Monthly Archives: October 2014

Significantly Improving Shoulder Range of Motion in One Treatment

30 Thursday Oct 2014

Posted by in Shoulder

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It can be difficult to treat people with a shoulder musculoskeletal disorder causing limited shoulder range of motion.  There are many ways to conservatively treat these individuals; such as using soft tissue massage (STM), joint mobilizations (JM), muscle strengthening, stretching, proprioceptive neuromuscular facilitation (PNF), modalities, etc.  A multitude of treatments can limit progress when used all at once or when they are not warranted.  I found an article that focused on treating individuals with soft tissue restriction from muscle as opposed to individuals with capsular restrictions by using STM and PNF.

Prior to treatment, the researchers measured glenohumeral range of motion in supine with the shoulder abducted to 45 degrees and again at 90 degrees shoulder abduction.  They defined individuals with muscular restrictions as individuals with an increase in external rotation range from 45 to 90 degrees shoulder abduction.  A capsular restriction presented as individuals with a decrease in external rotation from 45 to 90 degrees shoulder abduction and were not deemed suitable for this type of treatment.

1.  They first treated subjects with soft tissue massage to the subscapularis muscle with the subject supine and their shoulder abducted to 45 degrees and externally rotated to 20-25 degrees.  They poked around the armpit for areas of tissue restrictions and either used sustained pressure or slow deep strokes for 7 minutes.

2.  Then they maintained the shoulder in the same position and completed contract-relax PNF to the subscapularis and internal rotators of the shoulder.  The subject was instructed to complete a maximal isometric internal rotation contraction against resistance for 7 seconds and then maximally externally rotated.  The externally rotated position was help for 15 seconds.  This was repeated 5 times.

3.  Finally, the subject was instructed to complete 5 repetitions of the flexion-abduction-external rotation PNF pattern actively with manual facilitation.

(Click the link for access to the article)

The Immediate Effects of Soft Tissue Mobilizations with Proprioceptive Neuromuscular Facilitation on Glenohumeral External Rotation and Overhead Reach

Design: Randomized-controlled 2-group pretest-posttest, multivariate study of patients with shoulder musculoskeletal disorders

Purpose: To evaluate the immediate effect of soft tissue mobilizations with Proprioceptive Neuromuscular Facilitation to increase glenohumeral external rotation at 45 degrees of shoulder abduction and overhead reach.

Methods: Twenty subjects (10 male, 10 female) with limited glenohumeral external rotation and overhead reach for a duration of 1 year or less were assessed.  The glenohumeral external rotation was measured supine with the shoulder at 45 degrees abduction and overhead reach was measured from the tip of the middle finger on the wall to the floor.  The experimental group was treated with STM to the subscapularis and PNF to the rotators.  The control group received 10 minutes of resting supine on the treatment table.

Results: The experimental group significantly increased external rotation range by 16.4 degrees and the overhead reach by 9.6 cm.

Limitations: This was a single session so the study does not allow for conclusions on effects beyond 1 visit.  The study also did not compare different treatment interventions so other outcomes may be similar for other techniques.

 

 

An Exercise to Help Lower Trapezius Strength and Improve Neck Pain

22 Wednesday Oct 2014

Posted by in Exercise/Stretch Video

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Here is an exercise option for the last article I reviewed and posted.  I have combined two exercises together Scapular Depressions + Chin Tucks to improve neck pain.  I have posted two Youtube videos to this post.  The Scapular Depression Exercise helps to draw the shoulder blade to the ground by activating the lower trapezius muscle.  The Chin Tuck exercise helps to strengthen the deep cervical muscles and place the head in better alignment during the first exercise.  I prefer combining the two exercises together to get a the most out of the exercise.  I would recommend completing this exercise 2-3 times a day for 12 repetitions and holding each repetition for 5 seconds.

Scapular Depression Exercise

Chin Tuck Exercise

Neck Pain: Look A Little Further to the Lower Trapezius Muscle

09 Thursday Oct 2014

Posted by in Neck

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Trapezius_muscle_animation2

(Upper Trapezius = Orange; Middle Trapezius = Red; Lower Trapezius = Purple)

 Sometimes I find it difficult to remember to look further than the patient’s area of pain.  When assessing the neck, I may assess the posture of the head and upper back, range of motion of the neck and back, joint mobility, palpations, etc.  I may notice that the upper trapeziuses are overactive and strong but not consider the strength of the lower trapeziuses.  I started to wonder if the strength of the lower trapezius could be a factor for people suffering from certain types of neck pain.

I came across an article that assessed the strength of the lower trapezius muscle in individuals with single sided neck pain.  The article by Petersen and Wyatt found that the lower trapezius muscle on the affected side was significantly weaker than the lower trapezius muscle on the unaffected side.  They also did not want to assume that strengthening of the lower trapezius will help with neck pain even though they found a significant muscle strength difference.

(Click the link below for assess to the article)

Lower Trapezius Muscle Strength in Individuals with Unilateral Neck Pain

Purpose: To examine lower trapezius muscle strength in individuals with unilateral neck pain, as an initial step in determining if impairments need to be assessed and addressed in this population.

Methods: This is a descriptive and within-subject comparative study.  The researchers examined 25 individuals with unilateral neck pain for greater than 3 months and did not have radicular symptoms.  The examiners tested the strength of the lower trapezius by using a handheld dynamometer at the distal forearm with the subjects in prone and the upper extremity in line with the lower trapezius fibers (~130 degrees in shoulder abduction).  The examiners stabilized the contralateral scapula.  They completed 2 measurements and averaged the values.  Each subject was tested bilaterally and the examiners were blinded.

Results: The lower trapezius strength on the affected side was significantly (p<0.001) less than the lower trapezius strength on the unaffected side with a mean difference of 3.9N.  They did not find a correlation between duration of neck pain and lower trapezius weakness.

Limitations: The researchers did not include an asymptomatic group for comparison.  Also, there is conflicting evidence of which manual muscle test position for the lower trapezius and placement of the dynamometer are optimal.