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Workshop Four Scapular Control and ROM restoration

It would take the whole term just focussing on the shoulder girdle to cover protocols and
approaches to the numerous possible shoulder conditions.

Therefore we will focus on scapula control rehabilitation as the initial part of any shoulder problem
where you can identify scapular dyskinesis (very common!!!! Especially in those chronic patients and
patients with cervical conditions (see last weeks class on scapular offloading test).

You will not be commonly rehabilitating throwing athletes/tennis players etc you will need to do
your own CPD/reading on these topics if interested.

Scapular Rehabilitation

Assess scapulohumeral rhythm active ROM Abduction & scapular plane (some literature
advocates using weights to assess properly) focus on range and pain in GH joint, and then
focus on scapular control on upward and downward rotation. Is there jumping, shaking, lack
of motion or control?
Assess loaded scapula (standing push up or kneeling push up)

Standing assessment less fit, active shoulder pain patients, older patients

Kneeling push up for fitter patients, pts with minor shoulder pain = challenge scapular control

Assess control, symmetry. Look for medial border coming away from the thorax prematurely or
compared to the good side.
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Rehabilitation exercises for scapular control done closed chain and prior to strengthening of
rotator cuff muscles

Serratus anterior weakness (winging = medial border protrusion)

Progression

1. Closed chain - Isometric non WB standing against wall, + active ROM of ST joint open
chain into protraction to retraction and back (above left)
2. Closed chain: Isometric WB kneeling/full push up plank position move through closed
chain protraction/retraction
3. Closed chain WB/Functional theraband green/blue (above right)

Lower trapezius- Poor downward rotation control

1. Closed chain theraband: theraband green/blue (below) perform with elbows bent,
beginning at reduced ROM (e.g. from 90 degrees of abd to arms down to side in both
abduction plane and scapular plane activates both lats and lower trapezius. Below left

Low Row Isometric (above right)

Stand next to a medium height bench, place hand so you can push back into the bench. Lean slightly
back through your trunk, and push hand back into bench, focussing on the shoulder blade moving
back towards the spine, as well as the arm pushing back. Hold for 3-5 secs. This will strengthen your
triceps, shoulder blade stabilizer
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Progression closed chain repeat movement and position, slowly extending the elbow and
shoulder against resistance (theraband) then progressing to tricep dips (below)

Bent over row/lawnmover (below left)

Initially done without resistance (open chain active ROM), then progressed by adding theraband,
then hand held weights (e.g. filled up water bottles 500ml = 500g)

Closed Chain weight shift (above right)

1. Use table aks patient to shift their weight from good arm to bad arm, you can add small
movements into protraction/retraction
2. Use duradisc/wobble board as above, but duradisc adds challenge to control of movement

Restoration of ROM

If shoulder movement is significantly restricted and painful, try using pendulum exercises to gently
increase ROM early in presentation in acute patients. The important point is the patient needs to
relax the muscles and let gravity (initially) then a small weight pull the shoulder. The arm should
swing loosely (hang) through the ROM

Cane assisted exercises