What team open baseball the first 60 years?

How many president threw out the first pitch? Who was the first?

Eleven - Taft

What did Truman do differently?

First Southpaw

Opening day Snow Fight• Unfortunately, Opening Day has also been marred by riots and civil disobedience.

• At the start of the 1907 season, the New York Giants opened against the Phillies following a heavy snowstorm.

• In preparation for the game, groundskeepers were forced to shovel large drifts of snow onto the outer edges of the field in foul territory.

• • After falling behind 3-0, the disappointed fans at the Polo Grounds began hurling

snowballs onto the playing field, disrupting play.

• As the melee progressed, chaos ensued and fans began rushing onto the field to continue the snowball fight.

• After being pelted, Home plate umpire Bill Klem had enough and called a forfeit in favor of the Phillies.

Rehabilitation of Shoulder Instability

• Ligamentous/capsular laxity (non-contractile)

Treatment strategies

• Bracing• Taping• Muscle strengthening• Proprioceptive/kinesthetic training• Neuromuscular dynamic stability

• Posterior instability response better than anterior instability

Scapulothoracic Exercises4 Core Exercises (Mosley)

• 1. Scaption with the thumb up for the upper trapezius

Scaption

• (abduction in the scapular plane of 30-45 degrees forward in the horizontal plane) or flexion;

2. Press up for the lower trapes, latissimus doris and teres minor

3. Push up with a plus for the serratus anterior

4. Scapular Retraction for the Middle Trapezius and Rhomboids

Glenohumeral ExercisesTownsend 4 Core Exercises

• 1. Scaption with the thumb down (up) empty can or full can for the supraspinatus

2. Press ups for the lower trapezius, latissimus dorsi and teres major

3. GH flexion for the anterior deltoid and the coracobrachialis

4. External Rotation with horizontal extension for the infraspinatus, teres minor, and posterior

deltoid

Rotator Cuff Exercises (30/30/30 Position)

• 30 degrees of abduction• 30 degrees of scaption• 30 degrees of diagonal tilt

30 degrees of abduction

• Used to protect the rotator cuff and prevent wringing out effect on the supraspinatus tendon

Second 30 degree position places the arm into scaption

• Protects the anterior inferior capsule• Prestretches the posterior rotatator cuff

muscles• External rotation muscles are the weakest of

the 6 directions of the GH joint

30 degree diagonal tilt

• Prevents a posterior internal impingement and is more comfortable than the transverse plane position when performing GH rotation exercises

• Studies show that adducting muscle activity will increase the space of the subacromial space

Summary reason to use the 30/30/30

• Prevents the wringing out effect• Scaption position protects the anterior

inferior capsule• The scaption position is a functional arc of

motion for the shoulder• Comfortable positions to do ER/IR exercises• GH adduction increases the width of the

subacromium space

• Advance the patient to the 90/90 position to advance the rotator cuff strengthening program if the patient need to use the arm in overhead activities

Total Arm Strengthening Exercises (TAS)

• Biceps and triceps cross the GH joint can contribute to dynamic stability of the GH joint

Exercise Progression Continuum

• Multiple-angle isometrics submaximal effort• Multiple-angle isometrics maximal effort• Short arc exercises submaximum effort• Short arc exercises maximum effort• Full ROM exercises submaximum effort• Full ROM exercises maximum effort

Cross Education Training?

10-15% increase in strength on the contralateral side

Bilateral deficits?

Total strength is less than sum of each individually

Systematic Variable Range Repetition

E2C

E2C

Eccentric to concentric

Deceleration and acceleration impulses create more muscle tension

Increasing progressive ranging exercises the intensity of exercises is

increased at the additional angle

Progressive Range of Motion

Protects the soft tissue healing structures

As heal add more ROM

Time rate of force development

Ability to develop force rapidly (FT fibers)

Contra-Coup Concept of shoulder stability

(C3-S2)

Common Thought

• ER most important and the subscapularis for anterior instability

Contra-Coup Concept

• Subscapularis contraction cause anterior translocation of the humeral head

• Infraspinatus contracture causes posterior translation of the humeral head

• Use GH: IR:ER is 3:2 or ratio 100%:66%

Neuromuscular Proprioceptive/Kinesthetic Deficits (Functional Neuromuscular Dynamic

Stability

Functional Stability is dependent on neuromuscular dynamic control

Stage 1: Proprioception and Kinesthetic Exercises (baseline for Dynamic stability)

• Diminish Pain and Inflammation• Normalize motion• Restore proprioception and kinesthesia• Establish muscular balance

Stage 2: Dynamic (Proactive) Stabilization Exercises

• Restore muscular balance• Enhance dynamic functional stability• Rhythmic stabilization

Stage 3: Reactive Neuromuscular Control

• Improve muscular power and endurance• Enhance dynamic stability thru

proprioceptive and kinesthesia• Improve reactive NM abilities• Rhythmic stabilizations

Stage 4: Functional Skill Movements and Activities

• Maintain shoulder joint complex muscular balance

• Maintain reactive NM dynamic stability• Gradual return back to activities

Summary

• Heavy Focus on dynamic stabilizers and neuro muscular control