Presentation on theme: "The Body as One Upper Extremity Movement Mechanics"— Presentation transcript:
1The Body as One Upper Extremity Movement Mechanics Scapulothroacic Region = StableThoracic Spine = MobileThe Body as One Upper Extremity Movement MechanicsBy: Fabio Comana, MA., MS. NASM CPT, CES, PES; NSCA CSCS; ACS< HFS: ACE CPT, HC; CISSNNASM Faculty InstructorApril 24, 2014
2What Do You Want to Learn? Learning Outcomes:Describe the overall function of the human body in movement.Explain primary components of human movement science.Administer and interpret an upper extremity movement screen.Implement a simple UE corrective exercise program.Instruct proper mechanics for UE movements.
3Movement Fundamental trait we all share – improve movement efficiency. Requires appropriate levels of simultaneous stability and mobility.StabilityAbility to maintain or control joint movement or positionMobilityPossessing uninhibited 3-D ROM around a joint or body segmentMust Never Compromise Each OtherMovement EfficiencyArthrokineticsMuscle Properties(hardware)Neural Control (software)What happens when the Software or Hardware becomes faulty?Analogy of computer software and hardware
4Movement Examining the Body as One Glenohumeral = Mobile Foot = StableKnee = StableLumbar Spine = StableScapulo-thoracic Region = StableAnkle = MobileHips = MobileThoracic Spine = MobileGlenohumeral = MobileDefine Stability: Ability to control joint position or movementDefine Mobility: Functional ROM needed at a jointDemonstrate LE relationship with gaitDemonstrate UE relationship with overhead reach
5What Happens if the Body Loses / Lacks this Relationship? MovementWhat Happens if the Body Loses / Lacks this Relationship?Step One: Law of Facilitation = ‘Dyskinesis’Compensation: Compromised stability to facilitate mobility.Compensation: Movement into other planes.Example: Bird-dogWhy?Step One: Law of Facilitation = “Dyskinesis”Compensation: Stable joints give up some stability to help provide mobility.Example: Increased lumbar lordosis when trying to extend the thoracic spine.Compensation: Moving joint will incorporate movement into another planeExample: Hip extension (sagittal) involving transverse plane rotation.Step Two: Loss of stability = injury potential.Chronic overuse injuries versus acute injuries.Coincidence?Low back – stable !80 – 90 % of all adults,60% of work-related injuries involve LB = 9 missed work days / eventKnees – stable !200,000 ACL injuries/year. 70 – 75 % non-contact.Osteoarthritis = 10x increase with ACL injuriesShoulder girdle – stable !21 % of population with 40% persisting < 1 year
6Movement and InjuriesWhat Happens if the Body Loses / Lacks this Relationship?Step Two: Loss of stability = injury potential.Chronic overuse injuries versus acute injuries.Low back – stable !Knees – stable !Shoulder girdle – stable !80 – 90 % of all adults200,000 ACL injuries/year. 70 – 75 % non-contact.21 % of population with 40% persisting < 1 year$100 billion annually$650 million (surgery + rehabilitation)$39 billion annuallySport & Exercise-related InjuriesInjuries in Recreational & Sports FacilitiesSprain/Strain-type Injuries199713.4% of all injuries11.6% of all injuries26.4% of all injuries200717.9% of all injuries15.0% of all injuries30.7% of all injuriesStep One: Law of Facilitation = “Dyskinesis”Compensation: Stable joints give up some stability to help provide mobility.Example: Increased lumbar lordosis when trying to extend the thoracic spine.Compensation: Moving joint will incorporate movement into another planeExample: Hip extension (sagittal) involving transverse plane rotation.Step Two: Loss of stability = injury potential.Chronic overuse injuries versus acute injuries.Coincidence?Low back – stable !80 – 90 % of all adults,60% of work-related injuries involve LB = 9 missed work days / eventKnees – stable !200,000 ACL injuries/year. 70 – 75 % non-contact.Osteoarthritis = 10x increase with ACL injuriesShoulder girdle – stable !21 % of population with 40% persisting < 1 yearLook at popular programs since 2004 – What will happen to injuries between 2007 and 2017?
7Specifics: Shoulder Abduction Movement MechanicsSpecifics: Shoulder AbductionFrontal Plane ActionApplication:Internally rotate the arms and abduct as high as possible – notice end ROM.Externally rotate the arms and abduct as high as possible – notice end ROM.Difference?Impingement of greater tuberosity (humerus) against coracoid process (scapula) - space is generally small (~ 5-10 mm).Implications for Movement:Caution against excess shoulder abduction with internal rotation = bursitis and tendonitis (supraspinatus and biceps long head).Example: Upright rows, front and lateral raises.
8Specifics: Shoulder Abduction Movement MechanicsSpecifics: Shoulder AbductionScaption Plane ActionApplication:Perform a lateral raise movement with the arms in the frontal plane – notice any resistance to movement?Perform a lateral raise movement with the arms 30° forward in the frontal plane – notice any resistance to movement?Difference?With arms 30° forward to frontal plane, greater tuberosity falls in line with highest point of coraco-acromial arch - experiencing least amount of resistance.Implications for Movement:Perform lateral raises with slight external rotation or forward 30° in frontal plane.Example: Moving from 3 / 9 o’clock position to 4 / 8 o’clock position for shoulder flexion exercises (press, lat pull-down, lateral raises).
9Specifics: Overhead Press Movement MechanicsSpecifics: Overhead PressFrontal Plane ActionApplication:Three heads offer anterior, middle and posterior containment of shoulder (lowered position).Place index finger and thumb over origin and insertion points of anterior deltoid - perform overhead raise movement.Difference?Observe external rotation of humerus - changes muscle’s orientation.Arm lowering - no anterior stabilizer to prevent anterior humeral displacement (exacerbated with behind the head presses).Implications for Movement:Overhead positions – External humeral rotation creates no anterior containment beyond passive structures – need to engage lats as stabilizers.
10Scapulohumeral Rhythm Force-Coupling VectorsDirection, Magnitude and TimingMovement application?180° abduction - scapular and glenohumeral (GH) joint movement ratio = ~ 2-to-1.2° of GH motion for every 1° of scapular motion (120°-to-60° ratio).True scapulae movement = 45 – 60° upward rotation coupled with:20 – 40° posterior tilt.15 – 35° external rotation.All designed to reduce encroachment into sub-acromial space.
11Scapulohumeral Rhythm Scaption Plane ActionGlenoid fossa (GF) is ⅓ size of the gleno-humeral head (GH)Golf ball & tee analogy - labrum increases socket depth by 50 %.Due to GF-GH shape, rotator cuffs (RC) collectively coordinate GF-GH movement:Compress, depress, stabilize and steer the humeral head within socket - constrained within 1-2 mm of center of glenoid fossa (creates ICR).Also function to clear humerus from acromion process.RC muscles play important role in initiating movement and facilitating humeral inferior glide.MuscleFunctionSupraspinatusAbduction + compression/depression during arm elevation + slight external rotation (ER).Infraspinatus + Teres MinorER + compression/depression during arm elevation.SubscapularisInternal rotation (IR) + compression/depression during arm elevation
14Programming Pre-Requisites/Screens LPHC Low Back ArchOveractive MusclesHip Flexor ComplexErector SpinaeLatissimus DorsiIdealLPHC Low Back ArchUnderactive MusclesAbdominal ComplexGluteus MaximusHamstringsCompensation
15Programming Pre-Requisites/Screens Arms Fall ForwardOveractive MusclesIdealPectoralis MajorPectoralis MinorLatissimus DorsiArms Fall ForwardUnderactive MusclesCompensationMiddle/Lower TrapeziusRhomboids
16Corrective Exercise-Movement Quality Identify desired planes of movementIdentify regions of stability and mobility throughout kinetic chainExplain – demonstrate – practice trialsObserve movement efficiency and limitationsWhere to start?Segmental Corrective ExerciseDesired Movement?ObserveEducateValidateIdentify locations and movement breakdownIdentify possible reasonsInhibitLengthenStrengthen(type I fibers)IntegrateMyofascial releaseStatic StretchingPNFPositional IsometricsIsolated dynamic strengtheningIntegration(Mobility)(Stability)(Integration)
17Corrective Exercise-Movement Quality Scapula dyskinesis: Represents imbalance in stability-mobility relationship.Ineffective joint positioning; general lack of neuromuscular control of scapulae (altered muscle activation patterns).Causes - ExamplesInappropriate or deficient trainingRepetitive trauma (overuse)Improper posture / poor positioningStructural / congenital issuesDegenerative changesShoulder Program Overall GoalImprove parascapular stability – promote T-spine mobility & movement efficiencyPre-requisite: Lumbar StabilityPhase One:Promote Thoracic MobilityPhase Two:Promote Scapulo-thoracic StabilityPhase ThreePromote Integrated Function
18Corrective Exercise-Movement Quality Phase One: Promote Thoracic MobilityAddress planes sequentially:Sagittal Plane 1stFrontal Plane 2ndTransverse Plane 3rd – most problematic.Never compromise lumbar stability !! – demonstrationThoracic Spine:Supine foam-roller.Supine arm movement – short-to-long lever (progress to prone – short lever).Examples: Alphabets – “I”, “Y”Spinal twists with rib-grab.Thoracic matrix (Gary Gray).
19Corrective Exercise-Movement Quality Phase Two: Promote ST StabilityFocus: ST position & control (stability), not GH movementParascapular muscles best stabilized with CKC exercises (joint compression – muscles function as stabilizers).Too challenging initially?Start with OKC exercisesUse supported surfaces (e.g., floor, wall) + kinesthetic feedback ‘feel’Shoulder Packing (reduce scapular elevation)Reverse Codman’s – short lever (alphabets)Supine Letters – short lever (“I-Y-T-W”, “Wipers”)DepressRetract
20Corrective Exercise-Movement Quality Phase Two: Promote ST StabilityProgress to CKC: Example:Packed Quadruped Loading – progressionsLoading and 3-D weight shiftsOff-set hand positionElbow extensionLengthen moment armUnstable SurfacesScapular Clocks - hand fixed, change scapular loading positions.12 o’clock (depression).6 o’clock (elevation)3 o’clock (retraction)9 o’clock (protraction)
22References …American Council on Exercise (2010). ACE Personal Trainer Manual (4th edition). San Diego, CA, ACE.Bell, DR, and Padua, DA, (2007). Influence of ankle dorsiflexion range of motion and lower leg muscle activation on knee valgus during a double-legged squat. Journal of Athletic Training, 42:S84.Centers for Disease Control and Prevention (2009). Injury episodes and circumstances: National Health Interview Survey, , Vital and Health Statistics, 10 (241). Retrieved 06/15/13.Clark, MA, Lucett, SC, and Sutton, BG, (editors) (2012). NASM Essentials of Personal Fitness Training (4th edition). Baltimore, MD: Lippincott, Williams and Wilkins.Cook, G (2003). Athletic Body in Balance. Champaign, IL., Human KineticsGray, G and Tiberio, D (2007). Chain Reaction Function. Gray Institute, Adrian, MI.Gray, G (2008). The Thoracic Spine. Gray Institute Newsletter, Gray Institute, Adrian, MI.Kendall, FP, McCreary EK, Provance, PG, Rodgers, MM, Romani, WA (2005). Muscles Testing and Function with Posture and Pain (5th edition). Baltimore, MD., Lippincott, Williams and WilkinsSahrmann S, (2002). Diagnosis and Treatment of Movement Impairment Syndromes, St Louis, MO: Mosby.
25For Your Commitment to Excellence Thank You!For Your Commitment to Excellence
26Additional Professional Opportunities We are offering 20% off CPT promo code: FITCPT and15% off specializations with promo code: FITFESTCES = Corrective Exercise SpecialistPES = Performance Enhancement SpecialistFNS = Fitness Nutrition SpecialistWLS Weight Loss SpecialistGPT = Group Personal Training SpecialistMMA = MMA Conditioning SpecialistSFS = Senior Fitness SpecialistWFS = Women's Fitness SpecialistGFS = Golf Fitness SpecialistVisit us online at for more product information