Trouble treating overhead shoulder pain?

Proper shoulder function is all about proper starting posture. Many of our patients start from a poor position, and therefore have pain with overhead movements. For example, many patients rest is scapular downward rotation. This position places the rhomboids in a short, dominant position. In the same example, the serratus anterior and lower trapezius (both upward rotators) are lengthening and relatively inhibited. If we can neutralize scapulothoracic mechanics, chances of pain free overhead movement will increase. In this post, I break down Eric Cressey's video on Cues to Improve Shoulder Flexion.

Eric Cressey's 3 Cues:
1) Assess for an adducted/downward rotated posture. This patient is not appropriately activating their upward rotators. With these individuals cue them to make a bigger arc of motion as they are raising overhead. The bigger arc will allow for more scapular upward rotation.
2) Assess for anterior tilt and a prominent inferior angle of the scapula. With this cue, manually assist the patient into posterior tilt as they are raising their arm overhead. The practitioner will be mimicking the function of the lower trap and serratus by posteriorly tilting the scapula.
3) Assess for scapular depression and Lat Dorsi dominance. Due to their resting posture (clinically interpreted as downsloping shoulders), these patients often have lengthened upper trapezius muscles. Start in a neutral scapular posture. Have the patient raise overhead. When the subject gets to about 90 degrees of shoulder flexion have them perform a small shoulder shrug. This will help engage the upper trapezius and allow for better clearance of the humerus under the acromion.

-Jim

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Should the Upper Trap Be Stretched?

With the common perception that the UT is often short (especially with patient reports of the muscle feeling "tight" when put on stretch - of course), it is not surprising that stretching is frequently prescribed for the muscle in patients with neck and/or shoulder pain. That's not to say it is never warranted. If the muscle length is truly assessed and found to be adaptively shortened (and non-painful), of course we want to stretch the muscle. However, we must be certain that the muscle is indeed shortened first. Continue Reading

Parascapular Contribution to Cervical Pain

Those of you who are familiar with Shirley Sahrmann's work on the upper quarter are likely familiar with how scapular positioning can impact cervical mobility and pain. With downwardly rotated and depressed scapula, the upper trapezius, in addition to other cervical musculature, is placed on stretch providing a compressive force to the cervical spine, limiting cervical mobility and potentially causing pain. This can be assessed by providing support to the shoulder girdles and reassessing the motion and pain levels. Continue Reading