10 Shoulder Rehab Techniques MSanchez

The University of TexasHealth Science Center at San AntonioSchool of MedicineJanuary 17‐19, 2013Presented By:Manuel C. Sanchez, PT, MPT, ATC, LATFINANCIAL DISCLOSUREMr. Manuel C. Sanchez, PT, MPT, ATC, LAT has norelevant financial relationships with commercialinterests to disclose.This presentation is the intellectual property of the author. Contact them at msanchez‐cptsmr@att.net forpermission to reprint and/or distribute.

OVERVIEWyyyyyyyyyyyObjectivesAnatomy of the Shoulder ComplexTherapeutic Physical AgentsTaping & BracingManual Therapy TechniquesAerobic ConditioningTherapeutic Exercises: ROM, Flexibility & StrengthNeuromuscular Re‐Education ExercisesPlyometric ExercisesConclusionReferencesOBJECTIVESy To recall the anatomy of the shoulder complex in orderto formulate and implement an appropriate andeffective shoulder rehabilitation programy To attain the knowledge that a comprehensiveshoulder rehabilitation program is vital and crucial toprevent injury and maximize functionBasic Principles of Rehabilitation(Andrews and Wilk 1994)y The effects of immobility must be minimized.y Healing tissue should never be overstressed.y Rehabilitation protocol must be based on scientific andclinical research.y The patient must fulfill specific criteria to progress fromone stage of rehabilitation to the next (criteria basedprogression).y The rehabilitation program must be adaptable to eachpatient, allowing for the desired goals of each patient.y The rehabilitation process is a team effort with thephysician, therapist, trainer, coach, patient and family.This presentation is the intellectual property of the author. Contact them at msanchez‐cptsmr@att.net forpermission to reprint and/or distribute.

Anatomy of the Shoulder Complexy Primary purpose is to position the hand in spacey 3 Bones: Humerus, Clavicle, Scapulay 4 Joints: Glenohumeral, Acromioclavicular,Sternoclavicular & Scapulothoracicy 27 Muscles attach to the shouldery Designed for maximum mobility but inherentlyunstabley Scapulohumeral Rhythm‐Elevation of the armdistributed between GH & ST jointsTherapeutic Physical AgentsyMoist Hot Pack/Cold PackyElectrical Muscle StimulationyUltrasoundyIontophoresisTaping & BracingyShoulder StabilizersyShoulder SkeletonyAC joint tape with orthoplast padySC joint Kinesio TapeThis presentation is the intellectual property of the author. Contact them at msanchez‐cptsmr@att.net forpermission to reprint and/or distribute.

Taping and BracingTaping and BracingTaping and BracingThis presentation is the intellectual property of the author. Contact them at msanchez‐cptsmr@att.net forpermission to reprint and/or distribute.

Taping and BracingTaping and BracingManual Therapy TechniquesyyyyySoft Tissue MobilizationAxilla ReleaseCervical DistractionScapula MobilizationsGH Joint MobilizationsOpen Pack Position: 30 degrees of flexion, 55 of abductionLong Axis TractionAnterior GlidesPosterior GlidesInferior GlidesThis presentation is the intellectual property of the author. Contact them at msanchez‐cptsmr@att.net forpermission to reprint and/or distribute.

Aerobic ConditioningyUBEyAirdyne BicycleyElliptical TraineryTotal Gym Pull DownsTherapeutic Exercises: ROM,Flexibility & StrengthyROM EXERCISESyyyyyStick Exercises X 5Pulley Exercises X 3Pendulum X 4Table Top X 3Finger Ladder X 2Therapeutic Exercises: ROM,Flexibility & Strengthy FLEXIBILITY EXERCISESyyyyyyyyHorizontal AdductionIR with strapER at doorway, 0 and 90 degreesForward flexion at doorwayUpper TrapeziusLevator ScapulaSternocleidomastoidScalenesThis presentation is the intellectual property of the author. Contact them at msanchez‐cptsmr@att.net forpermission to reprint and/or distribute.

Therapeutic Exercises: ROM,Flexibility & StrengthySTRENGTH EXERCISESy Isometrics X 8y Theraband X 8y Isokineticy Free Weightsy Don’t forget to strengthening the joints aboveand below the shoulder bicep curls, tricepsextensions, cervical spineSTRENGTH EXERCISESy Glenohumeral JointFlexion: Supraspinatus, Infraspinatus,Subscapularis, Anterior & Middle DeltoidAbduction: Supraspinatus, Infraspinatus,Subscapularis, Anterior DeltoidScaption in IR: Supraspinatus, Subscapularis,Anterior & Middle Deltoid,Scaption in ER: Anterior & Middle DeltoidProne Horizontal Abduction at 100 degrees ABD:SupraspinatusProne Horizontal Abduction in ER: Infraspinatus,Teres Minor, Middle & Posterior DeltoidSTRENGTH EXERCISESy Glenohumeral JointProne Horizontal Abduction in Neutral:Infraspinatus, Teres Minor, Middle & PosteriorDeltoidMilitary Press with Dumbbell: Supraspinatus,Subscapularis, Anterior DeltoidExternal Rotation in Side Lying: Infraspinatus,Teres Minor, Posterior DeltoidProne Extension: Posterior DeltoidRowing: Posterior DeltoidPress Up: Pectoralis Major, Latissimus DorsiPush Up with Hands Apart: Pectoralis MajorThis presentation is the intellectual property of the author. Contact them at msanchez‐cptsmr@att.net forpermission to reprint and/or distribute.

Strength ExercisesStrength ExercisesStrength ExercisesThis presentation is the intellectual property of the author. Contact them at msanchez‐cptsmr@att.net forpermission to reprint and/or distribute.

Strength ExercisesStrength ExercisesStrength ExercisesThis presentation is the intellectual property of the author. Contact them at msanchez‐cptsmr@att.net forpermission to reprint and/or distribute.

Strength ExercisesNeuromuscular Re‐EducationExercisesNeuromuscular Re‐EducationThis presentation is the intellectual property of the author. Contact them at msanchez‐cptsmr@att.net forpermission to reprint and/or distribute.

Neuromuscular Re‐EducationExercisesPlyometric ExercisesPlyometric ExercisesThis presentation is the intellectual property of the author. Contact them at msanchez‐cptsmr@att.net forpermission to reprint and/or distribute.

Plyometric ExercisesConclusiony The shoulder complex is one of the most challengingjoints to rehabilitate. The goal of a comprehensiverehabilitation program should be to return the patientor athlete to their previous level of function, if not atan improved state.y By incorporating the physical therapist’s and athletictrainer’s overall knowledge of the shoulder complex,the patient/athlete will be provided with acomprehensive program that will not only lead to ahigh level of function but also a prevention of furtherinjury.References¾ Andrews, J.R., Harrelson, G.L., Wilk, K.E. (2004) Physical Rehabilitationof the Injured Athlete, Saunders, Philadelphia, PA, Pgs. 189‐212¾ Belanger, Alain‐ Yvan. Evidence‐ Based Guide to Therapeutic PhysicalAgents. Baltimore, MD 21201: Lippincott Williams & Wilkins, 2003. Print.¾ Brewer, P., (2006). Anatomy I notes UTHSCSA; San Antonio, TX¾ DeLee, J.C., Drez, D.,(2003). Orthopaedic Sports Medicine, Principles andPractice, Saunders, Philadelphia, PA, Pgs. 330‐334¾ Dutton, M., (2004) Orthopaedic Examination, Evaluation & Intervention.McGraw‐Hill, New York, Pgs. 1201‐1223, 1324‐1327¾ Geelhood, M., (2007) Orthopedic II Notes UTHSCSA; San Antonio, TX¾ Neumann, D. Kinesiology of the musculoskeletal system. St. Louis:Mosby, Inc, 2002. Print.¾ Wells, L., (2007) Orthopedic II Notes UTHSCSA; San Antonio, TXThis presentation is the intellectual property of the author. Contact them at msanchez‐cptsmr@att.net forpermission to reprint and/or distribute.

yElliptical Trainer yTotal Gym Pull Downs Therapeutic Exercises: ROM, Flexibility & Strength yROM EXERCISES yStick Exercises X 5 yPulley Exercises X 3 yPendulum X 4 yTable Top X 3 yFinger Ladder X 2 Therapeutic Exercises: ROM, Flexibility & Strength yFLEXIBILITY