- Back bends
Winging scapula .
The shoulder is a very mobile joint capable of many directions and ranges of movement . All this movement needs a stable base of support and this is where the job of the scapula becomes very important .There is a saying in the physical therapy world ” proximal stability begets distal mobility” simply put a stable core results in great flexibilty . In this case the scapula is the core and it needs to be stable so that the arm can move in all planes with out injuries occurring .
As soon as your client flexes and extends their arms and you see the scapula flying off the rib cage ( winging ) you are dealing with unstable shoulder blades . One of the muscle groups that suffer are the rotator cuff muscles , they attach onto the scapula and humerus their main job being stabilisation of the head of the humerus .
Ok you have identified a problem and now you are going to go after it and try to give your client some solutions . It is also a good idea to manually provide stabilisation to check if the pain decreases , if it does then you know stabilisation is the way to go .
- Wall slides
- Reach roll lift
- Cat stalking bird forwards and backwards
- Horizontal rows
- L sits
- Hand stands