Shoulder Assessment and Management – Alex Abundo

Kin Lab had the pleasure of collaborating with Alex Abundo, a practicing Physiotherapist and the Clinic Director at Myodetox Oak. The following information is based on Alex’s presentation on Shoulder Assessment and Management Strategies. It is statistically recorded that up to 70% of people may experience some form of shoulder pain in their lifetime.

Classification of Shoulder Musculature

There are several different classifications of muscles that help provide function at the shoulder girdle, including

• Prime Movers (Deltoids, Pec major)
• Scapular Muscles (Trapezius, Serratus anterior, Rhomboids, etc.); and
• Rotator Cuff Muscles (Infraspinatus, Supraspinatus, etc.).

This blog post will be focusing on the scapular muscle group as these muscles are shown to influence scapula positioning and can have a major impact on the optimal movement in the shoulder. These muscles function to move and stabilize the scapula throughout shoulder movement. For example, with shoulder flexion, upward rotation of the scapula is required. The diagram below shows how the upper trapezius, serratus anterior, and lower trapezius muscle attachments to the scapula help move the scapula in an upward rotation during shoulder flexion

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Scapular Dyskinesis

In a normal functioning shoulder, the scapula and shoulder joint move fluidly with one another. However, scapular dyskinesis can occur when there is irregular or altered movement pattern through the scapula. This occurs from altered muscle activation due to imbalances that can occur from a shoulder injury or from improper daily posture habits. Some observations of scapular dyskinesis may include

Increased Anterior Tilt

• • Reduced retraction & depression of the scapula
  • Hypertonic: Pec Minor/Major, Biceps
  • Hypotonic: Lower Trapezius

Increased Elevation

• Raised & downward rotated shoulder
• Hypertonic: Upper trapezius & Levator Scapulae
• Hypotonic: Lower trapezius

Increased depression

• Reduced Elevation (spine of scapula drops)
• Hypertonic: Pec minor & Rhomboids
• Hypotonic: Lower traps & Serratus Anterior

Increased protraction

• Increased protraction of the scapula
• Hypertonic: Upper traps * Levator Scap
• Hypotonic: Lower Trapezius

Increased winging

• Reduced medial border control (leads to prominence of medial border of the scapula)
• Hypertonic: Pec Minor/Major, Posterior rotator cuff, & Biceps
• Hypotonic: Serratus Anterior & Lower trap.

As observed above, the different patterns of muscular imbalances resulting from hypertonicity and hypotonicity indicate that there are certain muscles that are more likely hypertonic and hypotonic. The biggest takeaway for treatment is to address and strengthen hypotonic (weaker) muscles that oppose dyskinesis while also addressing the mobility of the hypertonic muscles. It is also important to look beyond the scope of the shoulder as well. Cervical mobility and thoracic mobility are important regions to assess as limitations in mobility or strength in those regions can alter shoulder biomechanics. See below for a list of exercises.

Mobility and Stretching

1. Cat Camels
2. Side-Lying Thoracic Spine Rotation
3. Levator Scapulae Stretch
4. Scalene and SCM Stretch
5. Suboccipital Release
6. Neck Mobility with Towel
7. Lacrosse Pec Ball Release

Strength and Stability

1. Neck Stability Isometrics
2. Prone Y’s (Lower trap isolation exercise!)
3. YTW’s
4. Wall Slides + Band
5. Supine Serratus KB punch

Dynamic Neuromuscular Stabilization (DNS):

In addition to these exercises, Alex also discussed Dynamic Neuromuscular Stabilization (DNS) based exercises to further improve shoulder strength and stabilization. DNS is based on developmental kinesiology that analyzes various positions that infants progress through. These positions outline strength and stability prerequisites that must be developed before progressing into advanced positions. Below are two examples that utilize these concepts to improve closed chain shoulder stability and strength.

1. Three Month DNS Prone Plank

• Increase serratus anterior activation and decreases upper trap activation

1. DNS High Oblique Sit

• Non-sagittal serratus anterior activation

Thank you for following along and reading! If you have any questions, feel free to send us a message. Thanks again to Alex for providing Kin Lab with an informative In-Service session.