Neuromuscular Therapy Approach to Shoulder Injuries Review of Anatomy

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Neuromuscular TherapyApproach to Shoulder
Injuries Review of Anatomy
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Muscles related to front of the shoulder pain
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Infraspinatus

• Pain in this muscle creates an inability to reach
  behind to a back pocket or to bra hooks , and in
  front to comb the hair or brush the teeth
• Corrective actions pillows , avoid abitual
  sustained repetitive motion (putting on curlers)

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Deltoid

• Pain in this muscle creates a dull ache
• Trigger points in this muscle may result from
  impact, trauma ,and sports,or from over exultion
• Posterior Deltoid Tps painfully weaken abduction
  of the internally rotated arm
• Corrective actions Include elimination of
  perpetuating mechanical stresses,and a program
  of daily stretching exercise to prevent
  reactivations of TPs

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Supraspinatus?Subdeltoid Bursitis Mimicker?

• Activation of TPs is likely to result when heavy
  objects are carried with the arm hanging down ,
  or when lifted above shoulder height
• Corrective Action include the avoidance of
  continued overload of the muscle ,and the use of
  a stretch exercise at home while seated under a
  hot shower

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Scalene Muscles?he Entrappers?

• Activation of trigger points occurs by pulling ,
  lifting , and tugging by over use of these
  accessory inspiratory muscles as in coughing and
  by chronic muscle strain due to a tilted
  shoulder-girdle axis caused by body asymmetry
  with a short leg or small half-pelvis
• Corrective actions essential for continued
  relief and require daily passive side bending by
  doing the neck-stretch exercise,correction of
  body asymmetry, relief of respiratory overload

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Pec Mayor ?oor posture and heart attack?

• Patient examination reveals shortening of the
  Pectoralis mayor muscle by active or latent TPs
  which pulls the shoulder forward to produce a
  stooped,round-shouldered posture
• Corrective Actions convincing the patients(when
  true) that the myofascial chest pain is a
  treatable pain of skeletal muscle rather then of
  cardiac origin. Correction of poor standing and
  sitting posture, avoidance of mechanical overload
  of this muscle, and in the door way stretch
  exercise help to insure continued freedom from
  this myofascial

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Subscapularis? Frozen shoulder?

• Patient examination identifies involvement of
  this muscle by the marked reciprocal limitation
  of abduction and external rotation of the arm at
  the shoulder.
• The humeral attachment of the muscle is tender to
  palpation.
• Corrective action include avoidance or prolonged
  shortening of the muscle both at night and during
  the day time , and regular use of in the door
  stretch exercise at home.

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Initial Assessment

• Twelve Steps
• 1. Client History
• 2. Assess Active Range of Motion
• 3.Assess Passive Range of Motion
• 4.Assess Resisted Range of Motion
• 5. Area Preparation
• 6. Myofascial Release

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Initial Assessment cont.

• 7. Trigger Point Therapy
• 8. Cross Fiber or Multidirectional Friction
• 9. Pain Free Movement
• 10. Eccentric Scar Tissue Alignment
• 11. Stretching
• 12. Strengthening

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The Physiological Factors

• 1.) Ischemia
• 2.) Trigger Points
• 3.) Nerve Entrapment
• 4.) Posture Biomechanical Dysfunctions
• 5.) Nutrition
• 6.) Emotional Well Being

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Acute Injury

• Rest
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• Ice
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• Compress
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• Elevate

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Chronic Pain

• Is considered to be that which remains at least
  three weeks after injury

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Four Steps of Soft Tissue Therapy-(In order
listed)

• 1.)    Decrease the spasm and hyper contraction
  of the soft tissue with neuromuscular therapy
• 2.)    Restore flexibility by appropriate
• stretching

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Four Steps of Soft Tissue Therapy cont.
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NMT-

• Powerful tool ? but commitment to
• change in lifestyle and self-care
• will be necessary for long lasting
• results

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Common features of Trigger Points

• Primary activating factors

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Secondary Activating Factors
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Active and latent features

• Trigger points may be either active or latent

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Activation of Trigger Points
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Evaluating for the presence of trigger points
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Other Common Observations
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Treatment Options
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Which Method was more effective
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Applications of NMT
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The order of the routines

• -         Superficial to deep
• -         Gliding strokes
• - Static pressure and T.P. don?t last

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Moderate Gliding Speed

• - Assures proper palpation of tissues

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How long to apply pressure

• - Will vary, should soften 8-12 sec.

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Amount of pressure

• -         Can vary greatly
• -         Physical make up
• - Scale 1-10 (5 ? 6 ? 7 ) ideal

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Communication during the therapy

• -         Pt. Active involvement in treatment.
• -         Q Is it tender?
• -         Q Does it refer
• Q Is it responding

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The Laws
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Specific Shoulder Dysfunction

• Capulitis
• Supraspinatus Tendinitis
• Bicipital Tendinitis

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Capsulitis

• Generalized pain rather than localized
• Frozen shoulder

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Supraspinatus Tendinitis

• - Associated with subdeltoid or acromeal bursites
  or rotation cuff dysfunction

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Bicipital Tendinitis

• Symptoms similar to superaspinatus tendonitis
  location differs
• (Lipmans test)