Shoulder subluxation

[theshoulderguy]

Hi Sally, thanks for the FB like.

My page is really going places and will look much better in a few weeks. If you want to keep in contact then just post questions there or just watch out for the occasional post from me.

IMO it is pretty hard to monitor all things going on when someone raises the arm up? You know...scapula upward rotation, muscle patterning sequence, scapulohumeral rhythm etc. It becomes a bit easier with practice.

What I meant by -'Focus on good cuff activation through abduction range first before moving to an upper body strength program' was to make sure that your patient has a nice stable looking scapula through abduction first without load and then make sure your patient has a nice stable looking scapula through abduction range with a very light external rotation load.

That load to initiate cuff (external rotation) activation could be a light resistance theraband.

You want your patient to have good external rotation activation on a stable scapula at 0 degrees abduction, 45 degrees all the way to 90 degrees and higher if the task/sport requires it.

Now here's a HUGE tip! (Keep it Secret Okay?)

The #1 mistake most physio's make is to tell their patient's to pull the arm/elbow into the side or forcefully into a towel when doing external rotation in neutral abduction or start by squeezing a pillow to your side to "engage the cuff". This tends to put the shoulder into a "co-contraction" with the larger internal rotators (Pecs and Lats) working more predominantly and not the external rotators (see Karen Ginn's work).

So a sign of good external rotation cuff control is when the arm can freely externally rotate but also maintain a level of relaxation not co-contraction. The arm has to be relaxed. Don't allow your patient's to pull the arm to their side as a way of cheating, because they will want too. The arm needs to just hang by the side in a relaxed way and the focus should be on strict pure rotation with relaxation.

If it seems too hard for the patient it probably is... so go slow and get good activation first then the strength will come.

I hope this helps you Sally.

Feel free to comment about this post on my FB page.

All the Best

Luke

The Shoulder Guy

[naveenedin]

hi there
thanks for innovative ideas. May i get more details about karen ginn's work and your concept about shoulder safe zone. i havent heard of neither of that before, would you mind sharing please.

[theshoulderguy]

Hi Naveenedin, Karen Ginn is a researcher at the University of NSW in Australia and I like the way she thinks. Search for some of her articles etc

The "Shoulder Safe Zone" is a concept that I use to describe where not to put the shoulder during rehab, gym based exercise etc. The "Safe Zone" is one where the elbows are kept in the scapula plane be it in standing, sitting or supine. The scapula plane is the limit of motion for things like rows, bench, overhead press, ER at 90 ABD etc.

As a rough estimate, stand up and pretend to wave good bye to someone...your arm position is pretty close to scaption in a nice and neutral relatively relaxed position. This position helps the HOH contact the sweet spot of the glenoid.

Check it out and use this principle for better results.

Cheers

Luke (The Shoulder Guy)


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