Comprehensive Neuromuscular Therapy for Shoulder Injuries Review

1. Neuromuscular TherapyApproach to Shoulder InjuriesReview of Anatomy

2. Muscles related to front of the shoulder pain

3. 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)

5. 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

7. 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

9. 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

11. 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

13. 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.

49. 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

50. 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