We’ve known for a while that thoracic spine mobility was a factor in the performance of the shoulder. That’s why we stressed the importance of regular mobilization of the thoracic spine in Inside-Out.
We now have research in support of the influence of thoracic spine mobility, and it’s effect on shoulder range of motion. Here’s a segment of the abstract:
“Title: THE EFFECT OF THORACIC STRETCHING AND MOBILIZATION ON
Place: CPRS Physical Therapy,
Results : Improvements in AROM and PROM shoulder flexion, IR, and ER were demonstrated in all treatment groups with the most significant improvements being made in AROM and PROM shoulder IR. Group 1 (SS): AROM IR change in degrees=(mean ± SD) 4.2° ± 4.4°, PROM IR change in degrees= 6° ± 4° ;Group 2 (MS): AROM IR change in degrees= 8.6° ± 6.5°, PROM IR change in degrees= 8.5° ± 6.9°; Group 3 (PS): AROM IR change in degrees= 5.2° ± 7°, PROM IR change in degrees= 6.3° ± 7.4°; Group 4 (TJM): AROM IR change in degrees= 10° ± 7.6°, PROM IR change in degrees= 5.8° ± 5.1°.
Conclusions : Based on our findings, maneuvers for addressing thoracic mobility and thoracic ROM correlate with improvements in glenohumeral ROM in each plane, with the greatest changes being made in glenohumeral IR. The most significant gains in IR ROM were made after treatment with a grade V thoracic spine mobilization. Not all changes in ROM demonstrated statistically significant changes after one treatment, however 18% average improvements in IR ROM after one treatment demonstrate clinically significant changes and the need for further research.
Clinical Relevance : Assessment and treatment of thoracic spine mobility and thoracic extension should be considered in the evaluation and treatment of decreased glenohumeral joint
Bill
After many requests here’s an example of the posterior capsule stretch.
To effectively stretch the upper and middle posterior capsule, a position of 30 degrees of elevation in the scapular plane with internal rotation was determined as more effective.
Source: The American Journal of Sports Medicine 36:2014-2022 (2008)
Bill
A common finding in cases of shoulder impingement is a loss of glenohumeral internal rotation. This loss of internal rotation, often referred to as glenohumeral internal rotation deficit (GIRD), promotes an upward and anterior shift of the humeral head into the acromion or coracoacromial ligament resulting in the impingement.
The ligamentous structure of the shoulder joint, the capsule, will often become stiffened or shortened over time due to daily/work activities, sporting activities (especially throwers), and those heavily involved in weight training (especially bodybuilders and powerlifters).
The common recommended stretch for posterior capsule stiffness is the “sleeper stretch”. This stretch is commonly performed in side lying with the downside arm at 90 degrees of flexion and then the shoulder is passively internally rotated until the optimal stretch is achieved.
Recent research shows that this position doesn’t actually produce any significant strain (stretch) to the posterior capsule making it ineffective for the intended purpose.
To effectively stretch the upper and middle posterio capsule, a position of 30 degrees of elevation in the scapular plane with internal rotation was more effective. To effectively stretch the upper and lower portions of the posterior capsule, the shoulder should be placed in 30 degrees of extension and then internally rotated.
This may explain some of the frustration experienced by many with posterior capsule stiffness and ongoing shoulder symptoms as their methods was simply ineffective. It wasn’t their lack of effort.
Source: The American Journal of Sports Medicine 36:2014-2022 (2008)
Bill
I’ve talked about this before, but I’ve been overrun (pardon the pun) by injured runners over the last 2 weeks. 4 new runners this week alone. All overuse injuries.
All of them had at least one, and more commonly several, significant finding such as weak core musculature, poor hip range of motion, poor hip strength, lack of ankle dorsiflexion, functional pronation, etc.
If your foot hits the ground 1,500 times per mile at 2+ times body weight loads with any of the above, something will eventually wear out and become symptomatic.
On my drive to my clinic, I counted 14 runners on the road and sidewalks making an obvious effort at weight loss in the wee hours of the morning. By observation, I’d say two of them were probably “in shape enough” to run.
Is there really that much “leftover” from the jogging craze?
Let me be blunt…
Unless you’re training for a marathon or some other endurance-related event and have been properly evaluated by a qualified health professional who gives you the green light that it’s safe to run….then don’t run.
Find another activity that is probably more effective in the first place. If you must run, then have the willingness to properly prepare to do so.
Bill
While there are tests or assessments I’ll do on just about everyone, I think you need to get more specific in your testing depending on the demands of the sport or activity in which an individual participates.
Case in point, I was working with firefighter recruit today who was having some ankle and achilles tendon pain when he ran.
[Note: Why do does every training academy feel it necessary to run their candidates to death. It's really not a great choice of training modality. Mike Berry at www.strengthcats.com has been promoting the importance of strength training for firefighters for years and rightly so. Check it out]
He’s been catching a lot of flack from his superiors because as long as he’s not running, he’s essentially painfree. They think he’s trying to get out the long runs.
In testing him in the clinic, there really wasn’t much that was influencing his symptoms. Range of motion, isolated and gross movements and strength testing, special tests, and several others failed to reproduce his pain.
So I had him run. And run some more…until he started to feel the symptoms in his achilles.
Then I retested him.
After running, his gluteus medius tested weak, he was unable to actively dorsiflex his affected ankle equal to his unaffected side, and his pronation increased during gross movement testing. The unaffected side continued to test normally.
With these findings, we can now address his weaknesses and provide some adaptive taping and temporary shoe modifications to get him back to normal training.
The take home point is that had I not tested him in the environment in which he was symptomatic, my conclusions may have agreed with his superiors and this guy wouldn’t have a shot at becoming a firefighter.
Make sure that your assessments give you the information you need by addressing the actual training environment.
Bill
P.S. You can get more info on the effects of fatigue and forces and how they affect testing and performance in the Indy Performance Enhancement Seminar DVD’s
