Download - Keeping Your Shoulders Healthy
-
8/2/2019 Keeping Your Shoulders Healthy
1/38
Keeping Your Shoulders Healthy
Witaya Mathiyakom1, PT, PhDJill McNitt-Gray2, PhD
1Andrus Gerontology Center2Biomechanics Research Laboratory
Department of Kinesiology
USC
-
8/2/2019 Keeping Your Shoulders Healthy
2/38
Musculoskeletal pain in dental hygienists
Neck/
Shoulders
Neck Shoulders Elbows/
Wrists/Hands
Elbows Wrists/
Hands
Prevalence of
Musculoskeletal
Symptoms
(%)
0
20
40
60
80
100
*
** *
Dental Hygienists
Reference
Akesson et al., Int Arch Occup Environ Health, 1999
-
8/2/2019 Keeping Your Shoulders Healthy
3/38
Common diagnoses observed among
dental hygienists with shoulder pain
Upper Trapezius Myalgia
Levator Scapulae Myalgia
Akesson et al., Int Arch Occup Environ Health, 1999
Thoracic Outlet Syndrome
Supraspinatus Tendinitis Frozen Shoulder
-
8/2/2019 Keeping Your Shoulders Healthy
4/38
Tasks
Force Repetition
Static posture
Common contributing factors
associated with the common diagnoses
Result
Adaptation andImbalance of the
muscles involved
-
8/2/2019 Keeping Your Shoulders Healthy
5/38
Static contraction:
Uppertrapezius
Levator scapulae Reducing circulation to these muscles
Repeated microtrauma
Upper Trapezius and Levator ScapulaeMyalgia
Prolonged stretch:
Lower trapezius
Middle trapezius Poor scapular stabilization
Prolonged elevation of the scapula
-
8/2/2019 Keeping Your Shoulders Healthy
6/38
Tightness: Pectoralis Minor
Brachial plexus
Axillary artery
underneath the pectoralis minor
Thoracic Outlet Syndrome
Prolonged stretch:
Lower trapezius
Middle trapezius
Poor scapular stabilization
Prolonged Anterior tilt of the scapula
-
8/2/2019 Keeping Your Shoulders Healthy
7/38
Strong contraction
Pectoralis major
Latissimus dorsi
Teres major
Counterbalanced by
Subscapularis
Imbalance between these muscles
will result in anterior translation
of humeral head - tendinitis
Static shoulder flexion
and internal rotation
-
8/2/2019 Keeping Your Shoulders Healthy
8/38
Static abduction of the shoulder
Strong contraction
Deltoid
Adequate activation of the
rotator cuffs to position the
humeral head
Imbalance between these muscles will result in upward
translation of humeral head impingement, tendinitis
-
8/2/2019 Keeping Your Shoulders Healthy
9/38
What do you need
to keep your shoulders healthy? Keeping good posture throughout the day
Changing position often
Preserving adequate muscle length and joint mobility
Tight and stiff muscles limit range of motion
and create compensatory movements Lengthened muscles are likely to be weak
Strengthening muscle at the range required
Weakness of the lengthened muscles observed in end range
Coordinating the involved muscles
Proper muscle length and strength provide a window for good
coordination
-
8/2/2019 Keeping Your Shoulders Healthy
10/38
What can you do?
If you have symptoms, pain, discomfort,
Seek professional help from MD and PT
You can benefit from a preventive exerciseprogram
Gentle range of motion and stretching
Simple strengthening exercise
Simple self-assessment will help you identifythe exercises that fit you!!!
-
8/2/2019 Keeping Your Shoulders Healthy
11/38
What to look for?
DepressedDownward Rotated
Scapula
Anterior tilt
of scapulaShoulder
Internal
Rotation
ForwardHead
Posture as a clue of alignment and muscle length
Long and Weak
Upper Trapezius?
Tight Shoulder
internal
rotators?
Long and Weak
Upper Trapezius
& Levator
Scapulae?
Tight
pectoralis
minor?
Weak Lower
Trapezius?
-
8/2/2019 Keeping Your Shoulders Healthy
12/38
Posture
Anterior tilt of
the scapula
Forward
Translation of
the humeral
head
-
8/2/2019 Keeping Your Shoulders Healthy
13/38
Pectoralis Minor Tightness
Anterior
tilt ofscapula
Between-sides differences in tightness of
the pectoralis minor
-
8/2/2019 Keeping Your Shoulders Healthy
14/38
Tight Pectoralis Minor
affects trunk control
-
8/2/2019 Keeping Your Shoulders Healthy
15/38
Tight shoulder internal rotators
limit external rotationStarting Position Finishing PositionResting Posture
-
8/2/2019 Keeping Your Shoulders Healthy
16/38
-
8/2/2019 Keeping Your Shoulders Healthy
17/38
Weakness of the external rotators
Starting Position Finishing Position
-
8/2/2019 Keeping Your Shoulders Healthy
18/38
Latissimus Dorsi Tightness
-
8/2/2019 Keeping Your Shoulders Healthy
19/38
Limited Shoulder Internal Rotation
-
8/2/2019 Keeping Your Shoulders Healthy
20/38
Weakness of Internal Rotators
SubscapularisStarting Position Finishing Position
-
8/2/2019 Keeping Your Shoulders Healthy
21/38
What can you do?
These exercises are suggested to improve your shouldermechanics.
You need to perform them correctly Check your posture throughout the day
Good quality practice at all time
To strengthen the muscles, use high enough weightbut without compensation
10 reps, 3 sets
Always check your form!!!
To stretch, hold the position at least 30 seconds
-
8/2/2019 Keeping Your Shoulders Healthy
22/38
Levator Scapulae Stretch
Starting Position Finishing Position
Lateral Flexion to opposite side
Flexion
Rotation to the opposite side
-
8/2/2019 Keeping Your Shoulders Healthy
23/38
Upper Trapezius Stretch
Starting Position Finishing Position
Lateral Flexion to opposite side
Flexion
Rotation to the same side
-
8/2/2019 Keeping Your Shoulders Healthy
24/38
Pectoralis Minor StretchStarting Position Finishing Position
Applied downward force on
the coracoid process
Added a roll of towel under
the spine
-
8/2/2019 Keeping Your Shoulders Healthy
25/38
Pectoralis Minor StretchStarting Position Finishing Position
Applied downward force on the coracoid
processAdded rotation to the opposite side
-
8/2/2019 Keeping Your Shoulders Healthy
26/38
Latissimus Dorsi Stretch
Starting Position Finishing Position
Maintained shoulder external rotation
Stabilized the inferior angle of the
scapula with the other hand if it
protudes out to the side
-
8/2/2019 Keeping Your Shoulders Healthy
27/38
Shoulder Internal Rotation Stretch
Limited shoulder internal rotation is
indicated by an inability to internally
rotated the humeral head to 70
Compensatory movement of the scapula
is observed when the person is trying to
internally rotate the shoulder beyond the
available range
To do this stretch, start with arm at 90
with your elbow flexed
Internally rotate your shoulder as far asyou can without moving your shoulder
blade, use the other arm to stabilize the
shoulder
-
8/2/2019 Keeping Your Shoulders Healthy
28/38
External Rotators Strengthening
Starting position:
Prone, Arm at 90, elbow flexed
Movement:External rotate your shoulder
as shown without movements
of the shoulder blade
Also, DO NOT move your elbowoff the table
Range of motion:
Normal range of motion is ~ 90
from the starting position
if you have limited shoulder
internal rotation range, you may
need to work your way toward that
-
8/2/2019 Keeping Your Shoulders Healthy
29/38
External Rotators Strengthening
Starting Position Finishing Position
-
8/2/2019 Keeping Your Shoulders Healthy
30/38
External Rotators Strengthening
Starting position:
Side lying, with a towel under
your arm, elbow flexed 90
Movement:External rotate your shoulder
as shown without movements
of the shoulder blade
Range of motion:Normal range of motion is ~ 90
from the starting position
if you have limited shoulder
internal rotation range, you mayneed to work your way toward that
-
8/2/2019 Keeping Your Shoulders Healthy
31/38
Internal Rotators Strengthening
Starting position:
Prone with arm at 90, elbow
flexed
Movement:
Internally rotate your shoulder
as shown without movements
of the shoulder blade
Also, DO NOT move your elbow
off the table or toward your body
Range of motion:
Normal range of motion is ~ 70
from the starting position
if you have limited shoulder
internal rotation range, you may
need to work your way toward that
-
8/2/2019 Keeping Your Shoulders Healthy
32/38
Lower Trapezius Strengthening
Starting position: Prone on your stomach with arms at 135, elbows extended
thumbs up
Movement: initiate with movement by squeezing the shoulder bladestogether then lifting the arms off the table
Tips: Add 1-2 lbs weight, progress slowly
-
8/2/2019 Keeping Your Shoulders Healthy
33/38
Lower Trapezius Strengthening
Starting Position Finishing Position
-
8/2/2019 Keeping Your Shoulders Healthy
34/38
Lower Trapezius Strengthening
Starting Position Finishing Position
-
8/2/2019 Keeping Your Shoulders Healthy
35/38
Middle Trapezius Strengthening
Starting position: Prone on your stomach with arms at 90, elbows extended
thumbs up
Movement: initiate with movement by squeezing the shoulder bladestogether then lifting the arms off the table
Tips: Add 1-2 lbs weight, progress slowly
-
8/2/2019 Keeping Your Shoulders Healthy
36/38
Middle Trapezius Strengthening
Starting Position Finishing Position
-
8/2/2019 Keeping Your Shoulders Healthy
37/38
Middle Trapezius Strengthening
Starting Position Finishing Position
-
8/2/2019 Keeping Your Shoulders Healthy
38/38
References Akesson, I., B. Johnsson, et al. (1999). "Musculoskeletal disorders among female dentalpersonnel--clinical examination and a 5-year follow-up study of symptoms." Int Arch
Occup Environ Health 72(6): 395-403.
Decker, M. J., J. M. Tokish, et al. (2003). "Subscapularis muscle activity during selectedrehabilitation exercises." Am J Sports Med 31(1): 126-34.
Hintermeister, R. A., G. W. Lange, et al. (1998). "Electromyographic activity andapplied load during shoulder rehabilitation exercises using elastic resistance." Am JSports Med 26(2): 210-20.
Hoppenfeld, S. (1976). Physical Examination of the Spine and Extremities. Norwalk,Appleton-Century-Crofs.
Reinold, M. M., K. E. Wilk, et al. (2004). "Electromyographic analysis of the rotatorcuff and deltoid musculature during common shoulder external rotation exercises." JOrthop Sports Phys Ther34(7): 385-94.
Sahrmann, S. (2002). Diagnosis and Treatment of Movement Impairment Syndromes.St. Louis, Mosby.
Yee, T., L. Crawford, et al. (2005). "Work environment of dental hygienists." J Occup
Environ Med 47(6): 633-9.