exercise & the older shoulderexerciseetc.com/file/exercise-the-older-shoulder.pdfexercise &...

Webinars on Demand 2017

(C) 2016 by Exercise ETC Inc. All rights

reserved. 1

Exercise & the Older Shoulder

Laura Abbott, MS, LMT • Master’s Degree, Sports Medicine

• Licensed Massage Therapist

• Undergraduate degree in Exercise Science

• Instructor of Kinesiology, Georgia State University

• ACE Certified Personal Trainer

• Guest speaker at Atlanta area massage schools and at the Georgia State University Physical Therapy department.

• Owner of Premier Performance, Atlanta, GA

How to Get Your CE Certificates

• View the complete webinar • Make sure your printer is “on” • Log on to our website: www.exerciseetc.com • Click on “Administration” • Click on “Webinar on Demand Certificates” • Complete all required fields & click “submit” • Your CE certificate will appear on the screen; you

may either save or print your certificate; even if you do not have a working printer, make sure to complete this form

• Remember: The WebEx program records when you log on and off; logging off early or fast forwarding to the end of the meeting may result in denial of your CEs.

http://www.exerciseetc.com/



reserved. 2

REMINDER

Obtain medical clearance and physician’s release prior to

beginning

an exercise program

for clients with medical or

orthopedic concerns.

Maintaining Older Shoulders

1. Understand Joint Dynamics

2. Evaluate range of motion & strength

3. Release and stretch tight muscles

4. Encourage excellent posture

5. Strengthen weak muscles – Isometrics, Bands and Tubing

6. Use biomechanically sound exercise technique

7. Modify exercises as necessary

The 4 Joints of the Shoulder

• Glenohumeral

• Scapulothoracic

• Acromioclavicular

• Sternoclavicular



reserved. 3

Static Stabilizers of the Shoulder

• Ligaments

• Capsule

• Glenoid Labrum

“Static stabilizers provide minimal structural support; “dynamic” stabilizers provide the primary functional stability.

Dynamic Stabilizers of the Shoulder

The Rotator Cuff Muscles

– Supraspinatus

– Infraspinatus

– Teres Minor

– Subscapularis

Anatomical Movements & Optimal Shoulder Range of Motion

• Flexion (180°)/ Extension (60°)

• Abduction (180°) / Adduction (5°)

• Horizontal Abduction (135°)

• Horizontal Adduction (45°)

• Rotation (Internal / External) (90°)



reserved. 4

Program Design for Healthy Shoulders

• Optimize Flexibility & Mobility

• Manage Strength Imbalances

– Push vs. Pull

– Internal vs. External Rotation

– Low Trap vs. Upper Trap

– Protraction vs. Retraction

• Balance Compound Movements

– More Pull than Push?

• Adhere to Biomechanically Correct Form

“Y” &“T” Arm Raises

“W” & “L” Arm Raises



reserved. 5

‘No Money’ Exercise

Watch Out for Hypermobility!

• Avoid hyperlaxity by limiting range of motion on high risk exercises that require advanced rotator cuff stabilization (dumbbell presses, pec flyes, flat & incline bench presses)

The Role of the Fitness Professional in Injury Prevention & Rehabilitation

• May “SCREEN” clients for risk of injury based on written/verbal injury history

• If PAIN is current, MUST refer

– i.e. Family Doctor, Orthopedic Surgeon, Physical Therapist, Certified Athletic Trainer

• May NOT “EVALUATE” injury based on symptoms present

• May Incorporate Exercises to Improve Function if Client is not experiencing Pain or Acute Injury



reserved. 6

Responses Requiring Referral

• If numbness, “pins & needles,” decreased circulation, burning, or radiating pain develops.

• If a decrease in strength occurs, especially on the eccentric phase.

• If pain free range of motion decreases.

• If pain (not soreness) develops that will not subside after 2 hours or more.

• If a partial or complete dislocation occurs.

• If swelling increases.

Four Common Chronic Shoulder Conditions

1. Impingement Syndromes

Supraspinatus

Biceps Tendon

2. Scapula Dysfunction

3. Rotator Cuff Dysfunction

4. Anterior Shoulder Instability

1) Identifying Impingement

• Typically present with pain through 60 to 120 degrees of shoulder abduction or flexion

• This is referred to as the “Painful Arc”



reserved. 7

Potential Causes of Impingement

• Anatomical or Bony Abnormalities

• Scapula Dysfunction

• Muscle Imbalances / Poor posture /

• Poor Respiratory Function

• Poor Exercise Technique

• Overuse

• Secondary due to anterior shoulder laxity

Acromion Shapes

Type 1:

Flat acromion

Type 2:

Curved acromion

Type 3:

Hooked acromion

Program Progressions for

Impingement

• Horizontal Pushing and Pulling

– 1 press for every 2 pull exercises

– Expect one or the other to be compromised; pushing or pulling

– Avoid what hurts!



reserved. 8

2) Scapula Dysfunction

• Present in nearly 100% of Impingement & Rotator Cuff Injury cases

• Repairing is often not strong enough component of rehabilitation protocols

The Role of the Scapula

• The scapula must upwardly and downwardly rotate during shoulder abduction and adduction

– 30-90 degrees

Roles in Scapula Rotation

• Upward Rotators

– Trapezius

– Serratus Anterior

• Downward Rotators

– Pectoralis Minor

– Levator Scapula

– Rhomboids



reserved. 9

Look for Imbalances Among the Scapula Stabilizers

• Trapezius – Upper, Middle, Lower

• Serratus Anterior

• Levator Scapulae

• Rhomboids

• Pec Minor

SCAPULA STABILIZATION

• Correct resting position of the scapula

• Improve co-contraction of scapula stabilizers

• Focus on Serratus Anterior, Rhomboids and Lower Trapezius

Training Scapula Adduction

• Trains the Rhomboids and Middle Trapezius

• Resist Scapula Adduction and Horizontal Shoulder Abduction



reserved. 10

Training Scapula Abduction

• Push-Up – Trains the Serratus Anterior

– May require muscle energy technique)

• Progress from the wall to the floor

• Optimal is with Shoulder at 110° Flexion

• Alternatives:

– Standing Tubing Presses

Training Scapula Depression

• Scapula Wall Slides

– Depress and tilt the scapula posterior

– Abduct/Adduct Shoulders

– Trains lower trapezius

• Start on floor and progress to wall

3) Rotator Cuff Dysfunction

• Significantly weaker External Rotators – <60% of Internal Rotation Strength

• Tight Posterior Shoulder Capsule causing poor internal rotation

• Posture – Excessive Cervical Lordosis

– Excessive Thoracic Kyphosis

– Excessive Internal Rotation



reserved. 11

No More “Empty-Can” Exercises!

Improving Internal Rotation

The Cuff is Reactive!

• Integrate Proprioception Training

• Pendulum Swing

– Used to maintain shoulder mobility during inflammation phase of acute injury

• Movement from Legs

– Forward/Backward

– Circular



reserved. 12

Tubing External/Internal Rotation

• Tubing Strengthens End ROM

• Tuck a rolled up towel tight to the armpit to stabilize the humerus

4) Anterior Shoulder Instability

• Hyper-mobility of the humeral head forward leading to possible subluxation or dislocation

• High risk positions:

– External rotation with

> 90 abduction, horizontal abduction

• Push ups, hands wide

• Pec deck

• Chest flye

• Flat bench press

• Military (Shoulder) Press

• Lat pulldown behind neck

High Risk Activities to Avoid



reserved. 13

Use the Plane of Scaption (The plane of the scapula)

• 30 to 45 degrees anterior to the frontal plane

POST-EXERCISE RECOVERY

• ICE massage immediately Post-Workout

• Light band or tubing exercises on recovery days

How to Get Your CE Certificates

• View the complete webinar • Make sure your printer is “on” • Log on to our website: www.exerciseetc.com • Click on “Administration” • Click on “Webinar on Demand Certificates” • Complete all required fields & click “submit” • Your CE certificate will appear on the screen; you

may either save or print your certificate; even if you do not have a working printer, make sure to complete this form

• Remember: The WebEx program records when you log on and off; logging off early or fast forwarding to the end of the meeting may result in denial of your CEs.

http://www.tartangroup.com/images/upload/items/large/144-12120-L.jpg

http://www.exerciseetc.com/



reserved. 14

Learning Objectives (5)

• After viewing this webinar you will be able to:

– Identify dynamic stabilizers of the shoulder

– Describe optimal shoulder range of motion

– Identify responses that require a referral to a physician

– List causes of shoulder impingement

– List causes of rotator cuff dysfunctions

Post-course Learning Assessment This assessment must be completed if you are certified by BOC, CSCS or NSCA

Question 1

Which of the following is not considered to be a dynamic stabilizer of the shoulder?

A. Glenoid labrum

B. Teres minor

C. Infraspinatus

D. Supraspinatus

Question 2

Optimal range of motion for horizontal shoulder abduction is ____



reserved. 15

Question 3

Which of the following is NOT a response requiring referral?

A. Pain free range of motion increases

B. Increased swelling

C. The development of the feeling of “pins and needles”

D. New pain especially 2 hrs post- exercise

Question 4

True or False

Shoulder impingement is rarely associated with anterior shoulder laxity.

Question 5

Scapular dysfunction is present in nearly ____ of impingement and rotator cuff injury cases



reserved. 16

Correct Your Work: Answer Key

1. A

2. 135 degrees

3. A

4. False

5. 100%

Make sure to keep this assessment with your other

recertification documents for 4 years. Questions about

any answer? Email us at: [email protected]

PLEASE NOTE:

• Remember to complete this webinar and print the certificate

by December 31 of this year.

• Certificates with next year’s date may not be accepted by your

credentialing organization.

mailto:[email protected]



exercise & the older shoulderexerciseetc.com/file/exercise-the-older-shoulder.pdfexercise &...

Documents