fixing the forward shoulder dr. evan osar & jenice mattek ... · title by presenter name fixing...

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Fixing the Forward Shoulder Dr. Evan Osar & Jenice Mattek, LMT, IMS

NEUROFASCIAL INTEGRATION™

FOR FIXING THE FORWARD SHOULDER

Dr. Evan Osar Jenice Mattek, LMT, IMS

Neurofascial Integration™

Optimal Posture

and Movement

Myofascial System

Neural System

Osseoligamentous System

Neurofascial Integration for the Shoulder ©2015 Fitness Education Seminars™ 3

Fascia

• Fascia – Neuro-

proprioceptive structure

– Myofibrils – Suspensory

structures

Neurofascial Integration for the Low Back ©2015 Fitness Education Seminars™ 4

©2015 Fitness Education Seminars™ 5

Why do so many of our clients have problems?

Developing Optimal Shoulder Function

Neurofascial Integration for the Shoulder

Our ________!!!

©2015 Fitness Education Seminars™ 6 Neurofascial Integration for the Shoulder

• The thing we do most of our lives…


What’s the number one cause?


• Shoulder ring • Thoracic ring • Pelvic ring


The Shoulder Complex


• Scapula and Thorax – Shoulder ring sitting

upon the thorax


The Scapulo-thoracic Articulation


• Concave-convex relationship ©2015 Fitness Education Seminars™ 10

Scapulo-thoracic Articulation



Neutral Alignment



• Optimal scapular alignment upon thorax

Neutral Scapular Alignment


• Upward rotators – A. _________________ – B. __________________ – C. __________________

Posterior view right scapula


Scapular Control


• Downward rotators – A. __________________ – B. __________________ – C. _________________

Posterior view right scapula


Scapular Control


• Scapula should not come into excessive downward rotation or anterior tilt


Key Point


• Downward rotation

• Anterior tilt • Depression


The Forward Shoulder


• The levator scapula sign • Common during:

• Rows • Lat pull downs / pull

ups • Triceps push down /

biceps curls


Exercises That Perpetuate Shoulder Dysfunction


• Cardio exercises


Exercises That Perpetuate Shoulder Dysfunction


• “Retract your shoulder blades back (and I mean pull them back, and keep them back) … keep your shoulder blades together…”


Cuing That Perpetuates Poor Stereotypes



• How is your client controlling their movement?

Perpetuation of Shoulder Dysfunction


• Achieving neutral alignment and control


Optimal Suspension



Lack of Suspension


• Common sign: Abdominal distension ©2015 Fitness Education Seminars™ 23

Lack of Suspension


• Can be caused by myofascial gripping – Latissimus dorsi – Pectoralis minor – Rhomboids – Serratus anterior – Thoracolumbar erector

spinae


Lack of Suspension


Optimal shoulder function is reliant upon an efficient control strategy

Optimal function is reliant upon a balance of the myofascial systems around the shoulder complex

Shoulder dysfunction is set up by non-optimal strategies – inhibition of the upward rotators and/or habits leads to ‘gripping syndromes’ limiting optimal stability and movement

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Recap

©2015 Fitness Education Seminars™ Neurofascial Integration for the Shoulder

26 ©2015 Fitness Education Seminars™ Neurofascial Integration for the Shoulder

The Principles of Posture and Movement

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Development Dictates Decision-making



Principle #1: Alignment

• Regulates internal pressure

• Activates the deep myofascial system

• Supports optimal alignment and mobility


Principle #2: Breathing

• WHAT IS THE ROLE OF PROPER BREATHING IN IMPROVING FUNCTION? – One of most effective ways of entering the central

nervous system – Direct and dramatic effect on every system in the

body – Down regulates sympathetic nervous system and up

regulates parasympathetic nervous system – Activates deep myofascial system – Improves a client’s awareness of their body


Breathing



Principle #3: Control


Alignment and Control


Alignment and Control


• Points of stability (circles)

• Points of mobility (arrows)


Happy Baby

Squatting Lunging Bending Rotation Pushing Pulling Gait

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The Integrative Movement System™

©2015 Fitness Education Seminars™

Posture & Movement

Alignment

Control Breathing


• Purpose: – To determine starting joint

position – Static posture often relates to

movement pattern – Goal is not to make posture

look ‘ideal’ however with improved joint centration posture should look more optimal


Postural Assessment

• OPTIMAL ALIGNMENT – Head – Thorax - suspended – Pelvis

• Anterior pelvic tilt –ASIS slightly anterior to

pubic symphysis


Postural Assessment

• 3 Common Postures • Sway back (left) • Flat back (middle) • Lower crossed

syndrome (right)


Postural Assessment

• Patient can be seated or standing; • Stand behind client and gently cup under

their GH region as close to lateral scapular border as possible;

• Client should be totally relaxed as you try to gently lift the scapula superiorly off their thorax;

• Also check posterior scapular glide by gently pulling the scapula posteriorly off the thoracic wall

• Note ease and any mobility restrictions – note also direction of pull


Scapular Lift Off Test

• Myofascial restriction can be from several sources:

• Anterior pull – tends to be from serratus anterior or pectoralis minor

• Inferior pull – tends to be from latissimus dorsi and pectoralis major

• Overall restriction of scapula on top of thorax – fascial restriction from pleural dome


Scapular Lift Off Test

• Optimal – Rib cage

should be mobile to enhance three-dimensional breathing


Rib Cage Mobility Test

• Optimal three-dimensional breathing

• Apical and abdominal –top-to-bottom

• Laterally –side-to-side

• Anterior-posterior –front-to-back


Assessment: Breathing

• Inspiration (left); expiration (right)

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Non-optimal diaphragm movement during inhalation

Non-optimal rib cage movement during exhalation


Breathing Assessment

• Lie and reach up towards ceiling

• Reach overhead with elbow straight

• Compare side to side


Overhead Length Assessment

• Note the difference: – TPC connected

(top) – Thoracolumbar

hinge (bottom)


Overhead Length Assessment

RELEASE ACTIVATE INTEGRATE


I.M.S.™ Corrective Strategy


• Scapulo-thoracic dissociation – Pectoralis minor – Latissimus dorsi – Superior fibers of serratus anterior – Anterior pectoral fascia

• Glenohumeral dissociation – Teres major – S.I.T.S. – Deltoid


I.M.S.™ Corrective Strategy - Release


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• Release anterior thorax – One hand under client’s neck as

to ‘lightly traction. – Other hand over sternum or

abdomen – Instruct client to take a deep

breath in, hold. – As they exhale your intention is

bring gently traction neck long and gently bring rib cage in direction of pelvis.

– There is no stretching or gliding.


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• Release fascial connections between latissimus dorsi and thorax – NFR lat/teres – Place hand over area to be released – Have cl. contract with 10-20% of

strength – Cl. deep breath – As cl. releases breath instructed to let

muscle relax or go long under your hand


• Release for latissimus

dorsi • Pin rib cage/ contract

lats for 5 second isometric with ~25% max effort

• Client releases and lengthens under arm

• Repeat 3-5x

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• Release for pectoralis minor

• Traction humerus/ contract pec minor for 5 second isometric with ~25% max effort

• Release and lengthen muscle/ cue to go ‘wide’ through front of shoulders

• Repeat 3-5x/side

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• ‘…visualization and imagery activates specific patterns in the brain and can be added to enhance formation and long-term maintenance of new brain maps.’ – Diane Lee

• The Pelvic Girdle 4th


I.M.S.™ Corrective Strategy - Activation


I.M.S.™ Corrective Strategy – Cuing

• *Deep myofascial system – ‘Imagine’ – ‘Think about’ – ‘Visualize’ – ‘Activate’ – ‘Feel’ or ‘connect’

• * Superficial myofascial system • ‘Move’ • ‘Contract’ • ‘Tighten’ or ‘squeeze’ • ‘Pull in’ • ‘Brace’ or ‘pack’


• Respiration –Activation of

the deep myofascial system

»Align »Breath »Control

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• Cues: – ‘suspend your ribs’ – ‘think long’ – ‘suspend your shoulders’ – ‘relax and open through the front

of your shoulders’ – ‘wrap your scapula’

Improving Function Through Visualization



Prone Lengthening

• Muscle Activation

• Modified quadruped with elbow extension

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• Muscle Activation – Isometric

hold – Arm

slides – Rotations


Modified Wall Plank for Shoulder Stabilization


• Suspension and alignment of TPC and rings

–Visualizing lifting gently superiorly and postero-medially

»‘up and back’

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I.M.S.™ Corrective Exercise Strategy - Integration


• PUSHING PATTERNS • Horizontal

• Push ups • Chest press • Chest flys

• Vertical • Overhead presses

• PULLING PATTERNS

• Horizontal

• Rows

• Reclined pull ups

• Vertical

• Pull ups

• Pull downs

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Integration into Fundamental Movement Patterns


Pulling Patterns

• Wide shoulders and scapular wrapped – optimal (left) • Scapula overly retracted – non-optimal (right)


• Optimal - wide shoulders and scapular wrapped (left)

• Over-retraction (middle); forward shoulder


Pulling Patterns


• Wide shoulders and scapular wrapped (left) • Scapula overly retracted (right)


Pushing Patterns


• Scapula wrapped – optimal (left) • Scapula overly retracted – non-optimal (right)


Pushing Patterns


• Strategy: – 3-dimensional breathing – Cue to think ‘long’ and

‘suspend’ – Relax gripping


Improved Strategy



Improved Strategy with Breathing and Suspension


Breathing and prone lengthening


Improved Strategy with Breathing and Suspension


• Primary cause of postural and movement dysfunction

• Principles of posture and movement

• Passion and empowerment

68


Optimal posture & movement

A

C B

Conclusion


• Cohen, R. 2011. Introduction to Reflex Locomotion According to Vojta. Naperville, IL; Course Handouts.

• Cohen, R. 2009. Introduction to Reflex Locomotion According to Vojta. Philadelphia, PA. Course Handouts.

• Kolar, P. 2009. Dynamic Neuromuscular Stabilization: A Developmental Kinesiology Approach. Chicago, IL; Course Handouts.

• Kolar, P. 2009. Exercise and the Athlete: Reflex, Rudimentary and Fundamental Strategies. Chicago, IL; Course Handouts.

• Kobesova, A and Jezkova, M. 2011. Dynamic Neuromuscular Stabilization According to Kolar. Course B. St. Louis, MO; Course Handouts.

• Lee D. 2011. The Pelvic Girdle. Fourth ed. Churchill Livingstone: Edinburgh. • Lee D and Lee LJ. 2013. Treating the Whole Person with The Integrated Systems Model. Discover Physio Course handouts:

Vancouver, CA.

• Osar, E. 2014. Integrative Movement Specialist Certification. Fitness Education Seminars. Chicago, IL; Course handouts.

• Osar, E. 2012. Corrective Exercise Solutions to Common Movement Dysfunction of the Hip and Shoulder. Lotus Publishing; Chinchester, UK.

• Richardson C, Hides J, Hodges PW. 2004. Therapeutic Exercise for Lumbopelvic Stabilization: a Motor Control Approach for the Treatment and Prevention of Low Back Pain. 2nd ed. Churchill Livingstone: Edinburgh.

• Suzan, Zuzana. 2010. Kolar’s Approach to Dynamic Neuromuscular Stabilization: Developmental Kinesiology Approach. Chicago, IL; Course Handouts


References


For more information..

• Visit our website for free resources, other learning opportunities and products.

• www.fitnesseducationseminars.com • Keep us with us on Facebook and YouTube. • Thank you!!!

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