Neuromuscular TherapyApproach to

Shoulder Injuries

Review of Anatomy

Muscles related to front of the shoulder pain

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)

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

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

Scalene Muscles典 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

Pec Mayor 撤 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

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.

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

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

The Physiological Factors:

• 1.) Ischemia• 2.) Trigger Points• 3.) Nerve Entrapment• 4.) Posture & Biomechanical

Dysfunctions• 5.) Nutrition• 6.) Emotional Well Being

Acute Injury

• Rest•  • Ice•  • Compress•  • Elevate

Chronic Pain

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

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

Four Steps of Soft Tissue Therapy cont.

NMT-

• Powerful tool � but commitment to

• change in lifestyle and self-care

• will be necessary for long lasting

• results

Common features of Trigger Points

• Primary activating factors

Secondary Activating Factors

Active and latent features

• Trigger points may be either active or latent

Activation of Trigger Points

Evaluating for the presence of trigger points

Other Common Observations

Treatment Options

Which Method was more effective

Applications of NMT

The order of the routines

• -         Superficial to deep• -         Gliding strokes• - Static pressure and T.P.

don�t last

Moderate Gliding Speed:

• - Assures proper palpation of tissues

How long to apply pressure:

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

Amount of pressure

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

ideal

Communication during the therapy

• -         Pt. Active involvement in treatment.

• -         Q: Is it tender? • -         Q: Does it refer• Q: Is it responding

The Laws

Specific Shoulder Dysfunction

• Capulitis• Supraspinatus Tendinitis• Bicipital Tendinitis

Capsulitis

• Generalized pain rather than localized

• Frozen shoulder

Supraspinatus Tendinitis

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

Bicipital Tendinitis

• Symptoms similar to superaspinatus tendonitis location differs

• (Lipmans test)