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Brian Schiff’s Blog

Injury Prevention, Sports Rehab & Performance Training Expert

Archive for 'shoulder injuries'

In the case of shoulder pain and dysfunction, the lower trapezius and serrates anterior are often implicated as part of the problem. Research has shown that these two muscles often fatigue and don’t contribute equally to the force couple between them and the upper trapezius that facilitates upward rotation of the scapula.

Building scapular stabilization and dynamic stability is a must for those doing repetitive overhead activities such as throwing, swimming, serving, or work-related tasks.  It is a given that asymmetries will exist, so optimizing the strength of the rotator cuff and scapular stabilizers is paramount to prevent injury and recover from overuse syndromes.

To strengthen the lower trapezius, one of my ‘go to’ exercises is the lower trap raise. It can be done with just the weight of your arms or using light dumbbells.  The link below includes the full description for the exercise, and I also embedded the video below.

http://fit-pro.com/article-4137-Lower-trap-raise.html

In the next column, I will include a serratus anterior exercise using a kettle bell as a follow-up to this post.

I work with a lot of baseball players in my clinic.  In many cases, I see similar issues and recurring problems in them, especially pitchers.  Some of these issues include:

  • Scapular dyskinesia
  • Limited thoracic spine mobility (extension and/or rotation)
  • Soft tissue tightness (lats, post shoulder, pec major/minor)
  • Poor muscular strength/endurance in the rotator cuff and scapular stabilizers
  • Glenohumeral internal rotation deficit (GIRD)

I integrate routine mobility exercises for my throwers, as well as other overhead athletes (tennis, swimming, volleyball, etc) to better prepare them for training and their sport, as well as prevent poor mechanics and compensatory motion that may lead to aberrant stress on the rotator cuff and labrum.

The following video reveals five of my preferred exercises using a foam roller to improve thoracic spine mobility, decrease latissimus tightness, and stretch the pec major/minor while facilitating lower trapezius activation.

In order you will see:

  1. Lat rolling
  2. T-spine extension in supine
  3. T-spine extension coupled with lat stretch
  4. T-spine rotation
  5. Retraction and downward rotation

I advise performing 5-10 repetitions of each prior to training and sport. These will help improve performance, optimize overhead mechanics and reduce injury risk associated with overhead sports.

This post is dedicated to improving mobility in two areas I commonly find restrictions in among my clients – the ankle and thoracic spine. Specifically, I often find limitations in dorsiflexion and thoracic spine rotation that create undue stress on other parts of the kinetic chain.

ankle-wall-mob-2

Standing wall touch

Recently, I wrote an article for the WeckMethod site on how to assess and improve ankle mobility.  As a clinician and coach, I see this issue in many runners and athletes I work with.  At times, it is joint restriction, while in other cases it is soft tissue limitations that impact mobility.

There are several potential reasons why one might possess less than optimal movement in the ankle.  The most common causes include: joint stiffness following injury and/or immobilization, soft tissue tightness in the gastroc/soleus complex, scar tissue from a prior injury, anterior ankle impingement, chronic ankle instability and adaptive shortening of the Achilles tendon.  Want to read more?

Click here to read my article on the WeckMethod site

Decreased mobility in the thoracic spine often creates dysfunction and stress on other parts of the kinetic chain, namely the shoulder and lumbar spine.  In many cases, clients will demonstrate asymmetry based on their sport, activity level and injury history.  In light of this, I often prescribe a simple, yet effective corrective exercise they can do at home to restore motion.  The exercise below is taken from my ‘Functionally Fit’ column I recently did for PFP Magazine.

Side lying t-spine roll

Side lying t-spine roll

In the full online column, I reveal two ways to do this and the applications for it.  This exercise also offers a way to assess your own range of motion, while teaching you a straightforward corrective exercise to improve mobility.

Click here to see the video of the side lying t-spine roll

Baseball pitchers who fail nonoperative care for SLAP injuries will undergo a repair if they wish to continue throwing. The injury may occur at ball release as the biceps contracts to resist glenohumeral joint distraction and decelerate elbow extension. The other thought is that injury occurs in late cocking as the result of a “peel back” mechanism when the abducted shoulder externally rotates. Previous research by Shepard et al. published in American Journal of Sports Medicine (AJSM) measured in vitro strength of the biceps-labral complex during the peel back and distal force and concluded that repetitive force in both scenarios likely causes SLAP lesions.

baseball_pitching_motion_2004

Baseball pitching motion 2004“. Licensed under CC BY-SA 3.0 via Wikimedia Commons.

One of the concerns for pitchers after surgery is regaining full shoulder external rotation and horizontal abduction. If too much tension is placed on the glenohumeral ligaments during surgery, regaining motion can be tough. Ironically, external rotation is limited in the early phase of rehab to protect the labral repair which may impair throwing mechanics later on. Appropriate rehab and progression is paramount for long term success.

Laughlin et al. at the ASMI sought out to explore in a labaratory if there are differences in pitchers who underwent a SLAP repair compared to those in age controlled groups without injury.  In a paper published in the Dec. 2014 AJSM, the researchers hypothesized that the SLAP group would exhibit compromised shoulder range of motion and internal range of motion torque during pitching. Of 634 pitchers (collegiate and professional) tested at ASMI from 2000 – 2014, 13 in this group were included in the SLAP group as they had undergone a SLAP repair at least 1 year before their biomechanical testing.


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I must admit that I am always looking for new ways or tools to enhance my practice and work as a sports physical therapist. I recently completed the necessary hours of training to perform dry needling in the state of North Carolina. I trained with Myopain Seminars and have nothing but great things to say about their courses.

For those unfamiliar with trigger point dry needling (TDN), it is a treatment gaining traction in the therapy world. Dry needling is a treatment that involves a very thin needle being pushed through the skin to stimulate a trigger point. Dry needling may release the tight muscle bands associated with trigger points and lead to decreased pain and improved function for those suffering from pain related to muscular dysfunction.

Trigger points may ultimately refer pain to other sites, and research indicates that TDN can reduce acidity in the muscle and clear out pain propagating chemicals. The picture below is an example of me performing trigger point dry needling to the upper trapezius of a 16 y/o female.

tdn-upper-trap

This particular client had been suffering from an inability to lift the arm above shoulder height and marked shoulder pain since September 2013.  She also mentioned having headaches at school.  Clinically, she was diagnosed with multi-directional instability and scapular dyskinesis by the referring MD. We began working on a scapular stabilizer and rotator cuff strengthening program in late November that was helping to diminish pain and increase function. However, she continued to c/o pain in school, stiffness and headaches.


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