Unraveling Muscle Imbalances Unraveling Muscle Imbalances in the - - PowerPoint PPT Presentation

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Unraveling Muscle Imbalances Unraveling Muscle Imbalances in the Shoulder in the Shoulder with Rick Kaselj, MS with Rick Kaselj, MS Rick Kaselj - Exercises For Injuries .com My Story My Story Rick Kaselj Exercises and injuries BSc

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SLIDE 1

Rick Kaselj - ExercisesForInjuries.com

Unraveling Muscle Imbalances Unraveling Muscle Imbalances in the Shoulder in the Shoulder

with Rick Kaselj, MS with Rick Kaselj, MS

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SLIDE 2

Rick Kaselj - ExercisesForInjuries.com

My Story My Story

Rick Kaselj

– Exercises and injuries – BSc – 1997 – MS – 2008 / RC – Work – physio, studio, gym, rec centre, rehab – Courses – live, webinars, video presentations – Writing – books, manuals – Blog – ExercisesForInjuries.com

Rick Hiking 4300 km / 5 months from Mexico to Canada

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SLIDE 3

Rick Kaselj – ExercisesForInjuries.com

Objectives of the MIRU Video Objectives of the MIRU Video Presentation Presentation

– Part 1 Part 1 – Structure & Movement Structure & Movement

  • Bones

Bones

  • Joints

Joints

  • Movement

Movement

– Part 2 Part 2 – Exercise for Muscle Exercise for Muscle Imbalances in the Shoulder Imbalances in the Shoulder

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SLIDE 4

Rick Kaselj - ExercisesForInjuries.com

Bones of the Shoulder Bones of the Shoulder (Osteology) (Osteology)

  • Sternum
  • Clavicle
  • Ribs
  • Scapula
  • Humerus
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SLIDE 5

Rick Kaselj - ExercisesForInjuries.com

Clavicle Clavicle

– 20 degree angle posterior from the frontal plane – Elevates – Posterior rotation for full abduction like a crank

Left Anterior Clavicle Inferior View Medial

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Rick Kaselj - ExercisesForInjuries.com

Scapula Scapula

– Glenoid Fossa – 5 degrees of upward rotation / not square

  • n

– Scapular Plane – 35 degrees from the horizontal

Left Scapular Left Scapular Lateral View Lateral View

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Rick Kaselj - ExercisesForInjuries.com

Humerus Humerus

  • Head of the Humerus (1)

– contact with the glenoid fossa

  • f the scapula to make of the

glenohumeral joint

  • Anatomical Neck (2)

– separates the smooth head from the shaft of the humerus

  • Lesser tubercle 3)

– where subscapularis inserts

  • Greater tubercle (4)

– supraspinatus, infraspinatus, teres minor insert Left Anterior Left Anterior 1 2 4 3

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Rick Kaselj - ExercisesForInjuries.com

Joints of the Shoulder Joints of the Shoulder (Arthrology) (Arthrology)

  • Sternoclavicular
  • Acromioclavicular
  • Scapulothoracic
  • Glenohumeral
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Rick Kaselj - ExercisesForInjuries.com

Sternoclavicular Joint Sternoclavicular Joint

  • Structures

– Medial end of clavicle – Sternum

  • Stabilized

– Cartilage of first rib – ligaments

  • Injuries

– Arthritis is rare – Fracture of clavicle > SC dislocation

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Rick Kaselj - ExercisesForInjuries.com

SC Joint SC Joint

  • Movements Around the Joint

– Elevation (45° ) / Depression (10° ) – Protraction / Retraction – Axial rotation of clavicle (50° ) – Allows for lots of movement of scapula

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Rick Kaselj - ExercisesForInjuries.com

Acromioclavicular Joint Acromioclavicular Joint

  • Structures

– Lateral end of clavicle – Acromium of scapula

  • Stabilized

– capsule – ligaments

  • Injuries

– Degeneration is common – Susceptible to dislocation (falling or striking tip)

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Rick Kaselj - ExercisesForInjuries.com

AC Joint AC Joint

  • Movement

– Upwards / Downward Rotation – Adjustment movement

  • Pivot (inferior angle side to side –

horizontal/frontal)

  • Tilt (inferior angle forward or back - sagittal)
  • Fine tuning of scapula / Rotational adjustments
  • 10°

to 30°

– Allows for subtle movements of scapula

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Rick Kaselj - ExercisesForInjuries.com

Scapulothoracic Joint Scapulothoracic Joint

  • Structures

– Scapula – Thorax

  • Movements

– Elevation / Depression – Protraction / Retraction – Upward / Downward Rotation

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Rick Kaselj - ExercisesForInjuries.com

Scapulothoracic Scapulothoracic Joint Joint

– Between 2nd (T2) and 7th rib (T7) – 6 cm (2-3 inches / ~3 fingers) from medial border to spine

  • Spine of Scapula

– T3

  • Now You Do It!
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Rick Kaselj - ExercisesForInjuries.com

Movement at Scapula Movement at Scapula

  • Elevation (Shoulder Shrug)

– Scapula follows path of clavicle at the SC joint – Downward rotation at AC joint to keep medial border of scapula vertical – Depression movement is the reverse

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Rick Kaselj - ExercisesForInjuries.com

Movement of Scapula Movement of Scapula

  • Protraction

– Rotation at the SC joint – Horizontal adjustment at the AC joint – If issue at one joint the other can compensate – Retraction is the reverse

  • Upward Rotation

– Clavicular elevation at SC joint – Scapula upward rotation at AC joint – 60°

  • f scapular rotation

– Downward Rotation is the reverse

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Rick Kaselj - ExercisesForInjuries.com

Glenohumeral Joint Glenohumeral Joint

  • Structures

– Convex head of humerus – Shallow concave glenoid fossa – Golf ball on a coin

  • Stabilized
  • 1. RC muscles
  • 2. Capsular ligaments
  • 3. Coracohumeral ligament
  • 4. Long head of biceps
  • 5. Glenoid labrum

2 4 3

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Rick Kaselj - ExercisesForInjuries.com

GH Joint GH Joint

  • Glenoid Fossa

– Lined with hyaline cartilage – Glenoid labrum

  • Fibrocartilage ring
  • Long head of biceps
  • riginates here
  • Creates 50% of the

depth

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Rick Kaselj - ExercisesForInjuries.com

GH Joint GH Joint

  • Static Stability

– Ligaments – Supraspinatus – Posterior deltoid – Negative intra-articular pressure of the capsule

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Rick Kaselj - ExercisesForInjuries.com

Coracoacromial Arch Coracoacromial Arch

  • = coracoacromial

ligament (1) and acromion process of the scapula (2)

  • Roof of the GH joint
  • 1 cm gap btw arch and

humerus

  • Subacromial Space (3)

– supraspinatus muscle & tendon, subacromial bursa, long head of biceps, superior capsule

1 2 3

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Rick Kaselj - ExercisesForInjuries.com

GH Joint GH Joint (Arthrokinematics) (Arthrokinematics)

  • Movement

– Abduction – 120 at GH / 60 upward rotation of scapula – Flexion – 120 at GH / 60 upward rotation of scapula – Extension – 45 to 55 – IR 75 to 85 includes some scapular protraction / ER 60 to 70 includes some scapular retraction

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Rick Kaselj - ExercisesForInjuries.com

Gluteus Maximus Gluteus Maximus Circulation Exercise Circulation Exercise

  • Wall supported

shoulder abduction ?

  • Wall supported

shoulder abduction in scapular plane (35° )?

  • Now You Do It!
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Rick Kaselj - ExercisesForInjuries.com

What Did You Find? What Did You Find?

– Limited by greater tubercle of the humerus compression contents of the subacromial space against the low point of the coracoacromial arch. – In order to complete abduction in the frontal plane need to externally rotate humerus – If move into the scapular plane greater tubercle moves under the high point of the coracoacromial arch

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Rick Kaselj - ExercisesForInjuries.com

Scapulohumeral Rhythm Scapulohumeral Rhythm

  • 2:1 ratio (Inman, 1944)
  • 3 degrees of shoulder abduction

– 2 degrees by GH joint abduction – 1 degrees occurs at scapulothoracic joint upward rotation

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Rick Kaselj - ExercisesForInjuries.com

What About Under Load? What About Under Load?

  • (McQuade, 1999).

– 1) arm completely unloaded and passively elevated - 7.9:1 to 2.1:1 (GH:Scap) – 2) light load consisting of active elevation against the weight of the limb - 3.1:1 to 4.3:1 – 3) heavy loading against maximal resistance - 1.9:1 to 4.5:1

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Rick Kaselj - ExercisesForInjuries.com

What About Under Fatigue? What About Under Fatigue?

  • (Szucs, 2009)

– Fatiguing out serratus anterior lead to:

  • Increase activation of upper trapezius
  • Altered serratus anterior and lower trapezius

activation ratio

  • Could lead to shoulder pathology
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SLIDE 27

Rick Kaselj - ExercisesForInjuries.com

Shoulder Kinematics Shoulder Kinematics

0 ° to 90 ° Abduction 90 ° to 180 ° Abduction

  • 60 °

GH joint

  • 30 °

scapulothoracic upward rotation

– 20 to 25 ° from clavicular elevation at SC joint –5 to 10 ° upward rotation at AC joint

  • 60 °

GH joint

  • 30 °

scapulothoracic upward rotation

– 5 ° from clavicular elevation at SC joint – 20 to 25 ° upward rotation at AC joint

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Rick Kaselj - ExercisesForInjuries.com

Muscles of the Muscles of the Scapulothoracic Joint Scapulothoracic Joint

  • Elevators

– Upper trapezius – Levator scapulae – Rhomboids (2° )

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Rick Kaselj - ExercisesForInjuries.com

Depressors of the Depressors of the Scapulothoracic Joint Scapulothoracic Joint

Lower trapezius Latissimus dorsi Pectoralis minor Subclavius *Function can flip as in lifting seat of

  • ut

wheelchair*

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Rick Kaselj - ExercisesForInjuries.com

Protractors of the Protractors of the Scapulothoracic Joint Scapulothoracic Joint

  • Serratus Anterior
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Rick Kaselj - ExercisesForInjuries.com

Retractors of the Retractors of the Scapulothoracic Joint Scapulothoracic Joint

  • Middle Trapezius
  • Rhomboids (2° )
  • Lower Trapezius

(2° )

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Rick Kaselj - ExercisesForInjuries.com

Full Arm Elevation Full Arm Elevation

  • Flexion

Flexion -

  • GH Muscles

– Anterior Deltoid – Supraspinatus (2° ) – Coracobrachialis – Biceps (long head)

  • Scapulothoracic Joint

Muscles

– Serratus Anterior – Trapezius

  • Rotator Cuff
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SLIDE 33

Rick Kaselj - ExercisesForInjuries.com

Full Arm Elevation Full Arm Elevation

  • Abduction

Abduction -

  • GH Muscles

– Anterior Deltoid – Middle Deltoid – Supraspinatus

  • Scapulothoracic

Joint Muscles

– Serratus Anterior – Trapezius

  • Rotator Cuff
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Rick Kaselj - ExercisesForInjuries.com

Supraspinatus & Deltoid Supraspinatus & Deltoid

– Line of pull is same during abduction – Most active until 90° – Create equal amounts of torque – If Deltoid Paralyzed

  • Supraspinatus can fully

ABD GH

– If Supraspinatus Paralyzed

  • ABD difficult

– Both

  • ABD not possible
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SLIDE 35

Rick Kaselj - ExercisesForInjuries.com

Upwards Rotators at the Upwards Rotators at the Scapulothoracic Joint Scapulothoracic Joint

  • Proximal Stabilizers

– O @ spine, ribs, cranium -> I @ scap or clavicle – Serratus anterior – Trapezius

  • Distal Mobilizers

– O @ scap or clavicle -> I @ humerus or forearm

  • Deltoid
  • Supraspinatus
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Rick Kaselj - ExercisesForInjuries.com

Upward Rotation Force Couple Upward Rotation Force Couple

– UT = Upper Trapezius – LT = Lower Trapezius

  • Most Active Later Stage

– SA = Serratus Anterior

  • Protraction force is

countered by MT & Rhomboids

  • If weak SA scap

retracted

  • If MT weak scap

protracted

L T S A UT Right Side Revolving Door

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Rick Kaselj - ExercisesForInjuries.com

Paralysis Paralysis

  • Trapezius

– Difficulty lifting arm – important for serratus to be active – Frontal plane abduction the worst due to lack of MT

  • Serratus Anterior

– Can’t elevate over 90 – With resistance scapula will wing & deltoid with downwardly rotate scap

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SLIDE 38

Rick Kaselj - ExercisesForInjuries.com

Rotator Cuff Rotator Cuff

  • Supraspinatus
  • Subscapularis
  • Infraspinatus
  • Teres Minor

– Rotator cuff muscles and capsular ligament blend into the fibrous capsule of the GH joint before attaching to Humerus

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Rick Kaselj - ExercisesForInjuries.com

Rotator Cuff Rotator Cuff

  • Distal Mobilizer

– Supraspinatus – moves humerus

  • Dynamic Stabilizer

– Stabilizes and centralizes humeral head against glenoid fossa

Subscapularis

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Rick Kaselj - ExercisesForInjuries.com

Rotator Cuff Rotator Cuff

– Supraspinatus (7) produces a compression force into glenoid fossa which stabilizes humeral head – Subscapularis, Infraspinatus (8), Teres Minor (6) produce inferior directed translation force

  • n the humeral head

– Infraspinatus (8) & Teres Minor (6) external rotate humeral head & in frontal plane helps ER so greater tubercle cleared

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Rick Kaselj - ExercisesForInjuries.com

Rotator Cuff Rotator Cuff

  • External Rotation

– Infraspinatus, teres minor and posterior deltoid – Supraspinatus – assists between neutral and full ER

  • RC

– Small percentage of total muscle mass in the shld – Creates smallest isometric force of all shld muscles – High-velocity concentric contractions – Eccentric activation decelerating internal rotation

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Rick Kaselj - ExercisesForInjuries.com

Supraspinatus Supraspinatus

– Most utilized muscle in shoulder – Assists deltoid in ABD – Dynamic stability – Static stability (at times) – Create 20 greater force than what is in the hand

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Rick Kaselj - ExercisesForInjuries.com

Dysfunction Dysfunction

  • Supraspinatus

– Counters deltoid superior force – therefore humeral head jammed into coracoacromial arch – Decrease shoulder abduction

  • Subscapularis / Infraspinatus / Teres Minor

– Counters deltoid superior force – therefore humeral head jammed into coracoacromial arch – Decrease shoulder abduction

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Rick Kaselj - ExercisesForInjuries.com

RC Exercises to Fatigue RC Exercises to Fatigue

  • (Ebaugh 2006)

– Performed RC exercises to fatigue – Less external rotation – Less posterior tilt of the scapula at the start of arm elevation – More scapular upward rotation and clavicular retraction in mid ranges of arm elevation

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Rick Kaselj - ExercisesForInjuries.com

Adduction & Extension Adduction & Extension

– Latissimus Dorsi – Pectoralis Major – sternocostal head – Teres major – Long head of triceps – Posterior deltoid – Teres minor

  • Rhomboids

– Main role is to stabilize scapula during ADD & Ext

  • Rotator Cuff

– Active during ADD & Ext

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Rick Kaselj - ExercisesForInjuries.com

Internal Rotation Internal Rotation

– Subscapularis – Anterior Deltoid

Also ADD & Ext

– Pectoralis Major – Latissimus Doris – Teres Major

  • IR > EX by 1.75

torque

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Rick Kaselj - ExercisesForInjuries.com

Horizontal Extension Horizontal Extension

– Primarily posterior deltoid – Lower Trapezius needs to stabilize scapula

  • Paralysis Deltoid

– Difficulty combining shld ext and horizontal ext (arm into a jacket)

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SLIDE 48

Rick Kaselj Rick Kaselj – ExercisesForInjuries Injuries.com

Other Exercises & Injuries Other Exercises & Injuries

– Scapular Stabilization Exercises – Plantar Fasciitis and Exercise – The Most Effective Rotator Cuff Exercise Program – Exercises for Prevention, Rehabilitation and Overcoming Knee Injuries – Corrective Exercises for Running Injury-free – Lumbar Spinal Fusion and Exercise

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SLIDE 49

Rick Kaselj – ExercisesForInjuries.com

Objectives of the Video Objectives of the Video Presentation Presentation

– Part 1 Part 1 – Structure & Movement Structure & Movement

  • Bones

Bones

  • Joints

Joints

  • Movement

Movement

– Part 2 Part 2 – Exercise for Muscle Exercise for Muscle Imbalances in the Shoulder Imbalances in the Shoulder

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Rick Kaselj - ExercisesForInjuries.com

Thank You Thank You

  • Send me your questions!
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$299 in Fitness Education Gifts

  • Rick Kaselj

– rick@ExercisesForInjuries.com – www.ExercisesForInjuries.com