A common shoulder pathology seen in the clinic is known as Subacromial Impingement Syndrome. Whether it be due to scapular dyskinesia, poor accessory motion, or whatever, we treat it the same. There are two mechanisms through which subacromial impingement occurs. 1) decreased subacromial space leads to compression of the tissues during abduction. 2) repetitive contact between the greater tubercle and the glenoid damages the tissues.
Due to the multiple contributors to subacromial impingement, the treatment must be addressed in various methods. Some common impairments seen include: decreased motor control of the middle/lower traps, decreased motor control of the serratus anterior, decreased inferior accessory motion, poor scapular humeral rhythm, and of course, poor posture.
An important component for good shoulder control includes proper usage of the scapular stabilizers. Some of the muscle tend to be overused, while others are under-utilized. To determine which muscles belong to, just observe the resting position of the scapula! The press-up and push-up plus have been shown to activate both the lower trapezius and serratus anterior greater than the upper trapezius. Prone flexion, one-arm row, and prone abduction activate the lower trapezius over the serratus anterior, while shoulder press and push-up plus activate the serratus anterior over the lower trapezius. The middle trapezius is activated more than the upper trapezius with prone abduction and one-arm row.
It has been shown that exercise and home exercise programs have success in improving the symptoms of the patient, but the addition of manual therapy (i.e. mobilizations, STM) could potentially improve symptoms even more or faster. Of course scapulohumeral rhythm is of concern. Eccentric exercises of the rotator cuff have been shown to improve the patient's complaints as well.
While other shoulder injuries do not particularly fall into the category of subacromial impingement, I usually include these treatments in my plan of care for many shoulder pathologies. Any time the shoulder undergoes limited motion, the inferior capsule has a tendency to become restricted. With inferior glides, you can help prevent that! And, of course, posture is an issue with almost every individual. Poor posture=poor scapular stabilization. Retraining of the scapular stabilizers can speed up the rehabilitation of your patient.
Andersen CH, Zebis MK, Saervoll C, Sundstrup E, Jakobsen MD, Sjøgaard G, Andersen LL. "Scapular muscle activity from selected strengthening exercises performed at low and high intensities." J Strength Cond Res 2012 Sep;26(9):2408-16. Web. 08/26/2012.
Başkurt Z, Başkurt F, Gelecek N, Özkan MH. "The effectiveness of scapular stabilization exercise in the patients with subacromial impingement syndrome." J Back Musculoskelet Rehabil. 2011;24(3):173-9. Web. 08/26/2012.
Bernhardsson S, Klintberg IH, Wendt GK. "Evaluation of an exercise concept focusing on eccentric strength straining of the rotator cuff for patients with subacromial impingement syndrome." Clin Rehabil. 2011 Jan;25(1):69-78. Epub 2010 Aug 16. Web. 08/26/2012.
Camargo PR, Avila MA, Alburquerque-Sendín F, Asso NA, Hashimoto LH, Salvini TF. "Eccentric training for shoulder abductors improves pain, function and isokinetic performance in subjects with shoulder impingement syndrome: a case series." Rev Bras Fisioter 2011 Nov 21. pii: S1413-35552011005000032. Web. 08/26/2012.
Şenbursa G, Baltaci G, Atay ÖA. "The effectiveness of manual therapy in supraspinatus tendinopathy." Acta Orthop Traumatol Turc. 2011;45(3):162-7. doi: 10.3944/AOTT.2011.2385. Web. 08/26/2012.
If you're a sports fan at any level, you are sure to be aware of a devastating hamstring strain and how limiting it can be. With some individuals, they never seem to fully recover or have a recurrence of the same injury just a few months later. While the hamstring being strained seems to be the common suspect, it is not always the source of the patient's symptoms.
This article takes a look at various injuries that present as hamstring strains and how to identify/treat them. An interesting finding in the article was the lack of support for hamstring stretching and strengthening for the acute hamstring strain. Better results (non-recurrence of injury) were found with core stabilization and agility training.
Things to know before graduation
While graduation just passed, I thought this updated blog post would be appropriate!
Whether you are interested in business, PT private practice, or not, Dr. Carter shares some great advice for anyone who is about to start their career or looking for career advancement.
1) Within some degree, we all have the ability to play a role in determining how much money we will make in our first job, and the difference could be a few thousand dollars.
At my first job I asked for 7,500 more than the starting salary they offered me. After a brief conversation, we settled at 3,500 more than the original offer!
2) Start marketing yourself now. Work on your negotiation skills and do your homework before going into any interview.
I was able to get 3,500 more because I knew the company valued advanced education. I stated that I was Orthopedic Residency trained and was preparing for my OCS and FAAOMPT at the time!
The video below is packed with valuable information for anyone looking to start their career or prepare for the next step in their career! More information on Dr. Carter can be found by clicking the book link below. While this book covers Cash Based Physical Therapy business model, it is loaded with general information regarding setting up a website, marketing in the community, and more. I read this book prior to starting my cash-based practice 1 year ago and it paid dividends.
I highly recommend checking it out!
Dr. Jim Heafner PT, DPT, OCS
More on Dr. Jarod Carter:
Dr. Brian Schwabe's NEW Book in partner with PaleoHacks!
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